As an optometrist, Dr. Langer can provide treatment for the majority of medical eye and vision needs that do not require surgery. When surgical intervention is the necessary or desired line of treatment, Dr. Langer works closely with the best ophthalmologists in Austin to co-manage ocular surgeries. The most common ocular surgeries Dr. Langer co-manages are LASIK and cataract surgeries.
The first question most patients have in regards to LASIK is, “Am I a good candidate?” The answer is usually, “Yes.”
Previously, LASIK wasn’t available to patients with large eyeglass prescriptions. With recent advances in laser technology, most prescriptions can now be corrected with LASIK surgery.
Modern lasers can correct up to 6 diopters of hyperopia (farsightedness), 6 diopters of astigmatism, and 12 diopters of myopia (nearsightedness). Because the majority of eyeglass prescriptions fall within these parameters, most patients are suitable candidates for LASIK corrective surgery.
There are a few exceptions.
During the LASIK procedure a flap is created with a laser on the cornea, or front surface of the eye. After this flap is created, the laser ablates (essentially removing tissue) areas of the cornea. This procedure allows light to focus directly on the retina, which provides patients with crisp, clear vision without glasses or contact lenses. If the cornea is very thin, the LASIK surgeon may not be able to safely ablate enough corneal tissue to complete the procedure.
Additionally, if the cornea has extensive scarring or the patient has a corneal disease, LASIK may not be an option.
To determine if someone is a good candidate for LASIK surgery, the age of the patient and the stability of their eyeglass prescription must be considered. Before age 18, eyeglass prescriptions are unlikely to be stable in many patients, changing from year to year. For this reason, patients under 18 are not good candidates for LASIK surgery.
Between ages 18 and 40, many patients have minimal to no change in their glasses prescription, making them prime candidates for LASIK. There are always exceptions to this rule, so it is important to look at two to three years of prescription data to determine if the patient’s glasses prescription is stable. If the eyeglass prescription is changing, it is likely to change again making the LASIK procedure ineffective.
For patients over age 40, the decision of whether to proceed with LASIK surgery is more complex. Between ages 40 and 60, glasses prescriptions tend to change and patients lose the ability to focus at near. This condition is known as presbyopia. Even though the distance prescription will likely change after LASIK surgery, it won’t change drastically. Patients with large prescriptions often experience and appreciate several years of perfect distance vision after LASIK, followed by a much milder prescription in years to come. Patients with milder prescriptions, may not appreciate LASIK, as their original glasses prescription can return several years after LASIK is performed. Unfortunately, LASIK can only correct distance or near vision in presbyopic patients, not both.
Patients over 40 have to make a compromise when it comes to LASIK. Luckily, there are other options available for corrective vision surgery that may be more suitable for presbyopic patients, such as elective lens replacement surgery.
As adults age, the lenses of the eyes cloud forming cataracts. Cataracts cause patients to experience blurry vision, the need for more illumination to read, an increase in glare at night, and colors not appearing vivid. Most cataracts develop slowly, with a gradual onset of symptoms. Cataracts are a normal aging change, and not an eye disease.
When cataracts are small and not causing symptoms, they are typically monitored on an annual basis. Once cataracts grow and begin to impact vision and quality of life, patients are referred to an ophthalmologist for cataract surgery.
Cataract surgery involves making an incision in the front of the eye, from which the cloudy lens is removed. The cloudy lens is replaced by an artificial intraocular lens or lens implant. The lens implant contains a prescription that can correct patients’ vision, often reducing or eliminating the need for glasses.
Intraocular lenses have come a long way since they were first introduced. There are lens implants available that can correct almost any prescription, including myopia, astigmatism, hyperopia, and presbyopia. Depending on your prescription, lens implants such as the Tecnis Symphony lens can provide clear vision across multiple distances. Many patients are thrilled to be free of glasses following cataract surgery.
The same artificial lens technology implanted during cataract surgery can be used for elective lens replacement. If a patient is not a suitable candidate for LASIK, or would like an option to correct presbyopia, elective lens replacement (also known as refractive lens exchange) is a good alternative. In elective lens replacement surgery, before cataracts develop the natural lens of the eye is removed and an artificial lens with corrective prescription is inserted in its place. After lens replacement surgery, the prescription is stabilized and stops changing, which is an advantage over LASIK surgery. Like LASIK, this procedure provides clear vision without the need for glasses. A bonus for patients who choose elective lens replacement surgery is that they will never develop cataracts later in life.
While Dr. Langer does not perform LASIK, cataract surgery, or elective lens replacement surgery, she has close relationships with top-rated Austin area ophthalmologists, and is able to provide pre-and post-operative care. If you are unsure which procedure is right for you, Dr. Langer is happy to offer her expertise.