Short Arm Syndrome, or Why Can’t I See Anymore?

What is Presbyopia?

Presbyopia is a condition of the eye where a progressive loss of magnification ability results in the inability to see near objects.

What causes it?

Presbyopia is caused by the hardening of the crystalline lens of your eye and occurs in a predictable fashion as a result of the natural process of aging.  The first symptoms of presbyopia normally occur between ages of 40-50 and the ability to focus on near objects continues to decrease.  In fact, if your eyes have a distance prescription of zero (“plano” in ophthalmology terms), you will first need reading glasses very predictably at 42 or 43 years old.

What happens if I have…

Myopia (nearsightedness) and Presbyopia?

If you’re myopic, as you age, you lose the magnification power of your lens just like any other person.

If you’re over 42 and wearing single vision distance contact lenses, you’ll notice that you have to hold things farther away when you’re wearing contact lenses for distance and trying to read, or that you need reading glasses on top of your contact lenses to see well up close.  You’ll also notice your presbyopia symptoms when you’re wearing glasses and have an irresistible urge to take them off to read.

Hyperopia (farsightedness) and Presbyopia?

If you’re a latent hyperope (person with farsightedness who doesn’t need glasses for distance until they get older), at a young age you probably had the best distance vision out of all of your friends.  However, as you get older, you need reading glasses far earlier than most people in your age group (even by your late 30s).

Here’s how it works:  hyperopes who don’t wear glasses in the distance are using their magnification power just to see far.  As you age, the lens in your eye becomes less flexible, decreasing its ability to magnify.   So, you’re a latent hyperope in your late 30’s  sitting in a chair, looking at the beautiful view, using most of your magnification power just to see far.  Now, you pick up something to read, and whammo!  It’s blurry.  This scenario happens earlier to untreated hyperopes than myopes (nearsighted people) or emmetropes (people who have no need for prescription in the distance) because their accomodation (ability to magnify) is already used up from looking far, and there’s not as much left to magnify to read.   Eventually, when the hyperopia is high enough or you get old enough, combining hyperopia and presbyopia blurs both your near vision and your distance vision.


What are the possible treatments for my eyes?

Bifocal spectacles – The most common type of bifocal spectacle is the Flat Top Bifocal and is comprised of two segments: one for far vision and one for near.  The segments are available in different sizes according to the field of vision you need to see.  The other bifocal “with line” spectacle style is the Executive Bifocal.  The lenses are also split into two segments, with a dividing line across the width of the lens.  They do not allow for a continuous range of vision and sometimes cause blurriness.  A third type of bifocal is the progressive or “no line” bifocal.  This is the type people are wearing when you see them bobbing their heads and looking for the sweet spot in their spectacles for focusing at that exact distance.

Monovision contact lenses – With monovision contact lenses for presbyopia, each eye is treated differently.  One eye (most commonly the dominant eye) is corrected for distance vision and the other eye is corrected for near vision.  Ideally, your brain will choose the magnified image and provide your eyes with what appears to be continuous, smooth vision.  However, Monovision contacts can sometimes cause a loss of depth perception which patients find difficult to adapt to.

Monovision LASIK or PRK – LASIK or PRK surgery is used to permanently correct one eye for near vision and the other eye for distance vision.  Monovision after LASIK or PRK tends to be better accepted by patients than contact lens monovision because the patient’s visual experience is the same all the time.  During LASIK surgery, a flap is created on the surface of the cornea (the front layer of the eye).  A laser is then used to re-shape the cornea back into a natural shape so that it focuses light more efficiently, and then the corneal flap is put back in place.

During PRK surgery, the surgeon removes the epithelium of the cornea altogether, and after the procedure, bandage contact lenses are worn to help in healing the epithelium.

About 10% of presbyopic patients prefer single vision distance correction over monovision.  I spend a great deal of time and care getting your prescription right (this includes whether to go with Monovision or not) and if so, the right amount.  I spend a significant amount of time learning about your daily activities and do my best to simulate your results so that you will be thrilled with the end product.

Most people find that they can adjust to Monovision LASIK or PRK far easier than contacts because the correction is 24/7, without the hassle of taking out and putting in contact lenses.  For the remaining 10%, single distance vision after LASIK or PRK with “drugstore readers” is an excellent choice.

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Sources:

https://www.seewithlasik.com/docs/presbyopia/presbyopia.html

https://www.pendletoneye.com/errors.htm

https://www.webmd.com/eye-health/tc/farsightedness-hyperopia-what-happens

https://www.docshop.com/education/vision/refractive/monovision/

How Long Does LASIK Eye Surgery Take?

