Vision Correction Options

Vision Correction Options for Patients Over 45 Years Old

Konrad Filutowski, MD

Konrad Filutowski, MD

As we age, many people start to have difficulty focusing on objects that are close-up. This loss of focusing power is generally caused by a condition known as Presbyopia. It is a part of the natural aging process and affects everyone.

That’s the not so good news.The good news is that the Filutowski Cataract & LASIK Institute offers many different options to enhance your vision. This article focuses on vision correction surgery options for patients over 45 who might struggle with presbyopia.

What is Presbyopia?

When we see, light enters the eye then the cornea and the lens refract (bends) it to focus on the back of the eye in a place called the retina. The curvature of the cornea and the lens determine where the light focuses in the eye. If either structure is curved incorrectly, light will not focus on the retina, and our vision is blurry.

Presbyopia is the gradual loss of flexibility of the clear lens behind your iris. With less flexibility, the lens loses the ability to refocus when switching from near vision to far vision. As a result, many people will need reading glasses as they age. Presbyopia symptoms generally begin around the age of 40 and affect everyone.

At first, you will notice it is increasingly difficult to see near items. Many people resort to squinting or holding books, papers, etc., at arm’s length to help their eye focus. The extra effort may cause eye strain, fatigue or headaches.

Please note, presbyopia is not a disease. It is just an age-related condition that is part of the natural aging process. You cannot prevent it. Luckily, however, there are many presbyopia treatment options such as corrective lenses or corrective procedures. Treatment options with corrective lenses or refractive lens exchange include distance correction, monovision, or multifocal vision. We discuss these in the next section.

What are the treatment options for presbyopia?

There are many different treatment options for people who are starting to notice signs of presbyopia. These most notably include:

  • Reading glasses
  • Multifocal contact lenses or glasses
  • Monovision with contact lenses
  • Vision Correction Surgery

All of these options will help with the refractive error that occurs when you try and see objects that are close to you. Distance vision, Monovision, and Multifocal vision are all possible through vision correction surgeries such as LASIK or Refractive Lens Exchange (RLE). A refractive eye surgery allows you to address the issues presbyopia presents and decrease your dependency on glasses and contacts.

Laser eye surgeries such as LASIK, PRK, or SMILE work by reshaping your cornea. Simply reshaping the cornea leaves your current natural lens in your eye with the same degree presbyopia. However, through methods such as distance vision correction and monovision, many individuals can enjoy life after vision correction surgery that includes less dependency on glasses or contacts.

During a Refractive Lens Exchange, an eye surgeon replaces the natural lens in your eye with an intraocular lens implant (IOL). You can have distance vision correction, monovision or multifocal vision with RLE. After RLE, the eye surgery recovery period might last a little longer than with laser vision surgeries, but it eliminates the ability of presbyopia to affect your vision any longer. As a bonus, it also eliminates your chance of developing cataracts and needing cataract surgery!

Multifocal Vision

A multifocal intraocular lens implant (IOL) is the best type of Presbyopia treatment option for most patients. The lens in our eye naturally changes curvature to focus on near and far objects. As the lens becomes less flexible, the ability decreases. Multifocal lens implants work to mimic the naturally occurring change in curvature with rings of correction that light hits as it enters your eye. The technology allows you to focus on both near and far objects, providing vision that is the closest equivalent to your natural vision – just clearer!

Few people find it challenging to adjust to multifocal IOLs, but the vast majority of patients acclimate within a few days or weeks. Nighttime visual side effects (such as halos or bursts around lights) might occur at first but usually resolve quickly.

Distance Vision Correction

If a patient chooses to undergo a vision correction surgery such as LASIK, PRK, SMILE or Refractive Lens Exchange, they have the option to correct their vision for distance in both eyes. Doing this would allow patients to see far objects clearly without the hassle of glasses or contact lenses. However, this would require patients to wear reading glasses when working with mid-range or close-up objects.

The benefit of having clear distance vision in both eyes is the freedom from bifocal or multifocal contact lenses or glasses that correct both your distance vision and your near vision. Instead, you would only need reading glasses to correct your near vision.


Monovision is a strategy that addresses presbyopia. It gives the patient the ability to see both near and far without corrective lenses or glasses in most circumstances. One eye is corrected to see distance, and the other is corrected to see near. Generally, patients are satisfied with the results of monovision. Although the eye that is “set” to distance will be fuzzy when focusing close up and the eye that is “set” to near will be fuzzy when seeing distances, vision is typically clear and comfortable at the two distances with both eyes open.

Most people have a dominant eye that sees more when looking at distance objects. When you come in for a refractive surgery exam, your physician will be able to determine which of your eyes is dominant. The dominant eye is generally corrected to see distance. Your brain will adjust and learn to use the dominant eye for distance and the other for close-up vision. This process is quick (within a few hours or days) for most people, and they end up enjoying the added freedom from reading glasses.

Before choosing monovision, we show your expected vision after surgery so you can determine if it is the right course of action for you. A small number of individuals cannot adjust to monovision and would be better off with either distance vision correction or a multifocal lens implant.


Presbyopia is a naturally occurring condition that eventually affects everyone. It is caused by a stiffening of the lens inside your eye. As the lens becomes less flexible, its ability to change curvature to focus on objects both near and far decreases. After the age of 45, most people will end up needing reading glasses as a result of presbyopia.

There is no “cure” or way to prevent presbyopia, but there are several treatments for presbyopic symptoms available. You can wear corrective lenses – either contact lenses or glasses.  

There are also many vision correction surgeries that correct presbyopia without using contacts or glasses.  These include LASIK, Photorefractive Keratectomy (PRK), SMILE, or Refractive Lens Exchange (RLE). You can utilize monovision through any of these means. If you want the most “natural” strategy for combating presbyopia, multifocal lens implants through RLE might be the option for you!

If you are interested in any vision correction surgery, think you are noticing signs of Presbyopia, or just want more information, please contact us here or call 800-393-3926 to speak with one of our refractive surgery counselors.


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