LASIK (Laser-Assisted In Situ Keratomileusis) is a widely performed procedure designed to correct common refractive errors such as nearsightedness, farsightedness, and astigmatism. This surgery offers many people the freedom of excellent distance vision without relying on glasses or contact lenses, often achieving 20/20 clarity or better. The core question for individuals over the age of 40 is whether achieving this excellent distance vision means they will successfully bypass the need for reading glasses. The answer lies in understanding the difference between the vision problems LASIK fixes and the one it does not.
The Underlying Cause of Reading Glasses: Presbyopia
The eventual need for reading glasses is not a failure of LASIK surgery but a result of a separate, natural aging process called presbyopia. This condition is a universal physiological change that affects everyone, regardless of their prior vision status or whether they have had laser surgery. Presbyopia typically begins to manifest noticeable symptoms in the early to mid-40s.
The mechanism behind presbyopia involves the gradual stiffening of the crystalline lens inside the eye. A young, flexible lens changes shape, a process called accommodation, which allows for clear focus on near objects. As the lens ages, it loses this elasticity, becoming harder and less pliable. This hardening reduces the eye’s ability to change focus between far and near objects, forcing people to hold reading material at an increased distance to see clearly.
Why LASIK Does Not Prevent Age-Related Near Vision Loss
LASIK surgery works by precisely reshaping the cornea, the clear, dome-shaped front surface of the eye. The laser removes a microscopic amount of tissue to correct the cornea’s curvature, allowing light to focus correctly on the retina. This procedure is highly effective because it permanently alters the eye’s primary focusing surface to fix distance vision problems like myopia or hyperopia.
However, the cornea is only one focusing component of the eye; the other is the crystalline lens located behind the iris. Since LASIK operates exclusively on the cornea, it does not interact with the internal lens in any way. The surgery cannot stop the inevitable aging and stiffening of that internal lens, which is the root cause of presbyopia. A person who had LASIK at age 25 will experience presbyopia at age 45 at the same rate as someone who never needed distance correction.
The effect of traditional LASIK is to provide excellent vision at a single distance, typically far distance. It corrects a refractive error caused by an imperfectly shaped eye, not the biological aging of the lens. While LASIK corrects the shape of the eye, it has no power to stop the aging process occurring within the eye. The stability of the corneal correction post-LASIK is permanent, but the internal lens will continue to age, leading to the eventual decline of near vision.
Managing Reading Vision After LASIK
When the effects of presbyopia begin after successful LASIK, the most common and simplest solution is the use of over-the-counter reading glasses. These glasses provide the necessary magnification to compensate for the lens’s lost focusing power during close-up tasks like reading a menu or a phone screen. This solution allows the distance correction achieved by LASIK to remain untouched.
Alternatively, some patients choose a pre-planned surgical strategy called monovision, or blended vision, during their initial LASIK procedure. Monovision corrects the dominant eye for clear distance vision while intentionally leaving the non-dominant eye slightly nearsighted to enable clear near vision. While this technique reduces the dependence on reading glasses, it can compromise depth perception and requires the brain to adapt to the different focus points of each eye.
For those who develop presbyopia years after a standard LASIK procedure, other advanced options are available to manage their near vision loss.
Advanced Surgical Options
Multifocal LASIK, or PresbyLASIK, involves sculpting the cornea to create multiple power zones for near, intermediate, and distance vision. Surgical options that go beyond the cornea, such as Refractive Lens Exchange (RLE), replace the eye’s natural lens with an artificial intraocular lens that is capable of providing clear vision at multiple distances.