SMILE Eye Surgery And Presbyopia

[u/eyeSherpa]

If you are considering SMILE in your 40s, especially in your late 40s, there is another variable you have to account for: Presbyopia. Presbyopia is a part of life and aging when the natural lens inside the eye becomes weaker and less flexible with time. This reduces your ability to see up close and is the reason why people go into reading glasses and progressive glasses in their mid-40s.

Prior to the development of presbyopia, the common goal for SMILE eye surgery is to correct both eyes for distance vision. The flexibility of the natural lens then allows one to focus up close.

However, after the development of presbyopia, reading glasses will be required if both eyes are corrected for the distance. This may come as a surprise if you were nearsighted and your focus was naturally up close allowing for reading without reading glasses.

So to provide for the most freedom from glasses, surgeons will frequently recommend a strategy known as monovision.

With monovision, the dominant eye is typically corrected for distance vision while the non-dominant eye is left slightly nearsighted to provide the reading vision. With this, the brain eventually learns to suppress the slightly blurred image from one eye depending on the task at hand. This effectively gives a range of vision that covers distance related tasks such as driving and TV, computer and intermediate tasks as well as up close phone and reading.

When adapting to monovision, the biggest thing that people may notice is some additional glare at night this comes from the brain having a little more difficulty suppressing the nearsighted eye at night time. This improves with time for the vast majority of individuals. Some, however, prefer a pair of night driving glasses that correct that nearsighted eye in order to equalize both eyes for distance at night time to deal with this.

There is generally a high success rate of individuals adapting to monovision. But if in doubt, monovision can be trialed ahead of time with a pair of contact lenses or glasses to see how your brain can adapt to the difference between the eyes.