contacts are great but can't read with them

I am considering Lasik or something similar to correct my nearsightedness. I
have some astigmatism in one eye, but nothing too exciting. I currently have
contacts, but mostly wear glasses.

My glasses are an old prescription and don't correct my myopia all that
well, but good enough. At least I can read the newspaper with them on and
can sort of see distant things.

If I wear my contacts - a recent exam (last summer) is when I got them - I
have great vision - probably 20/15 or so, but I can't see anything within a
4-6 ft. radius clearly. They're a pain for that reason.

Now - if I get Lasik - will my eyesight be just like with contacts or what?
My wife has pretty good distance vision, but only needs glasses for tiny
print. I'd hate to have to wear glasses for everything within 4-6 ft. With
my contacts I can't clearly read the speedometer in the car. Now, I can't
drive with reading glasses. Is this normal presbyopia? If so, I'll stick
with my current glasses which aren't too great for distance, but good
enough. I don't know too many people in their 50s who have such bad close up
vision problems as I do with my contacts in.

I'm hoping that Lasik's version of 20/20 will reduce the presbyopia radius
to something normal like tiny print at 12" or so! But I guess that's too
much to ask for, huh? And I don't like the idea of monovision really.

I'm a 51 yr old male, with moderate myopia, some astigmatism.

 

If you elect to go with monovision LASIK, make sure that you try it out
first with contact lenses. Some surgeons neglect this important step.

DrG

 

I like this warning on Glenn's monovision web page.

"... however monovision is not for everybody and some people really dislike
it effect."

DrG

 

I done real good English too.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

 

Yes they do, and for the life of me I can't figure that one out.

Without the contact lens trial the doctors have no way of knowing if
the patient will like monovision at all, if 0.75 or 1.75 diopter
undercorrection is better, if the patient will be able to drive at
night with monovision, etc. If they get it wrong, then they have all
the overhead expense of doing the surgery again. Doing monovision
without a contact lens testing just makes no sense to me.

EVERYONE considering surgically induced monovision should try it with
contacts for several weeks before they have it lasered into their
eyes.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

 

Guess I have not room to brag. Whoops, I mean "no" room to brag.

DrG

 

BTW, will you be in New Orleans for the AAO?

 

One of the forgotten problems in the statement above from Glenn is the
increase of presbyopia over the years.
It is not only about either 0.75 or 1.75 diopters at the specific moment you
measure.
If done on a relative young presbyopic you have most certainly a lesser
addition as done on an older presbyopic.

Which addition should you choose, to strong and thereby having some spare
for the without any doubt increasement of presbyopia but at the same time
having a short reading distance, or a lower addition, knowing later on the
client has to wear glasses or contactlenses to overcome the increasment in
needed addition?

One of the advantages in contactlenses is the possibility to change the
addition when needed , when having LASIK it is impossible.
This has to be explained IMHO before surgery.

 

Glenn Hagele - Council for Refractive Surgery Quality Assurance
wrote in

I didn't realize that optoms were welcomed.

DrG

 

I agree, Glenn. When I see an unhappy post-op LASIK monovision
patient, they always look at me like I'm from another planet when I
ask them if they tried monovision in contact lenses before they had it
lasered into their eyes. Trial fitting MUST BECOME a standard of
care.

Incidentally, I have stumbled upon a "new" way to explain monovision.
I mention to the patient that his/her brain is always making choices
between the two sides of the body that they never "think" about. For
example, if you approach a curb and have to "think" about how to step,
you could simply fall while deciding. So, you simply step with your
"favorite" foot.

When monovision works, the brain decides at a subconscious level to
use both pictures simultaneously and share the best of both sides,
picking one when it "has to."

This is consistent with the work of Dr. Jan Jurkus from the Illinois
College of Optometry, who has shown that people who have total
"one-handedness", as if the second half of their body can't catch
anything, are very poor monovision wearers. Their brains don't want
to share the picture from side to side, as they have never done so for
anthing else.

