BLOG: The 50+ LASIK consult
A patient calls your office to make an appointment for a LASIK consultation. She has finally decided to do something about her vision, but she is 55 years old. What do you do?
In my practice, what used to be a difficult conversation has become a much easier one. My staff educates patients (of all ages) that we offer multiple vision correction procedures — not just LASIK — and will determine the best procedure for them tailored to the appropriate stage of ocular maturity guided by our advanced vision analysis.
Once they arrive in our practice, patients follow various diagnostic tracks, depending on their age and refractive error. Younger patients are worked up for LASIK, high myopes for an ICL (STAAR Surgical), and low to moderate myopes who are in their mid-50s or older and hyperopes who are in their mid-40s or older for a refractive lens exchange (RLE). We evaluate axial length and vitreous status to determine candidacy for RLE in our advanced vision analysis and have a low threshold for retina clearance in borderline cases.
Regardless of the track we are following, we describe the exam to patients as an advanced vision analysis. Using client-centric language, we take them on a digital tour of their eye. I review all the diagnostic results and talk to them about the relative risks and benefits of the different procedures we can offer them.
For older patients, RLE with implantation of an extended depth of focus and/or mid-add multifocal lens is typically recommended. We refer to this procedure as a custom lens replacement, or CLEAR, and explain that CLEAR restores vision by replacing the cloudy lens with a crystal-clear, restorative implant that lasts a lifetime and prevents the continued deterioration of their vision as they age.
Here are five reasons why I find that patients in this 50+ age group (or younger for hyperopes) are more satisfied with RLE than with monovision LASIK:
1. Retention of stereopsis, which helps with depth perception, reaction time and three-dimensional vision.
2. Binocular summation. With both eyes corrected for distance with presbyopia-correcting IOLs, patients achieve better uncorrected distance and reading acuity than with monovision.
3. Better quality of vision, thanks to the elimination of any early age-related opacity, light scatter or higher-order aberrations in the lens. Most patients in this age group are already in stage 2 dysfunctional lens syndrome (DLS), with myriad effects on quality of vision, even though they don’t have “cataract” quite yet.
4. Prevention of cataract and visual deterioration. With a single procedure, we can prevent cataract and addresses ametropia, presbyopia and DLS.
5. It’s still a laser. Patients who are attracted to the idea of laser surgery are reassured that we perform lens surgery with a femtosecond laser.
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