A new University of Illinois at
Chicago study appearing in the online edition of the journal Ophthalmology
reports on the safety, efficacy and predictability of laser eye surgery (laser
in situ keratomileusis or LASIK) in patients 40-69 years old.
"We are seeing an increasing demand for LASIK surgery for older adults, who
present special challenges," said study co-author Dr. Dimitri Azar, Field chair
of ophthalmologic research at UIC.
In LASIK surgery, adjustments in correction are routinely made to compensate
for the cornea's strong healing responses in younger patients, Azar said.
Increased age has been previously associated with poorer final clarity of
vision, as measured on an eye chart (visual acuity).
"We were able to show that fine adjustments in the correction to the cornea
in our older patients that compensate for differences in age-related healing
resulted in reliable predictability of correction," said Azar, who is also
professor and head of the UIC department of ophthalmology and visual sciences.
The researchers examined the case histories of 710 consecutive laser eye
surgeries on 424 patients between 40-69 years old. The LASIK surgeries were
performed to correct myopia (nearsightedness), hyperopia (farsightedness) and
astigmatism. All surgeries were performed by Azar between January 1999 and
The cases were divided into three groups based on age: group one, 40-49 years
old (359 eyes); group two, 50-59 years old (293 eyes); and group three, 60-63
years old (58 eyes).
Outcomes of the laser surgery corrections were analyzed for near-sightedness
with or without astigmatism (511 eyes) and far-sightedness with or without
astigmatism (199 eyes). Patients' outcomes included a follow-up of at least six
months and, where possible, 12 months. The study found no difference in safety
between the groups.
At the final follow-up of the nearsighted-corrected patients, 86 percent of
eyes in group one, 85 percent of group two, and 100 percent of group three had
20/30 or better visual acuity without glasses. In all groups, there was 20/40 or
better visual acuity for 91 to 100 percent of patients.
For farsighted patients, 80 to 84 percent of all groups had 20/30 or better
visual acuity at final follow-up, with 91 to 97 percent of all groups achieving
20/40 or better uncorrected vision. There was no statistical significant
difference in final visual acuity between the different age groups.
Another challenge for older patients is difficulty with near vision after
LASIK due to the loss of the ability to accommodate (presbyopia), Azar said. "As
we age, we lose some elasticity of the lens of the eyes, making it impossible to
maintain a clear image as objects are moved closer," he said.
Many patients in the study opted for monovision, a strategy that compensates
for presbyopia by correcting one eye for distance and the other eye for near
"Patients who understand that monovision is a compromise that does not
restore accommodation, but rather compensates for its loss, are most likely to
adapt well to monovision," Azar said.
"Although LASIK presents different challenges in the presbyopic age group,
our study showed that for this age group, 40-69 years old, LASIK correction for
near-sightedness and far-sightedness has reasonable safety, efficacy and
predictability," he concluded.