| HN Mirror

The reason laser eye surgeries such as PRK and LASIK are not recommended for people aged 40 and up, at least if your ophthalmologist is ethical and honest, are Presbyopia and later on Cataracts. The former, because applying correction to a lens and muscles that are starting to lack accommodative ability is likely still going to necessitate glasses, at least for reading. In fact, this can mean that a previously myopic eye post-surgery in someone suffering from Presbyopia will now need glasses for reading when some people with light Myopia and Presbyopia can read without glasses.

Beyond Presbyopia, there are cataracts, which do affect almost everyone at some stage in their later life and whose solution is Cataracts surgery, which is essentially pretty much identical to refractive lens exchange (RLE), both in the way the procedure is carried out and how they address vision problems.

The main difference is mainly that RLE is generally an expensive elective for younger people, and cataract surgery is more commonly covered by insurance, though this of course depends on your local healthcare system. Also, there are very significant differences in the lenses one can use, as well as whether and how much these can accommodate at different vocal lengths, with the best often being very expensive options. Monofocal (read one/fixed focus) are generally the standard and most commonly covered by (public) insurance, though there are also options which can work across a wider range.

Multifocal and accomadating lenses are available both in RLE and Cataracts, again because the procedure is the same, so anyone trying to sell older people on RLE without informing them about Cataracts is likely maximizing profits. Unfortunately, there are some rather unethical doctors charging for RLE on people eligible for cataract surgery, often leading to these people paying thousands for a less advanced (in sever cases monofocal) lens. This is especially targic as had these people gone for Cataract surgery, they could have safed money or gone for a higher-end option.

Any good ophthalmologist will inform you about that. Then, you are still free to make the choice that, knowing everything, you don't want to wait to become eligible for Cataract surgery. At that point RLE can be a good, albeit expensive, option that will save you from needing Cataract surgery later in life. If you are a very wealthy 40-60 year old, getting RLE with the best lenses on the market is thus fair game.

Cataracts/RLE surgery is an incredibly safe procedure, and a good ophthalmologist knocks them out in less than 10 minutes, a great one easily gets below five and complications are beyond rare.

Because you are getting into an age range where Cataracts could start becoming a concern, any laser eye procedure doesn't make sense, as once you are eligible for Cataracts, you could almost certainly get literally the same you would receive with RLE, though at a far more subsidized price (again, depending on your health care system, private insurance, etc.).

I had Trans-PRK at age 25, and, despite a few days of rather painful healing of the upper layers of the epithelium (it has the most nerve endings in our body after all), I'd do it again in a heartbeat. I can see slightly better than 20/20 and can use even the furthest corners of my eyes reliably, something not fully possible without discomfort with hard contacts. Once Presbyopia truly sets in, I'll make a decision based on how it progresses, what lenses are on the market by then and whether I can justify it financially, but that's going to not be for a few decades.

Also, don't worry, the discomfort during post PRK healing is not the case with Cataract surgery (or LASIK for that matter), as they only necessitate a small incision (or flap in the case of LASIK) that heals differently. SMILE also uses a small incision, but honestly, purely personally I made the decision to go with Trans-PRK over SMILE and LASIK despite knowing the pain, simply because of the data.

Essentially, once you can, consider Cataract surgery with your doctor and consider using the best lens you can afford. And, if you are able and have someone in the right age range with vision problems in your family whom you truly love, consider gifting them surgery. They will benefit for at least 20 years till Presbyopia slowly sets in and they will thank you for it every day.