Does the LASIK operation work for presbyopia?

Find out more about the different laser processes

Over 40 million people over the age of 16 in Germany are dependent on visual aids. Especially among the boys, the proportion of people who wear glasses is steadily increasing: it has more than doubled in the last 60 years. The causes: changed living conditions and increased work on the computer screen.

However, glasses and contact lenses are impractical in many situations and often need to be replaced or bought new. For many glasses and contact lens wearers, laser eye surgery is an interesting option to get rid of the annoying visual aid forever. Learn from this article

  • that laser eye surgery can correct nearsightedness, farsightedness, presbyopia and astigmatism between -10 and +5 dioptres.
  • that the individual laser methods differ in the type and size of the incision in the cornea.
  • that you will not need visual aid for at least 15 years after a successful operation in an eye laser center.

Types and causes of ametropia

Refractive errors are caused by Deviations in shape of the eyeball. These lead to a calculation error in visual acuity. Ametropia can have 4 different forms:

  • Nearsightedness / myopia: In myopia, the eyeball is too long. You are nearsighted when you can see details in close proximity but are blurred in the distance.
  • Farsightedness / hyperopia: Farsighted people have an eyeball that is too short. You are farsighted when you can see things far away but not near things.
  • Corneal curvature / astigmatism: The human eye is not perfect: almost everyone has a crooked cornea. The decisive factor for the ability to see is how strong it is. If you see blurred both near and far, this is called astigmatism.
  • Presbyopia / presbyopia: In old age, most people suffer from presbyopia. This means the natural and physiological aging and hardening of the lens of the eye. As a result, the ability to “focus” disappears.

With a laser operation on the eye, depending on the method, all 4 causes of ametropia can be eliminated. In order for you to be suitable for such an operation, you have to meet a number of requirements.

General requirements for an eye operation

Since every eye is different and individual, the organ of vision is carefully examined before a possible eye operation. On the one hand, this is important in order to find out which method is suitable for you. On the other hand, you have to meet certain requirements. These differ depending on the method used. In general, the following applies:

  • you are at least 18 Year old.
  • Your ametropia has not changed much in the past year.
  • They have no other eye diseases or inflammation.
  • They are psychologically suitable.
  • You are not pregnant or breastfeeding.
  • Your poor eyesight is in the range of -10 to +5 diopters.

Different methods of laser surgery

Ametropia can have many causes. One thing always applies: The Rays of light in the eye are focused on a wrong point. Usually they are on the so-called yellow spot (Macula) bundled on the posterior retina. This spot is also known as Place of sharpest vision. However, if the light converges in front of (nearsightedness) or behind (farsightedness) this point, the image becomes blurred.

With an eye laser operation, the cornea of ​​the eye can be processed in such a way that its refractive power changes. This way the light rays are correctly focused again and you can see clearly. The graphic illustrates the general procedure for laser surgery:

Depending on the procedure, duration of healing and price, there are different variants of the procedure. A distinction is made between the following Methods of laser treatment:

  • LASIK: The upper corneal layer is partially peeled off with a kind of scalpel and opened. The cornea is then reshaped using a laser until the visual defect is corrected. Here you can find out more about the LASIK method.
  • Femto-LASIK: The upper corneal layer is partially detached and unfolded with the so-called femtosecond laser. The cornea is then reshaped using an excimer laser until the visual defect is eliminated. Here you can find out more about the Femto-LASIK method.
  • ReLEx Smile: First, an incision about 2 to 3 millimeters long is made in the cornea. Then the cornea is prepared and the visual defect is corrected. The small piece of excess cornea is removed through the incision opening. Here you can find out more about the ReLEx smile method.
  • LASEK: The LASEK method begins with detaching and pushing aside the upper corneal layer. A laser beam then models the cornea until it has the desired curvature. Finally, a soft contact lens is temporarily inserted as protection. Here you can find out more about the LASEK method.
  • Epi-LASIK: With Epi-LASIK, the upper corneal layer (the so-called epithelium) is gently pushed aside without cutting. The eye is then processed using a laser. After the cornea is corrected, the epithelium is pushed back and temporarily covered with a soft contact lens. Here you can find out more about the Epi-LASIK method.

