I had lasik surgery on Feb. 5 2003. I am very discouraged at my near and mid range vision. My doctor keeps telling me to wait, but it isn't getting any better after 2 1/2 months. Is there anyone out there that had improvement after that time? I am not yet 50 but I feel so OLD now! I have three pairs of reading glasses depending on how close I need to see. Can I have an enhancement to help? Can I wear one contact lens to compensate for the mid-range vision and then have reading glasses around my neck to see close up?? What are my options? I feel so discouraged. Thanks

It seems that people who have poor middle vision are dealing with two very different, but contributing, problems. One is that the correction is not accurate. You are probably just a little undercorrected, overcorrected, or have some residual or induced astigmatism. You need to ask your doctor for a new prescription. This will help us understand what is going on with your vision.

The other issue is probably what I call Sudden Presbyopia.

There are two ways to look at myopia. One is that you cannot see things far away very well. The other is that you can see things close very well.
When a normal sighted person looks at something distant, the natural lens of the eye relaxes to its normal shape. When that same person looks at something close, the muscles around the lens stretch or squeeze the lens to change its focus. This change of the lens shape for close vision is called accommodation.

Someone who is myopic has a lens with a normal shape that focuses on things close. To see something close accommodation is not necessary - the lens is already set to focus on things close. Even with lenses to correct the myopia, the natural lens does not have to accommodate to see things close.

As we mature, the natural lens in our eye expands, firms, and loses its ability to accommodate. This normal condition is known as presbyopia and develops in most people in between 40 and 60 years of age. Presbyopia may not be noticed in a myopic person because the need for accommodation is diminished by the myopia. Presbyopia can be masked by myopia. The lens may be unable to accommodate, but since the lens is already focused for close vision and the corrective lenses take care of the myopia, the lack of accommodation is not noticed.

When you have refractive surgery and remove all of the myopia, suddenly the lens is expected to accommodate. Since accommodation has not been an issue before refractive surgery, the muscles may be weak. The stiffness of the lens was not an issue before, but now this stiffness reduces the amount of accommodation possible to change from distant to close vision.

Glenn Hagele
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org