Dr. Komaroff, 12-27-11: Are you too old for laser surgery?


Q: After more than 30 years of wearing glasses and contacts, I am finally in a financial position to have my eyes surgically corrected. I'm excited about the possibility, but my wife thinks that undergoing LASIK at the age of 48 is a bad idea. I plan to consult with an ophthalmologist, but in the meantime, what are some of the risks and benefits of vision correction surgery for older adults?

A: You're not alone in wondering about having your vision surgically corrected later in life. As you age, your contacts may feel less comfortable, or perhaps you hate wearing reading glasses. If your eyes are otherwise healthy, laser refractive surgery may provide the results you're looking for. But the risks and benefits do shift around midlife, so you need a thorough evaluation and a frank assessment of what you might gain -- or lose.

Laser refractive surgery corrects vision by reshaping certain layers of the cornea, the clear dome at the front of the eye that bends and focuses light.

You should look for an ophthalmologist with extensive experience and up-to-date equipment (less than 10 years old). At your consultation, the surgeon will thoroughly evaluate your eyes. Your surgeon also needs to know about your general health and any medications you are taking.

Your age itself isn't the key factor in deciding whether to have LASIK. Still, various age-related eye conditions should influence your decision. These conditions may need to be diagnosed and treated differently in someone who's had laser eye surgery:

CATARACTS. With age, the lens of the eye can become clouded, a condition called cataract. The clouded lens can be removed and an artificial one implanted, restoring normal sight. LASIK does not prevent the development of cataract, so a later cataract will mean another surgery. If you've already had refractive surgery, it's trickier to choose the correct artificial lenses for cataract surgery.

GLAUCOMA. Glaucoma is due to a buildup of pressure inside the eye that eventually damages the optic nerve. Untreated, it can result in blindness. Ophthalmologists screen for glaucoma by checking pressure within the eye. Surgery thins the cornea, leaving it softer and more flexible, so subsequent glaucoma screenings will show lower pressure readings, which may result in failure to diagnose early glaucoma. LASIK is not recommended if you have moderate or severe glaucoma because your treatment will become more difficult to monitor.

DRY EYE SYNDROME. With age, your eyes produce fewer tears, and you may notice an itching, burning or scratching sensation that results from decreased lubrication. If you have severe dry eye, you shouldn't undergo LASIK because you are more likely to develop chronic dry eye afterward.

PRESBYOPIA. In your 40s and 50s, the lens of the eye naturally becomes more rigid and less able to focus clearly on near objects, a condition called presbyopia. Laser refractive surgery doesn't prevent presbyopia. If you have the procedure in your 40s, you'll still likely develop the need for reading glasses within the next 10 years or so.

If you and your doctor decide that you're a good candidate for laser refractive surgery, it's important to be aware of side effects. Dry eye is common after LASIK. Immediately after surgery, you may notice glare, halos or double vision, especially at night.

Other possible problems include the development of a new astigmatism, a reduced ability to see contrasts, and under- or overcorrection requiring glasses or further surgery. The surgical site can become infected and the inner cornea can become inflamed, causing hazy vision.

As an older candidate for laser surgery, you should be aware of these possible problems. Keep your expectations realistic. But your age isn't a problem in and of itself, especially if your ophthalmologist sees clear to give you the go-ahead.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: harvard_adviser@hms.harvard.edu.)

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