Advantages and disadvantages

An operation on the eye may sound tricky to many. However, the technology is now so advanced that the success rate for better vision after the operation is very high. In general, you have the following advantages from laser surgery on the eye:

  • Correction of image errors
  • Better Contrast vision
  • Better color perception
  • Better ones Sharpness and focus
  • No disruptive visual aid during sport
  • In winter: no fogging of the glasses when changing from cold to warm
  • No annoying and painful pressing of glasses or contact lenses
  • No restrictions in everyday working life
  • Over the long term: lessercosts compared to visual aids

These advantages are offset by the following disadvantages:

  • Possible risks: loss of eyesight, failure of the tear nozzle, corneal deformations, infections, eye pain, increased sensitivity to light, Foreign body sensation
  • High immediate costs
  • Statutory health insurance companies do not cover the costs of laser eye surgery

How much does it cost to have your eyes lasered?

If you are toying with the idea of ​​having your eyes lasered, you should also take a look at the costs. These vary depending on the procedure used, the diopter value and the treating clinic. In Germany the costs are currently approx between € 800 and € 2,600 per eye. Thus, when treating both eyes, costs in the four-digit range must always be expected.

The table shows the areas of application of the individual methods. You will also see a comparison of the duration of the procedure and healing, as well as the costs.

Duration of the procedure per eyeHealing time until vision improves Cost per eyeApplication at
LASIK 5-10 min 1-2 daysfrom € 1,000Myopia, hyperopia, astigmatism
Femto-LASIK15 minutes2-3 Daysfrom € 1,300Myopia, hyperopia, astigmatism
ReLEx smile 10 min1-2 daysfrom 2.0250 €Myopia, astigmatism
Epi-LASIK10 min5-7 daysfrom 1,700 €Myopia, astigmatism
LASEK 10 min 7-10 daysfrom € 1,400Myopia, astigmatism

Is the laser eye surgery paid for by the health insurance?

The statutory health insurance companies usually do not cover the costs of laser eye surgery. Some private health insurances will cover part of the LASIK treatment - sometimes even the full cost.

Conclusion:

Which eye laser method is right for you depends on many aspects. In addition to your physical requirements are your own too needs crucial.

It is also important whether laser eye surgery is used for farsightedness, nearsightedness or corneal curvature.

Last but not least, costs also play a role. A laser surgery is expensive at first glance. But visual aids can also cost several hundred euros. If you have astigmatism or high diopter values, glasses can quickly become expensive. Especially with a fancy frame. Buy it a new visual aid every 2 to 3 years, the overall costs are significantly higher than for an eye operation. Since you have at least 15 years of rest after a laser operation, you should definitely weigh the costs.

10 questions to Dr. med. Ulrich Zenk, specialist for laser eye treatments in Jena

Dr. med. Ulrich Zenk is a specialist in ophthalmology. As an experienced eye surgeon, he works in Weilheim, Munich and Jena. He is also a trainer for the Commission for Refractive Surgery (KRC) of the Professional Association of Ophthalmologists in Germany and the German Ophthalmological Society.

Are you interested in laser eye surgery? Then take part in one of the regular information evenings from Dr. med. Ulrich Zenk part. Or register for a preventive medical check-up.

Further information can be found at www.augeauge.de

How safe are laser eye surgeries in general? How do you assess the dangers?

Laser eye treatments are a group of safe operations. They are exceptionally well researched scientifically. The laser eye method most frequently used to date, the LASIK procedure, is the elective operation that has been best studied in medicine.
The safety leads to an extraordinary success: With the high patient satisfaction after these laser treatments, the method is one of the most successful surgical procedures ever - in all of medicine. Long-term side effects are extremely rare.

