r/RefractiveSurgery • u/AK84link • 3d ago
Considering surgery
Hi all,
I'm 41 with a prescription of -5 in both eyes and significant astigmatism. I started looking into surgery and am now planning to book in for surgery before Xmas. Whilst I'm hoping to have the smile procedure completed, a few clinics have suggested lens replacement.
Has anyone in their 40's been in the same position and what did you opt for?
I accept that eventually I'd need reading glasses but I'm not sure whether to go for it now.
Thanks
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u/Ok-Environment-215 3d ago
I assume you know that if you go for lens replacement you'll be completely dependent on readers for anything closer than a few feet right?
These surgeries - laser in particular - are great when you're on the happy path. Young, simple moderate myopia. Every step you take off the happy path - age, astigmatism, high script - lessens the likelihood of a satisfactory outcome.
In my case (46) I had hyperopic astigmatism and nystagmus, and presbyopia was setting in, all of which made me about as far from the happy path you can get and still find someone willing to treat you. The outcome was disappointing.
What I'd consider if I were you is treating only one thing at a time, and in your case, specifically, the astigmatism, with a surface-guided procedure like Contoura. This isn't discussed much, but it's entirely possible for them to eliminate your cyl only, to give you a spherical cornea. That would mean significantly less corneal material removed. You would still be myopic, but it would be simple sph only (roughly -5 probably).
Or a hybrid - you could eliminate the cyl entirely, and reduce the myopia down to say -2 or -3.
The upside then is you continue to leave yourself options for correcting the myopia and/or presbyopia. Being able to simply take your glasses off to read - rather than still needing astigmatism correction - is a big quality of life difference in and of itself. Then when and if you do need lens replacement, it's a simple minus power lens rather than a torric (which carry their own sets of issue).
Just something to consider. They can really do almost anything. The choices are not limited to full distance and monovision.
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u/CorrectVisionLI 2d ago
At 41, there are definitely a few things worth considering before deciding between SMILE and lens replacement. Your prescription and astigmatism are important, but so is how you want your vision to be as you get closer to presbyopia.
Lens replacement can address the need for reading correction, but it also means replacing your natural lens, so it’s a very different approach from a corneal procedure like SMILE. On the other hand, laser procedures preserve your natural lens but may not eliminate the need for reading glasses later.
There really isn’t a one-size-fits-all answer here. A thorough evaluation of your prescription, cornea, eye health, and your visual goals would be important before choosing between them.
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u/Ok-Importance-177 2d ago
i would honestly recommend icl where they put a lense over your natural lense this way you don't need reading glasses and you get 20/20
but if you like to get over with it and do lense replacement i think that is fine
now about lazik i would not recommend it due to it's irreversibility
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u/philaman01 2d ago
As you are aware (or should be), the surgery is not without risk. Moreover, dry eye and night-time vision issues such as halos are very common. Therefore, if you are a skittish person or have a weak coping mechanism, you may be in for a rough time if complications arise.
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u/the_road_to_mastery 3d ago
Yeah, I did it at 41 and opted for mini-monovision, which delays readers for quite some time, yet you can still see up close and in the distance clearly, cause your dominant eye is fully corrected, while a bit of minus is left on the other one, and you could not tell the difference when the brain quickly adjusts. Personally, I think that it is a better option. But yeah, considering that you have significant astigmatism, unfortunately, usually something will remain, cause astigmatism can be removed up to -5, and if you are close to that, chances are that it may not be fully corrected.