If You Want . . . Contacts
What’s New: Contact Lenses That Are Progressive or Bifocal
In progressive contacts, distance vision falls in the center of the lens, and intermediate and near vision are in the more peripheral zones of the lens. (However, this can be customized. If you prefer, the center can be made for near vision, and distance put on the periphery.) Bifocal contact lenses are just like bifocal glasses—the top is for distance, the bottom for close work. A possible downside: The bottom of the bifocals is made heavier so they won’t spin in your eyes (as do regular contacts), but that weight annoys some users, says Sandra Belmont, MD, founding director of the Cornell Laser Vision Center at New York–Presbyterian Hospital.
If you have been unable to wear flexible contact lenses because of astigmatism (an irregularly shaped cornea that makes it hard to focus), toric contact lenses, which correct for the uneven cornea, are now available as progressives or bifocals.
If You Want . . . Surgery
What’s Out There: Laser Vision Correction (think LASIK and PRK)
Mostly done to permanently improve long-distance vision in patients under 40, these painless surgical procedures use an excimer laser to reshape the cornea. If you are over 40 and have presbyopia, you can opt for monovision, in which one eye is corrected for near vision and the other for distance vision. The brain then “selects” the image it wants. But not everyone can adapt to monovision correction, so before deciding on surgery, you may want to try contact lenses with the two different focuses (close and far) for a day or two to see if that might work for you. Most doctors will provide you with the trial lenses at no extra cost.
The best candidates for Lasik and PRK are people older than 18 with stable prescriptions, normal eye exams, no uncontrolled autoimmune diseases and no visually significant cataracts, says Belmont. If you’re pregnant, postpone eye surgery until after the delivery.
“Dry eye can sometimes be seen in patients after Lasik surgery but very rarely after PRK,” says Belmont. The procedures usually cost $2,000 to $2,500 per eye, which most health insurance policies don’t cover.
If You’re Ready For . . . A Last Resort
What’s Out There: Lens Implants
The eye surgeon implants a synthetic lens that either replaces your natural lens or is put in front of it. This is serious surgery that comes with many risks and no promises. But if you have tried everything else and still have trouble seeing, it might be worth discussing this option with your ophthalmologist. There are two types of lens implants: intraocular and phakic.
With intraocular lens implants, your natural lens is removed and replaced with a presbyopia-correcting multifocal synthetic lens. The typical patient has cataracts, but this surgery is occasionally done on people who don’t want to use reading glasses or contact lenses. “Contact lenses can be multifocal, but the problem is, they may move around on the eyes. By contrast, when multifocal lenses are put inside the eyes, they stick and don’t move,” says D. Rex Hamilton, MD, director of the UCLA Laser Refractive Center at the Jules Stein Eye Institute and associate clinical professor of ophthalmology at the university. The surgery carries a small risk of eye infection, and possible complications include less sharp color contrast.
Phakic lens implants are placed in your eye on top of your natural lenses. These are generally used for people with such severe myopia that they are not good candidates for Lasik, but a recent study in the United Kingdom found that phakic implants may work well for people with moderate forms of nearsightedness: A year after the procedure, patients who received the implants could see as well as those who’d had Lasik. In addition, among those with moderate to severe myopia, the phakic-lens patients had higher satisfaction scores. The caveat: “These lenses can cause glaucoma or cataracts, inflammation and infection,” says Gill. Since this is a relatively new procedure, exact complication rates are still being determined.