Farsightedness impacts about 5 to 10 percent of the American population, the National Eye Institute explains, and it can impact both children and adults. There are two main types of farsightedness, hyperopia and presbyopia, and treatment options can vary depending on the type and severity of the condition.

There are three main forms of refractive laser surgery for farsightedness, including LASIK (laser-assisted in-situ-keratomileusis), PRK (photorefractive keratectomy), and RLE (refractive lens exchange). Laser surgery involves permanently reshaping the cornea. While it is considered a minimally invasive procedure, there are some potential risks involved; however, the benefits often outweigh the possible cons.

There are some things you should know before getting laser surgery, and you will need to take certain measures before undergoing the procedure. Your eye prescription will need to have been stable for at least a year, and since the cornea is being reshaped, the measurements must fit into a certain range to be eligible for laser surgery. Recovery time is relatively quick, and it is important to take care of your eyes and follow your doctor's instructions after surgery to ensure a healthy recovery.

Laser surgery can eliminate the need for glasses or contacts, and be an effective means to correct blurry vision. Laser surgery has a high success rate, and most people are happy with the results.

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Hyperopia and Presbyopia

Farsightedness is the ability to see things well at a distance, but not up close. There are two main forms of farsightedness: hyperopia and presbyopia.

Hyperopia 

Hyperopia is the most common form of farsightedness, affecting 5-10% of Americans. It affects people of all ages, and those with hyperopic parents are more likely to be hyperopic themselves.

The condition is caused by misshapen corneas or eyeballs that are too short from front to back. Because their eyeballs are still growing, some children with hyperopia will grow out of the condition over time.

Hyperopia can be difficult to spot during a basic eye exam. This is because people with hyperopia can see things that are a few feet away from them (such as eye charts) just fine. However, if the condition exists, an eye doctor will spot it following a comprehensive exam.

Many people with hyperopia use prescription eyeglasses to see better. Others choose to have their hyperopia corrected with surgery.

Some symptoms of hyperopia include:

  • Eye strain
  • Headaches
  • Difficulty focusing on things that are up close
  • Blurred vision when looking at things that are close to you
  • Difficulty reading, especially when the print is small

If you think you may have hyperopia, talk to your eye doctor. Only a qualified professional can diagnose and treat this condition.

Presbyopia

Presbyopia is a form of farsightedness that typically develops in older people. According to the Mayo Clinic, presbyopia usually appears around age 40. From there, it often gets worse until a person reaches age 65.

Over time, eye muscles grow weaker and the eye’s lens loses much of its flexibility. A harder lens causes light to focus behind the retina, making it hard to see things that are close to you.

Presbyopia has the same symptoms as hyperopia, including:

  • Eye strain
  • Blurry vision close-up
  • Difficulty reading

The difference is that for a person with presbyopia, these symptoms are new. For example, you may suddenly find yourself holding books and newspapers at arm’s length to try to see them better, even though you never used to do that.

Presbyopia can also only be diagnosed after a comprehensive professional eye exam. If you are worried you might have it, make an appointment with your eye doctor.

Farsightedness Laser Surgery Treatment Options

Mayo Clinic publishes that refractive surgery is most commonly used to treat nearsighted eye conditions (myopia); however, laser surgery can be a viable option for farsightedness as well. Laser eye surgery uses a specialized laser to ablate the cornea, reshaping it to correct refractive errors.

In the case of hyperopia, the laser shapes the cornea to make it steeper, lengthening it so the focusing power is directed onto the retina instead of behind it. Both LASIK and PRK are forms of laser refractive eye surgery that can be used to correct hyperopia.

Presbyopia can be treated with a specialized procedure called monovision that corrects one eye for distance vision and the other eye for close-up sight. This procedure may not be for everyone, as it can take some getting used to as the eyes will no longer focus together, and there is an adjustment period. Hyperopia and presbyopia can also be treated with intraocular lens (IOL) implantation or RLE, which involves replacing the natural lens with an artificial clear lens.

The three main types of laser surgery options for farsightedness are:

  • Laser-assisted in-situ keratomileusis (LASIK). LASIK is one of the most common forms of laser eye surgery with a high success and satisfaction rate. The S. Food and Drug Association (FDA) publishes studies indicating that about 95 percent of patients are happy with their vision following a LASIK procedure.With LASIK, a specialized laser is used to create a small flap in the epithelial (outer part) of the cornea, which is hinged back, while a secondary laser is used to ablate the stroma (inner part), reshaping the curvature to the premeasured point. The flap is then replaced and allowed to heal on its own without the need for stitches or further medical intervention. The procedure is typically performed in under an hour, noninvasive, and considered safe.
  • Photorefractive keratectomy (PRK). PRK is actually a type of LASEK (laser-assisted subepithelial keratectomy) surgery that involves cutting a thin flap into the cornea's epithelial layer and removing it entirely before reshaping the cornea underneath. The epithelial will grow back on its own and fit to the new corneal shape naturally. PRK is an option for people who have thin corneas and may not be eligible for LASIK.
  • Refractive lens exchange (RLE). Lens replacement eye surgery, or RLE, actually replaces your natural lens with a completely new clear lens. This procedure is generally intended for people who may not be candidates for PRK or LASIK procedures and suffer from a high degree of hyperopia or presbyopia without cataracts. The journal Touch Ophthalmology publishes that RLE is generally more suited for correcting hyperopia than myopia, and the procedure can be helpful in correcting farsightedness when other options are not as viable.

