How Your Vision Can Change After 40

   If you're age 40 or older, you may be noticing some changes in your vision.  You may be having a harder time reading type or driving, or it may take longer for your eyes to adjust when you change your focus from a distant object to a closer one.  In fact, you may find that you need glasses or bifocals for the first time in your life.  Or you may notice that you need a stronger glasses prescription.

I've Been Farsighted Forever

   Even if you've been wearing glasses or contact for farsightedness for a long time, you may be noticing greater vision problems.  Your farsightedness is getting worse.  Since you already wear corrective lenses, you're wondering, "What's the next step?"  For many, using two sets of glasses - one for distance and another for near vision - getting bifocals, or using a combination of glasses and contact lenses is the next step.  Those aren't always good choices for active, busy people.

I've Never Worn Glasses and Now I Need Them
You're not alone.  More than 50 million Americans age 40 and older wear glasses or contacts for farsightedness.  Many of them never had to worry with vision correction until they reached age 40.  As we mature, the focusing lens inside our eye begins to lose its flexibility, making it more difficult to see things close-up.  People over age 40 who are mildly farsighted may suddenly lose their ability to see near objects without a considerable focusing effort.  Then, you reach a point where you have to get glasses or contacts to make it through the day.  But now, there's a better way to see life. It's Laser Vision Correction just for you.

   Hyperopia or farsightedness - Whereas in myopia the cornea is too steep or the eye is too long, here the conditions are reversed: the cornea is either too flat or the eye is too short.  In this condition, light bent by the cornea and lens is focused behind the retina.

Persons affected by hyperopia are said to be farsighted because they are more often able to focus on distant objects rather than objects close to them.  However, the difficulty in focusing on near objects is automatically overcome early in life by an effortless accommodative response.  Therefore most hyperopes do not wear glasses in early life, and are unaware they are farsighted until the accommodative response slips away in their forties.

   There is a progressive hyperopic shift with age, and eventually the focal point has moved so far back that the hyperope has trouble seeing objects at intermediate and longer distances, as well as close-up.  Ultimately, the farsighted person does not see well at any distance.  Because hyperopia typically becomes a problem only with age, and because the farsighted person has not had to wear glasses early in life, the manifestation of hyperopia is both a very unwelcome inconvenience and a reminder that one is getting older.

   Astigmatism - Astigmatism is produced by a cornea that is steeper along one curve than another.  The cornea is out of round, and its curvature more resembles that of a football than a basketball.  Because the astigmatic cornea's curvature is steeper in one direction than it is in another, there are multiple focal points.  Not all of the light rays can be focused on the retina.  Both near and distant vision are blurry.  This disorder affects approximately 25% of the population, and it can occur alone, or in combination with hyperopia.

How can CK help correct vision for presbyopia?

   A refractive surgery procedure called Conductive Keratoplasty, or CK for short, is used to correct mild to moderate farsightedness (hyperopia).  In addition, CK can be used to convert a normal presbyopic eye with good distance vision but poor near vision to one with improved near focus.

   It is important to recognize that when your near vision is improved, your distance vision usually becomes less sharp.  In order to maintain good distance function, therefore, only one eye is set to near focus, while the other eye is left or set at good distance vision.  This approach is called "monovision."  You can achieve monovision with contact lenses or with refractive surgery.

   Depending on your underlying refractive error, CK can be used on one eye, or both, to achieve this blended vision such that corrective lenses may not be needed for distance or near vision.  One eye (usually the non-dominant eye) can be treated with CK to allow clear vision up close while the other eye is either not treated or is partially treated to allow clear distance vision. Your ophthalmologist (Eye M.D.) will discuss this option and together you will decide which treatment is right for you.
 
How is Conductive Keratoplasty done?

   If you've been afraid of surgery, but still want to temporarily reduce your dependence on reading glasses or other corrective lenses, CK (Conductive Keratoplasty) may be the right choice for you. It's a quick procedure with no cutting involved. You don't even have to go to an outpatient surgery center. It can be performed in as little as three minutes in the doctor's office.  CK uses a pen-shaped instrument with a cool tip as thin as a human hair. After application of anesthetic eye drops, Dr. Cano will apply controlled amounts of radiofrequency (RF) energy in a circular pattern that applies heat to the peripheral portion of the cornea. This pattern is applied in the periphery of the cornea and therefore minimizes interference with your line of sight.  A device called a "speculum" is inserted to hold your eye open during the procedure.
 

A tiny probe releases controlled amounts of radio frequency.		The heat from the radio frequency causes the peripheral cornea to tighten like a belt.

   The heat then causes the peripheral cornea to tighten like a belt, shown above right, increasing the curve of the central cornea.  This moves the point at which light is focused onto the retina. 

   Keep in mind that recovery of your best vision after CK is slower than after having LASIK. Some people have vision fluctuations for several days to weeks after having CK.

   CK is considered painless.  Once finished, you don't have to wear a patch and can usually return to work the next day.  During the first 24 to 48 hours after the procedure, you may experience some mild discomfort, including a foreign-object sensation or "scratchiness" in the eye.  While vision is improved in the vast majority of patients, some people still need glasses or contact lenses for sharpest distance vision.  Also, CK may not be a permanent correction; for some patients, hyperopia may return over time. 

The results

   CK modifies the topographical (surface) curvature of the cornea, making it temporarily steeper and improving near vision. In FDA clinical studies, 98% of patients were able to read newspaper-size print without reading glasses after the CK procedure (12-month follow-up data).  
 

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