LASIK surgery takes very little time to complete.  On average it takes about twenty minutes from the time my patient enters the operating room to when he or she gets up and leaves.

This means that the actual surgery takes an even shorter amount of time – each eye normally takes me 5-7 minutes to complete.

Most of my patients are amazed at how quickly the surgery is accomplished and even more amazed at how they notice a drastic improvement in their vision the same day.  But that’s how it works at La Jolla LASIK Institute – I provide efficient, professional medical services and deliver excellent results.

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How will I know if I am eligible for LASIK?

La Jolla LASIK Institute’s latest laser technology has made it possible for more people to have LASIK than ever before.  Here are a few guidelines to determine LASIK eligibility:

  1. You are at least 21 years old.
  2. You are in good general health and free of infection or autoimmune disease affecting healing.
  3. You are free of certain eye diseases like keratoconus, cataracts, retinal diseases, ocular herpes simplex and ocular herpes zoster.
  4. You have had stable vision for at least one year before surgery, defined by the FDA as less than or equal to 0.5 diopters’ change in your prescription.  (Don’t worry, I can tell this from your old glasses on your consult day).
  5. Pregnant people are welcome to come in for a consultation.  Your procedure after you give birth will be something to look forward to.

These are general guidelines to determine if you are a good candidate for LASIK.  I’ll give you the full answer when you come into La Jolla LASIK for a free consultation!

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Pilots and Astronauts Approved for LASIK

“Can I get LASIK or PRK and become a pilot?”

San Diego LASIK patient Arnel Nacino
Arnel Nacino, American Eagle Pilot and La Jolla LASIK patient

Absolutely.

LASIK is now approved for most jobs– even astronauts can have LASIK these days.  So, if you are an aspiring pilot, know that the FAA allows commerical airline pilots to have LASIK.  Also, most branches of the military approve LASIK for most military jobs, and the last time I checked, LASIK was approved for all jobs in the Navy, even special operations.

Of course, always check with your superior or your recruiter. But generally, if LASIK is not OK, PRK will be. This means you can achieve your dream of flying planes AND your dream of great vision.

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When can I start exercising after LASIK?

When you exercise after LASIK I want you to be careful to prevent two things:  1) infection and 2) a wrinkled flap.  So, let’s keep you away from nasty bacteria, and make sure you don’t squint or rub or squeeze your eyes for a week or two.

To prevent squinting your eyes when you strain during a workout, wait three days to exercise.  If you exercise in a gym, assume the equipment is covered in toxic bacteria.  Wash your hands before touching your face when working out after LASIK.

If you sweat a lot, use a cap, sweatband, or scarf to absorb the sweat so it doesn’t pour into your eyes.

But, yes, you can work out.  Just use a little care and judgment.  No problem.

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How Come Doctors who Perform LASIK Still Wear Glasses?

What an interesting question!

I had LASIK myself 9 years ago, and I’ve asked colleagues who never had it why they haven’t.  Most eye surgeons really believe in the procedure and would have it if they could.  I’ve discovered that most doctors who never had LASIK are not LASIK candidates and wish they were!  The LASIK surgeons I know who have never had the procedure have told me they are not LASIK candidates because their prescriptions are too high or their corneas are too thin.  This has happened enough times that I wonder if having an unusually high prescription or other eye condition is what attracted many people to becoming ophthalmologists in the first place.

Now with the implantable contact lens, there will be more and more people with high prescriptions, including eye surgeons, who are vision correction candidates.

I had LASIK myself 9 years ago, and I’m so glad I did.  I also performed LASIK on my husband and other relatives, so I truly believe that the procedure can change your life.  It certainly has changed mine!  If you’re thinking about LASIK, I’ve been in your shoes, and I can tell you all about my personal experience at your LASIK consultation.

Am I Old Enough or Too Old for LASIK?

Have you asked the questions ” Am I too old for LASIK ?” or ” What age can you get LASIK ?”

If you are at least 18 years old, you can get LASIK.

But what if you’re 40, or 60, or 80?  If you are 40 or 50, you’re still young for LASIK.  I can help you to see up close AND far. Because LASIK occurs on the part of the eye that remains stable over long periods of time, LASIK won’t change the rate at which your eyes age.

If you are in your 70s, though, it might be better to opt for cataract surgery instead of LASIK.  In your 60’s, I’ll check you carefully for early cataract and we’ll decide if early cataract surgery or LASIK is a better choice for you.

Of course, every person’s eyes and circumstances are different, so regardless of your age, I still need to examine your eyes to make sure you’re a LASIK candidate. So call and make an appointment, and I’ll answer all the questions you have.