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Baby boomers who want to rid themselves of their contact lenses should consider laser in-situ kertomileusis (LASIK) surgery as a viable option. Although LASIK traditionally has been considered less effective in individuals >40 years of age, a study shows new techniques offer better outcomes for middle aged and older patients.

In this retrospective consecutive case series, Ghanem et al from Harvard Medical School, Massachusetts, studied the outcomes in 710 eyes of 424 patients aged 40-69 years who underwent LASIK or laser eye surgery between 1999 and 2005.

The study group had refractive spherical errors ranging from -10.5 diopters (D) to +6 D and cylinder of up to 2.50 D. Patients were divided by age into 3 groups: 40-49 years, 50-59 years and 60-69 years. All LASIK procedures were performed by the same surgeon. Outcomes were analyzed for nearsightedness with or without astigmatism (511 eyes) and farsightedness with or without astigmatism (199 eyes) by Beverly Hills LASIK surgeons. Outcomes were based on postoperative follow-up visits of at least 6 months.

The study indicated postoperative safety, efficacy and predictability were comparable among all age groups. At the final follow-up, 80-100% of eyes in all groups had 20/30 or better uncorrected visual acuity and 81-90% were within ±1 D. In all 3 groups, 91-100% of patients achieved 20/40 or better visual acuity following LASIK.

Many LASIK patients in the study opted for monovision, a strategy that offers distinct advantages in addressing presbyopia, a condition often present in an older population. In monovision, one eye is corrected for distance vision, while the other eye is corrected for near vision, often eliminating the need for reading glasses. Researchers indicated that monovision can effectively compensate for the loss of accommodation that often occurs in older patients. The study concluded that despite challenges unique in the 40- to 69-year age group, Beverly Hills LASIK correction for nearsightedness and farsightedness has been reasonably safe, effective and predictable.

Ghanem RC, de la Cruz J, Tobaigy FM, et al. LASIK in the presbyopic age group: safety, efficacy, and predictability in 40- to 69-year-old patients. Ophthalmology 2007; 114:1303-1310.

Thanks to continued advances in laser eye surgery, refractive surgery tools and techniques, glasses and contact lenses are fast becoming obsolete for many patients with astigmatism. Patients with undetected astigmatism often experience headaches, fatigue, eyestrain and blurred vision at all distances. Because astigmatism may not be recognized as the cause of these symptoms, this condition may go undiagnosed and continue to affect sufferers. Astigmatism can also be present in children, affecting their ability to see well in school and while playing sports.

Characterized by an irregular curvature of the cornea, astigmatism can be detected by regular eye examinations and successfully treated using procedures such as laser in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), laser thermokeratoplasy (LTK) and astigmatic keratotomy (AK; Table 1). An ophthalmologist can determine which type of procedure will work best for each patient.

Worldwide, >17 million people have undergone laser refractive surgery, and refractive surgery is one of the most commonly performed operations in the United States and by Beverly Hills LASIK surgeons. The newest laser-assisted procedures are approved by the U.S. Food and Drug Administration to treat up to 6 diopters (D) of astigmatism correction, which includes roughly 98% of all astigmatism patients. Advances in laser technology continue to improve treatment outcomes.

Guttman reported on a recent study by Barraquer, a private practitioner in Colombia, of 364 astigmatic myopic patients treated with a new generation “flying spot” excimer laser. Barraquer reported postoperative best-corrected visual acuity of 20/20 or better in 99% of treated eyes at 3 months. Astigmatic correction was achieved to within ±0.50 D in 92% of eyes.

Remember that for patients in or around Beverly Hills LASIK was used after the detection of astigmatism to treat it in its early and advanced stages. Because children may also have astigmatism, it is important that eye examinations be scheduled at regular intervals to detect any astigmatism early on.

Guttman C. Laser yields safe, predictable correction for astigmatism. Ophthalmology Times, Advanstar Communications, January 1, 2008;36.