Patients of all ages ask me what they must do to be free of eyeglasses.  The answer lies in their age and their vision requirements. 

The first group of folks are the younger aged.  These are people who are nearsighted or farsighted with or without astigmatism and who when they have their contacts or glasses on, can read without the need for additional reading glasses.  This group is “pre-presbyopic.”  The approach to getting this group out of glasses or contacts is straight forward.  We must correct the refractive error (nearsightedness, farsightedness or astigmatism) and they are set.  In most cases this is done with LASIK or PRK in individuals who have a refractive error which has stopped changing with age and meet the other criteria for safe refractive surgery. 

Eliminating the need for glasses gets a little more involved in the next group; the presbyopic group.  These people need reading glasses in addition to their contacts or distance glasses correction; this is the group that wears bifocals.  There are several theories as to the mechanism of this progressive need for reading glasses but the bottom line is that the lens of the eye losses its ability to focus at near.  This inability is superimposed upon ones nearsighted or farsighted condition.  This gets confusing because a 48 year old nearsighted individual can see well at near without glasses but once the glasses go on they no longer can see close.  A younger nearsighted person will see well at near with the distance correction.  So what must we do to eliminate glasses?  In my surgical ophthalmology practice there are two ways to do this.  The first is to do LASIK or PRK with the dominant eye corrected for distance and the non-dominant eye for near (monofocal).  While this may sound “wild and crazy,” about 20%-30% of the population is capable of doing this.  When patients inquire about this approach, we fit them with trial contact lenses for the day which simulates the monofocal condition.  In general, people who are not suited for the monofocal correction know immediately after putting the lenses on.  For those who are comfortable we go to LASIK or PRK and permanently correct the refractive error.

The other 80% used to have no option but to wear bifocals.  Now there is an excellent second option; multifocal lenses.  These are acrylic lenses which can be permanently placed inside the eye which give good distance and near vision in each eye.  The lenses create two images at the retina, one for near and one for far.  Depending upon which image your brain wants to see will determine which image it recognizes.   This works similarly to being in a room where there are several conversations going on simultaneously.  Your brain will direct your attention to one of these conversations and you will hear it at the exclusion of the others and in an instant you can switch to another conversation and not hear the first.

In multifocal lens surgery your clear lens is surgically removed and replaced with an acrylic lens which has been calculated to neutralize your refractive error and at the same time correct for near vision.  I prefer the Restor Lens manufactured by Alcon Labs.  The surgery takes about 15 minutes and one eye is operated at a time.  The second eye is operated about 2 weeks later.  There is very little down time as people feel good the next day. 

This surgery is available for those of any age as long as they are presbyopic.  In younger presbyopes we remove the clear lens and instill the multifocal lens.  In those older presbyopes requiring cataract surgery, the same lens is placed with the same benefits. 

I or one of the surgery counselors will be pleased to discuss these options with you.  Give a call.

It is my pleasure to open the BLOG section of this website.  I hope to give the reader an opportunity to obtain up to the minute information about the newest technologies offered at MIAMI EYE CENTER as well as the greater ophthalmic community.  I encourage those with an interest to become involved with questions or comments.

This evening, I was reviewing the chart of patient C.B. who is a very young 72 years.  He had R.K. (radial keratotomy) surgery in Columbia 15 years ago.  He was quite pleased with the outcom of that surgery until recently when became bothered by nighttime glare while driving.  He consulted an optometrist who diagnosed cataracts and referred him to this office.

I began performing radial keratotomy surgery for myopia in 1982, PRK in 1996 and LASIK in 2000.  Now that many of my patients from those days have “grown up” they are developing cataracts.  Cataract surgery in folks who have had prior RK, PRK or LASIK presents a unique challenge to ophthalmic surgeons but one which I have managed incorporating the newest technology.  The challenge facing the surgeon is in selecting the proper intraocular lens to place in the eye at the time of surgery.  For patients who have not had prior refractive procedures, the selection process is routine.  However, the standard computer programs used for the average patient do not work for people who have had prior RK, PRK or LASIK.  If the incorrect lens is utilized, the patient will be nearsighted or farsighted following the surgery.

In the clinic today, I measured the power of C.B’s eye as one would for making eyeglasses.  I then inserted a special diagnostic contact lens and repeated the process.  This yielded the true power of the cornea and that data was used in two additional programs to yield the power of the intraocular lens to be inserted at surgery.  These mathematical manipulations have been evolving over the past several years and I have found them to be quite accurate.

The goal of modern cataract surgery is not only to achieve excellent vision for the patient but excellent vision without glasses.  This goal can be achieved for many patients even in complex cases as outlined here.