Why are so many patients afraid of laser eye surgery despite the low risks?

With laser eye treatments, as the name suggests, a treatment is carried out on the eye. That alone worries patients. In addition, the surgeon and the laser take control during the treatment. Loss of control is often an uncomfortable thought. However, if patients believe that they have full control over possible side effects when using contact lenses, for example, then they are mistaken.
Ophthalmologists trust eye laser treatments and are often treated with the laser themselves.

When would you advise patients to have laser eye surgery?

I would only recommend eye laser treatment after a detailed examination by a specialist. The extremely rare side effects tend to occur if the patient was already suffering from symptoms or unfavorable conditions prior to the operation. However, some of these unfavorable conditions are difficult to identify.

Which difficult to detect unfavorable conditions do you mean exactly?

The exact assessment of the cornea can be very complicated in individual cases. It doesn't just depend on the thickness of the cornea. The distribution of the corneal thickness is also important. The cornea of ​​the eye is not the same thickness in all places. Conclusions about possible diseases can be drawn from the distribution of the various corneal thickness values. The cornea also has different radii of curvature and other properties that are of great value for assessment.

When would you advise patients against laser eye surgery?

Who has an unsuitable eye, e.g. B. a cornea not suitable for laser treatment, should refrain from eye laser treatment. Also, the treatment is very rarely given to patients who are younger than 18 years old. As a trainer for the Commission for Refractive Surgery, I convey recommendations for the selection of suitable patients to ophthalmological colleagues and surgeons.

Which process do you currently consider to be the safest and most advanced?

It is not possible to choose one of the laser procedures as the best and most advanced for every patient. It is rather the case that a decision has to be made for each individual patient which procedure is suitable. I personally consider the introduction of the femtosecond laser to be a particularly important step on the way to greater safety for patients. There are now several surgical procedures that use the femtosecond laser (Femto-LASIK, ReLEx Smile) and do without cuts with a mechanical device.

Can you describe the advantages of the femtosecond laser compared to an incision in the cornea of ​​the eye?

The alternative to using a femtosecond laser on the cornea is to use a mechanical microkeratome. The latter can be compared with a plane that cuts off a layer of the cornea like a sharp knife.
The femtosecond laser, on the other hand, does not need a mechanical blade, but generates small gas bubbles in the cornea, which, if lined up, form a carpet of gas bubbles. This makes it possible to prepare slices (flaps) and lenticles (lens-shaped pieces of tissue) of the cornea with particularly high precision. With a mechanical device like the microkeratome you are much more limited than with a laser. You can also make slices, but not in the same quality and shape.

Are there cases in which laser eye treatments are paid for by health insurance?

Private health insurance companies participate i. d. Usually in eye laser treatments that are used to change the number of diopters. Statutory health insurance does not do that.

What should patients look out for when choosing an eye clinic and doctor?

Laser eye treatments are carried out on an outpatient basis. Patients need an extensive examination and education before surgery. From my point of view, it is optimal if the patient can clarify all questions with his experienced surgeon before the operation, after he has examined him. I do not consider the personal separation of surgeon and examiner before the operation to be a good thing. It is of little help to the patient if the center he visits has a lot of experience. But not the doctors he meets on the day of his treatment.

Can ametropia occur again under certain conditions after an eye laser operation? How likely is that?

Fortunately, laser eye treatments are not a particularly deep intervention in the eye. Most of the eye remains completely unchanged. You only change the cornea. The normal changes of the eye in the course of life take place anyway. Whether and when ametropia could develop must be checked in each individual case.
However, it is atypical for the laser treatment to “reverse” itself. Rather, after eye laser treatments, patients usually enjoy the independence of visual aids for a long period of time.


We thank Dr. Zenk for the interview.

Informed and secure in every situation
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