Dr. Dello Russo

Information About Vision Conditions and Lasik

Why do I need reading glasses after forty?

"Everybody after about the age of forty and beyond will need reading glasses if they see perfect for distance." – Dr. Joseph Dello Russo.

This statement is true and applies to everybody who has ever lived or who will ever live.

How can we help someone to read? By using reading glasses! But you say you do not WANT them? Is there some kind of surgery for this so called "presbyopia"? Not as of yet, perhaps in the future.

When people wear glasses (or contact lenses) for distance vision, they will need a reading prescription as well: bifocal glasses or reading glasses over contact lenses.

Is there a compromise between perfect distance vision along with some reading ability? Yes, and it is called either "mono vision" or "modified monovision".

Dr. Dello Russo explains: "as a LASIK surgeon, a large part of my practice is dealing with older persons who want LASIK and want to see for distance as well as near objects, as they were able to do before they turned forty. I discuss with them that if Lasik makes them see perfect in BOTH eyes for long distances, but they will need reading glasses for near vision, which usually prompts the patient to say ‘well, why would I spend $xxxx to only see well for far?’ They may not want to exchange far vision for reading glasses. With all of my patients I discuss the compromise of the LASIK correction: good adequate distance vision and useful near vision."

Dr. Dello Russo often chooses do not make BOTH eyes perfect for far vision. This compromise is known as Monovision. One eye is treated perfectly for distance and the other eye is treated a little (or a lot) for near, but will be a little blurry for far vision if used alone. With both eyes open and looking at distant objects, the brain may be able to tolerate the slight blur from one of the eyes in certain people.

Monovision is not for everyone. It should be personalized for each person in accordance with their daily lifestyle, seeing a slight blur for distance with one eye. Dr. Dello Russo always performs a trial using contact lenses. One lens is for perfect distance vision and the other not quite perfect so as to allow some degree of near vision (while being slightly blurred for far vision). This allows the doctor to adjust vision on the "near" eye to the patient’s desired working distance, most often to use his/her computer.

There are many variations to making people happy with some degree of Monovision. First, the closer a person wants to see with the "near" eye, the more difficult it is for the brain to adjust properly when looking at far targets. However, adjusting for a computer distance is much easier (modified Monovision).

The trial with contacts is conducted as follows. Dr. Dello Russo provides patients with a set of lenses to take home and use in their daily life. If they like the compromise, then they are likely to be candidates for this "modified Monovision" procedure. If they can walk around all day and see well (but not perfect in one eye) and see properly at a middle range (computer) then they are usually very happy people.

Another pearl: people need glasses for distance if they are either nearsighted or farsighted. Nearsighted people have more difficulty adjusting to mono. Only about twenty percent can be successful when they perform a trial with contact lenses, says Dr. Dello Russo.

The most successful Monovision candidates are those who are currently without glasses and are after forty, who cannot see for distance and sometimes even see worse near objects. Monovision gives them vision right away for distance and they really don't care if the "near" eye is a little blurred for distance. Suddenly they can see without glasses, and they also can see better for close ranges.

"Maybe some day we will have surgery that will specifically target reading problems," suggests Dr. Dello Russo. "I know that it is being researched right now, but we don't know if it will work or when."

Laser cataract surgery

The hottest topic among eye surgeons today is the possibly soon to introduce "laser" or femtosecond cataract surgery. The subject dominated the last few national professional meetings and is found in all of our publications.

Most people think that cataracts are already being treated with lasers however that is not true yet. About 3.5 million surgeries are performed each year nationally by 80,000 eye surgeons. Nobody uses a laser except for a small group like Dr. Stephen Slade, who said that "if we are going to give people the good vision that they are anticipating - we will need a device like the femtosecond laser to make our surgery even more precise". There are presently three laser companies with possible commercial release of their first laser device possibly by the end of 2011.

As reported in Ocular Surgery News, Dr. Agarwal of India, convened a panel of cataract surgeons who have used one of the new laser (femtosecond) cataract devices. This is "likely to be the greatest paradigm shift in cataract surgery since the development of ultrasonic phacoemulsificaion", which is the present device used all over the world to remove cataracts.

Dr. Ronald Krueger states that the device is expected to "improve safety as well as visual results". It is very difficult to describe what components of this device will allow for better vision, but I will try. A cataract is the natural lens of the eye (like the lens in a camera) which with age may get cloudy. The surgery exchanges the natural now-clouded lens with a new artificial plastic lens. Studies so far appear to show that the greater precision of the laser will allow the doctor to place the artificial lens in a position in the eye that will make it most efficient, thus giving better vision.

There are a number of differnet practices and doctors that contribute to create better vision and eyesight for patients. Age Management Medicine doctors have been using supplements, nutrition, exercise, and dieting to aid in the process of slowing down aging. By slowing the aging process, men and women have been recored as maintaining good eyesight through useage of anti aging prorgrams. Walk In clinics often find themselves treating patients for eye infections and irritations to preserve their patient's vision.

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