 

Very important. Reportedly at least 1 in 5 people are not ABLE (for
physiological reasons) to adapt to monovision, to say nothing of those
who simply decide they don't like it. For a surgeon to fail to perform
this step is altogether against the patient's interests because if the
patient is in that 20+%, either the surgery will have been a waste of
time because the patient will have to wear glasses again, or the
patient will find himself subjected to the significantly increased
risk of a second surgery.

It should also be a proper trial - the patient should wear the lenses
for several days so that they can see how their vision will fare
during all different kinds of activities they normally engage in.

Rebecca Petris
www.lasermyeye.org

 

If you opt for monovision, you
may have trouble with close-focus work. I had monovision and found
afterwards that surgery was quite difficult, as was threading needles,
removing splinters and even fly-tying fish lures. With time I became
quite farsighted in the eye that was originally 20:20 and am now
approaching 20:20 in the eye that was burned for reading. Now when I
wear glasses and look in the mirror one eye looks grossly enlarged in
the lens.

 

The way monovision was presented to me was, oh well, if you don't like
it, you can always have your undercorrected eye retreated to be
corrected for distance as if it were a no big deal everyday thing. Kind
of like, if it doesn't fit you can always return to the store for an
exchange.

 

The above is correct when wearing contactlenses, having had LASIK or an
other refraction surgery is a totally
different story.

 

Bob wrote in message news:

From the way you describe things, Bob, it is very possible your
contact lens Rx is "overminused." That is, it leaves you slightly
farsighted and you use your remaining accommodation ability to bring
your effective Rx to plano. In middle-aged people, this often results
is truly excellent distance vision, but compromised middle-distance
vision, as well as horrible close-up vision. This overminusing occurs
because some people like the super-crisp distance vision they get by
using their accommodation ability to fine tune a slightly plus Rx.
They don't realize that by doing this they exacerbate any existing
presbyopia. Even though they know better, ODs often go along with
this because the patient wants it and it doesn't damage the eye in any
way. Of course, it is also possible you just suffer from an
age-accelerated form of presbyopia, but I don't think so, because if
that were the case spectacles that give you good close-up vision would
result in quite significant myopia and very poor distance vision, but
from what you say that does not appear to be the case. I suggest you
go to your OD and have him fit you with a set of contact lenses that
have the weakest Rx necessary to bring your distance vision up to a
clear 20/20. It is likely this will solve your middle-distance
problem, and improve your close-up vision noticeably. This is also
the vision you are likely to get with LASIK surgery. Also, as others
have pointed out, you could also opt for monovision LASIK, though a
contact lens trial is a must, as many people do not like monovision
even though it works.

Bryce Carlson, PhD

 

An OD ''overminused'' a 51 years old, you must be out of your mind.
''Overminusing'' gives you a better vision ? what an unprofessional idea.
OD's often go along with ''overminusing'' ? see the above

Read the statement Bob has made about his old glasses, they do not correct
his myopia completely and therefore you might consider these glasses as
''underminused'' and also as a (weak) pair of reading glasses to Bob.
If Bob's myopia is exceeding the 5 diopters you have to consider the
accommodation- and convergence- effects when wearing contactlenses instead
of glasses.
An eyecare specialist should be familiar with these effects when explaining
the pro's and contra's in LASIK in my opinion.

 

Well then, there you go.

DrG

 

(CHip) wrote in

Because I value my stereopsis (3D vision) in the examination room, I cannot
tolerate monovision. A sense of depth is very important when performing
binocular retinoscopy.

Drg

 

I'm sure you're right, Ragnar. However, they might be better served if
they did let in the occasional critic who has something useful to
contribute.

I would like to meet you at the door.

DrG

 

....or how silly you look not knowing it.

Yes, what logic is that?

If there is a genuine interest in informational exchange, then I am open to
a "parlay." Otherwise, I guess I can go another 54 years without
attending.

DrG