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Comment by amelius | Hacker News Reader

As we age, most of us will have to deal with farsightedness. What's the best treatment option nowadays, besides prescription glasses?

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As both Presbyopia and Cataracts come for us all, it is generally not advisable to do laser eye surgery once the former has set in. Both are a result of changes to the lens (and the ciliary muscles to some extend), so long term, a lens exchange, whether partially covered by (public) insurance as part of cataract surgery or as an expensive elective procedure is the only effective surgical option we have currently available.

That brings me to one of my personal pet peeves which is selling pensioners that qualify for cataract surgery on an expensive, but in fact identical but privately paid for IOL.

Same with selling some Myopic+Presbyopic person on laser eye surgery of any kind. At best you get a few short years out of the expense before it catches up with you or you tolerate mono, at worst you spend thousands to suddenly need reading glasses you didn't require before.

Course, if you are financially solid and Presbyopia is starting, getting a high quality lens exchange can be a very neat luxury, with the added benefit of not needing Cataract surgery later in life. Do note though that artificial lenses, while incredibly advanced, still cannot accommodate as well as the real deal as of now.

As someone who had perfect vision until 40 but now must wear reading glasses, I am super intrigued to hear about lens exchange!

When I heard that LASIK is not a solution to farsightedness, I specifically asked my eye doctor if there are other solutions for this. The only one mentioned was monovision (getting two different prescriptions for different eyes).

> Do note though that artificial lenses, while incredibly advanced, still cannot accommodate as well as the real deal as of now.

Cannot accommodate what as well?

"Eye accommodation is the eye's ability to automatically adjust its focus to maintain a clear image as the distance to an object changes. This process involves changes in the shape of the lens, the constriction of the pupil, and the convergence of the eyes. It's a reflex action that allows us to see objects clearly both near and far" (Google)

"Accommodate" means change focus, like your natural lens does when you focus on objects at different distances. Most artificial lenses implanted today have zero ability to change focus. There are newer "accommodative" lenses that have a limited ability to change focus, but from what my ophthalmologist told me, they're still primitive and not even close to what natural lenses do, which is why fixed focus lenses are still more common.

> As both Presbyopia and Cataracts come for us all, it is generally not advisable to do laser eye surgery once the former has set in.

I had a conversation with my ophthalmologist about this. She said the same thing. Then I said, I don't understand, right now I have to wear glasses for far vision and glasses for near and mid vision. If I got the surgery, I would still be presbyopic, but I wouldn't need glasses for far vision, only for near vision? and she said yes. So I said, that sounds like in improvement. What's the catch? She said it's mostly a matter of expectation. People think that LASIK means they don't have to wear glasses again, period.

But I keep hearing this, so I'm wondering if there's something more to it that she didn't explain? Is there some other disadvantage?

Have you tried being severely myopic to begin with? :D My presbyopia has kicked in surprisingly quickly (at a guess, 1.5 diopters over 2-3 years) but that just means I can look past my glasses at close things, like the opposite of your stereotypical half-moon reading glasses. Hey, I should make some of those out of an old pair...

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