I am 45 and wear soft contacts at 2.75 and 3.0. My cornea thicknesses are 507 and 509. I currently do not need reading glasses -- my reading vision is excellent with or without my contacts. I read and/or do computer work about 10 hours/day. I hate glasses of any nature and would hate to give up my "contacts/no glasses" situation for a "Lasik/reading glasses" situation. I consider my contacts a minor hassle but not unbearable by any means. I am considering Lasik with wavelength and Interlase. My questions are:
1. Is there any chance that Lasik will accelerate my need for reading glasses - that is, if I get regular Lasik (no monovision) might I need reading glasses immediately, or sooner than I would if I don't get Lasik? THIS IS THE CRITICAL QUESTION
2. What are the benefits, if any, of having monovision Lasik done now (when I don't need it)?
3. If I don't get monovision now (just Lasik) there is no way to get it later, correct?
3. Does Monovision eliminate or just delay the need for readers? If delay, any way to determine how long?
4. If Monovision is done for somebody who needs readers of +1.5 and then a couple years later the person needs readers of +2.5, can the monovision be adjusted or must the person wear readers?

Thanks so much for your assistance.

The answer is yes - in the vast majority of cases - one will need reading glasses if they are age 45 and have LASIK with the goal of distance. In my experience - the reason for a person who is 45 years old and can see distance and still read with their contacts is because their current contact lens prescription is not perfectly optimized. Typically, one or both eyes are just a little undercorrected. But I can tell you from experience as well that if you make both eyes perfect for distance - at age 45 one will generally need reading glasses.

I hope this helps

Bill Trattler, MD
Miami, FL

Thanks for the prompt reply. I understand that typically if the patient does not like the monovision, the non-dominant eye can be re-corrected, resulting in the need for reading glasses. given my cornea thickness of 507, is there a chance that I will not be able to undergo this re-correction

D,
You should definitely try out monovision first by getting a reduced soft contact script for your non-dom eye and use the existing contact for the dominant eye for distance if it gives you sharp 20/20 distance vision. This way you'll be able to experience the offset to see if your brain will adapt and you can use the non-dom eye for reading comfortably. Only about 1/3 of everyone who gets monovision likes it and can tolerate it. Many experience a "loss of equilibirium" in losing good binocular vision the brain has been used to for so long. They can't deal with the offset and get headaches and/or dizzy spells. I would think you would want to only half-correct your non-dom eye to do this, resulting in about -1.5, a very good reading script at age 45.
I had lasik over 5 years ago and almost opted for monovision. I'm glad I didn't. Readers aren't so bad compared to coke bottles. Plus real binocular distance vision has big benefits and advantages.
The need for readers hits at about age 45 as most folks typically get a +1.25 to +1.5 script. About every 3 to 4 years after that, the script increases by 1/4 diopter on average and then levels off around age 65 or 70. That's why dimestore readers range from +1.25 to +3.25. But many folks seem to level off around +2.5.
Monovision is said to be effective for only about 10 years and then you would need a retreatment or readers. I am of the opinion that retreatment is not a wise option since it entails a fair amount of downside risk cutting a second flap. For your thin corneas, LASEK or PRK for the initial procedure would probably be recommended anyway. I wouldn't tempt fate with your precious eyesight. But in another 10 years technology will be better.

You guys have been very helpful. I'm pretty sure I don't need readers today - without any glasses or contacts I can read fine print well at 8" and not at all at 20". Is there any benefit to waiting to do Lasik w/ monovision until I need readers, as opposed to doing it now when I don't need them? Will it extend the time until I need them - for example, if I do monovision Lasik today in 2005 and need readers in 2010, if I wait to do monovision lasik for 2 years until 2007, will I not need readers until 2012? If so, I'm pretty satisfied with my contacts and would rather wear them for 2 more years and delay the readers for 2 years

Thanks

At your age, right on the cusp of presbyopia, doing lasik now when you're happy with contacts and willing to wait makes no sense. While distance vision would be corrected, your reading vision is going to change and challenge your comfort level in the very near future. Lasik would only complicate that. Waiting for better lasik always makes good sense. I wish I had waited, as custom wavefront would probably have given me better acuity. As time goes on the technology only gets better. They may have a lasik-based procedure to cure presbyopia in the next 5 years.