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See the light with laser vision correction: technological advances have made this surgery safer and more effective at correcting an array of vision disorders.

You're tired of wearing your old eyeglasses all the time, and you want another option to correct your nearsightedness (myopia). You're at the age when you also need help to see nearby objects, read, or work on your computer, but you don't want bifocals.


If your eyes are healthy and show no signs of cataracts, laser vision correction may allow you to discard those eyeglasses. Advances in technology now allow refractive surgeons to better customize procedures for the individual patient and avoid vision aberrations that accompanied early laser vision surgery.

"There are a number of people who come in even in their 60s who after many years just want to consider doing something about their vision," says Ronald Krueger, MD, medical director of the Department of Refractive Surgery at Cleveland Clinic's Cole Eye Institute. "Laser vision correction is really becoming a mature product to offer the wonderful gift of sight, of seeing without glasses and having that freedom."

As with any procedure, you should understand the risks associated with refractive surgery, undergo a proper evaluation, and know what to expect after the treatment.


The most popular refractive surgery is laser in situ keratomileusis, or LASIK. You're a candidate for LASIK if your eyes are healthy, you've had a stable eyeglass prescription for at least two years, and your vision is within a correctable range.

You may not be a candidate for the surgery if you have severe dry eyes, a previous eye injury, or a history of eye diseases, including kera-toconus or advanced glaucoma.

If you have very thin corneas, you may need a refractive procedure such as photorefractive keratectomy (FRK) or laser epithelial keratomileusis (LASEK) instead of LASIK. For severe myopia, an implantable col-lamer lens may be necessary.

Since cataracts become more common with age, older men, as well as those with extreme farsightedness (hyperopia), may want to bypass LASIK and wait until they need cataract surgery.

"When you're in your late 60s, you want to make sure that there is no sign of a cataract before you do LASIK," Dr. Krueger advises. "In many cases, if you have a cataract, you can put in an implantable lens and it will correct your vision just like LASIK." He notes that LASIK also may be performed on people who haven't gotten optimal vision from cataract surgery.

If you have to hold a book at arm's length to read it, you probably have presbyopia, which occurs when the lens of the eye loses flexibility and the ability to focus on nearby objects. Reading glasses or corrective lensesincluding bifocals, trifocals or progressive lensesare the simplest, ways to correct this condition.

But if you don't like these options, you might consider mono vision surgery through LASIK. In monovision, the doctor corrects one eye for distance vision and the other for close-up and mid-range vision. Monovision takes some getting used to, and your brain may need a few weeks to adapt to the change in eyesight.


Dr. Krueger sees his patients the day after surgery, and then at one week, three months and nine months postoperatively.

Your vision may be somewhat blurry immediately after LASIK, but it usually improves within a day or so. By some estimates, about 95 percent of patients achieve 20/20 vision with refractive surgery on initial treatment. The remaining 5 percent may require an enhancement about three months later to fine tune their eyesight.

LASIK causes little or no postoperative pain and usually can be done on both eyes at once. Less than 5 percent of patients undergoing conventional LASIK experience a worsening of dry eyes or visual aberrations such as glare, halos and poor night vision. About 1 percent have correctable complications involving the flap created during the surgery. Less than 1 percent develop infections or vision-threatening problems.

New technology, such as wave-front-guided and wavofront-opti-mized LASIK, has greatly reduced the risk of aberrations, Dr. Krueger says. In these procedures, a scanner produces a map of the eye that is used to program the laser so that the doctor can precisely customize the reshaping of the cornea. Wavefront-optimized LASIK also takes into account the curvature and thickness of the cornea and compensates for any changes that the laser makes, to maintain the corneal shape.

"It's really allowing us not to have any more of those halos and glare," Dr. Krueger says. "Each doctor is going to be comfortable doing it in one of these two ways. You just want to have an experienced doctor doing the best possible treatment, one that he is most comfortable in performing."


Before surgery:

* Choose an ophthalmologist experienced in refractive surgery who uses the latest technology, such as wavefront-optimized LASIK.

* If you have contact lenses, stop wearing them at least 2-3 weeks before your pre-operative exam.

After surgery:

* Use artificial tears and blink frequently to keep your eyes moist.

* Avoid touching your eyes, and refrain from sports 5-7 days after the procedure.

* Wear sunglasses to protect your eyes from the sun's ultraviolet rays.

Laser vision surgery may not be an option if:

* Your vision is not within a correctable range.

* You have severe dry eyes.

* You've had a previous eye injury.

* You have a history of eye disease, such as keratoconus or glaucoma.

* You have cataracts (wait until you need cataract surgery). Tibia
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Title Annotation:VISION
Publication:Men's Health Advisor
Geographic Code:1USA
Date:Sep 1, 2011
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