Should you get laser eye surgery

It's easy to imagine that someone considering laser eye surgery might be doing so for cosmetic reasons. The perception is that it’s the eyesight equivalent of having a facelift — where someone feels their thick, nerdy glasses makes them look like Mr Magoo — but the reality is far different.

Laser eye surgery has been around for more than 20 years and our reasons for having the procedure are varied. While some might be looking to it for a midlife-crisis-style makeover, the majority are interested because it will improve their lifestyle.

Sydney ophthalmologist Dr Con Moshegov says there are quite a few misconceptions about the surgery and the reasons people seek out his services. “People don’t believe us when we say it is not a cosmetic operation. It is very seldom that the motivation is to get out of wearing glasses or contact lenses,” he says, though he concedes some people want it after a tough marriage break-up.

Nonetheless, in his experience most people — young or old — want laser eye surgery because they are sporty types, they travel a lot and don’t want the inconvenience of carrying various glasses or lenses, or they are keen surfers or swimmers who love being able to see properly in the water.

Dr Moshegov says what needs to be understood, however, is that laser eye surgery is not a “one size fits all” scenario. What works for a 20 or 30 year old is not necessarily going to work for anyone over 40 as that’s when middle-age works against us — our eyesight changes as we get older. His patients aged over 45 tend to be more women than men, a ratio of about 60:40.

Types of laser eye surgery
The most popular form of corrective eye surgery is known as Lasik. It’s not invasive, the recovery time is quick, and it’s great if you’re under 45. Unfortunately, if you’re closer 50 or older, you’re likely to be throwing your money away as it would only improve your eyesight for a few years.

Fortunately, there are other options.

“What we do is refractive surgery. It is a field of ophthalmology that allows people to get out of glasses,” says Dr Moshegov. “There are two arms to it: one is laser vision correction and the other is the implantation of lenses inside the eye. Older patients from 45 onwards often fall into the second arm of refractive surgery.”

Those of us with poor eyesight fall into distinctly different groups. You can be myopic, which means you see well close up, but need glasses for driving, movies, or watching TV. You can have astigmatism, where nothing is clear because your cornea is slightly oval in shape, or you can be long-sighted (hyperopia), where you see clearly at a far distance, but struggle to see objects close up.

“The thing we would need to explain to someone who is long-sighted and aged over 50 is that it is likely their eyesight is going to get worse. We therefore recommend they don’t get laser vision correction,” says Dr Moshegov.

However, there is a laser eye surgery that can work extremely well for older Australians with eyesight problems such as long-sightedness, myopia, or astigmatism. It’s known as Refractive Lens Exchange (RLE). Any older Australian with good eye health who is currently wearing glasses or lenses can explore having RLE.

Dr Moshegov says RLE is an almost identical operation to having cataracts removed — one of the most common procedures done in this country. RLE involves removing the natural lens of the eye and replacing it with an artificial intraocular lens.

“RLE works differently to a cataract operation because it has to be done with incredible finesse,” he says. “There are risks involved, and the question that everyone asks is ‘Can a person go blind?’ The answer is yes, but the chances are very slim.”

Other risks include bleeding, infection, detachment of the retina, or swelling of the cornea. Anyone at risk of glaucoma or macular degeneration won’t qualify for RLE.

Dr Moshegov says it’s best to get a referral from your GP or optometrist before visiting an ophthalmologist. There, an initial consultation will take place, followed by a recommendation on the type of surgery, and a check up after the procedure.

The RLE procedure is performed as a day surgery, at a cost of around $12,000 — check with Medicare to see whether you qualify for a rebate (it will depend on why you’re having the surgery). You will need up to five days’ recovery time and you won’t be able to drive immediately.

Do you wear glasses? Have you ever thought about getting laser eye surgery?

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