Risks and Rewards of Laser Surgery for Farsightedness

LASIK and laser surgery procedures were initially intended to treat nearsightedness, or myopia. The Peer-Reviewed, Open Access Journal (PLOS One) publishes that it presents a different potential risk than myopic corrections, as it has been common for hyperopic eyes to lose their refractive power and regress post LASIK. Advances to technology over the years has lowered this potential risk, and laser surgery is more effective in treating hyperopia today.

Presbyopia has traditionally been treated with monovision LASIK, which means that the eyes are corrected differently. Since it can take a lot of adjustment, the eye being corrected for hyperopia often cannot be corrected as much as it may need to be for crystal-clear, close-up vision. Monovision can also cause some blurring with distance vision for some people. Newer technologies, such as IOLs and clear lens exchange procedures, are often preferable, the journal Review of Cornea and Contact Lenses reports.

Advances in IOL implants continue to be made, reducing the risks and improving the rewards for eligible patients. According to Optometry Times, RLE is a viable option for people who are not eligible for LASIK or PRK, even if their lenses are clear to begin with. There is a small risk for loss of vision due to infection or lens detachment, but it is considered minimal. In general, an RLE procedure is considered to be as safe and effective as other laser surgery procedures.

Laser surgery is a same-day procedure that is classified as minimally invasive, but it is still a surgical procedure with potential risk factors. Dry eyes, glares, halos around lights, decreased night vision, vision changes, and infection are all possible complications resulting from a laser eye surgery. The journal Review of Ophthalmology publishes that negative nighttime visual symptoms and prohibitive costs can be potential barriers for people seeking out IOLs for presbyopia.

Laser surgery for farsightedness is considered an elective procedure, and as such, it is rarely covered by insurance. Costs can range between $1,500 and $3,000 for each eye and can vary depending on the exact treatment needed and the severity of the condition being corrected.

In the long run, however, laser surgery may actually save you money on eye exams and prescription eyewear, as it can decrease the need to wear contacts or eyeglasses. There are payment and financing options to help people budget for laser eye surgery. The benefit of improved sight is often worth the cost.

patient undergoing prk surgery

Preparing for Laser Surgery and Eligibility

In order to be eligible for laser eye surgery to treat hyperopia or presbyopia, you will need to be in good health, and this includes good optical health. Your eyes will need to have been stable with their prescription for at least a year. For the treatment of presbyopia, you will need to not have cataracts forming. Mayo Clinic warns that LASIK procedures may not be ideal for severe hyperopia.

Your doctor can determine if you are a candidate for a laser eye surgical procedure and which one might be best. The ophthalmologist will perform precise measurements of the eyes prior to this determination to ensure that you have enough thickness on your cornea for LASIK. If you don’t, PRK may be a better option.

Consider your expectations for the procedure and talk with your doctor in order to ensure that you are both on the same page. In preparation for a laser eye surgery, you will usually need to stop wearing your contacts (if you wear them) for a few weeks.

What to Expect

Laser eye surgery can help to improve your farsighted vision and decrease your need for reading or prescription glasses. Your eyes may still change with age. Just because you've had LASIK or another procedure, you may still need reading glasses later in life. In addition, cataracts can still form, and laser surgery does not affect the risk for these either.

Recovery from a laser eye procedure is relatively quick, with LASIK being the least invasive and having the fastest recovery time. Generally, you will need to take a day or so off work and refrain from eye strain. You may need to avoid watching TV, reading, or spending time on the computer for a few days.

Strenuous exercise and contact sports, as well as swimming or hot tubs, should be avoided for a few weeks after a laser eye procedure. You will also need to keep lotions, creams, and makeup off your face and away from your eyes for a week or two. Avoid rubbing your eyes.

The FDA publishes that your vision can take a few months to stabilize completely, but you should be seeing better within a few days after a laser surgery procedure. You will need to attend a follow-up appointment with your surgeon a day or two after the procedure, and follow the instructions given by the surgical team to enhance healing.

Alternatives to Laser Eye Surgery for Farsightedness

Not everyone with Hyperopia and Presbyopia is a candidate for corrective surgery. In addition, some people with these conditions are apt to first try alternatives to surgery.

In these cases, eye doctors may recommend one of the following treatments to correct farsightedness instead:

  • Photorefractive keratectomy (PRK)
  • Refractive lens exchange (RLE)
  • Phakic intraocular lenses (IOLs)

Photorefractive keratectomy (PRK)

PRK uses a laser to reshape the cornea, correcting its curve and improving your vision. While this is still technically a type of laser eye surgery, it is still a notable alternative because many patients who are not good candidates for LASIK can get a PRK instead.

Refractive lens exchange (RLE)

RLE removes your eye’s natural lens and replaces it with an artificial one that is better at seeing things close-up. This treatment is invasive, but it works very well and even helps prevent cataracts in the treated eye.

Phakic intraocular lenses (IOLs)

IOL procedures implant an artificial lens behind your retina or between your retina and cornea to improve the focus of light in your eye. This treatment works well for correcting farsightedness, but it becomes less effective after age 50.

References

Facts About Hyperopia. (July 2016). National Eye Institute.

Hyperopia FAQs. (2018). American Optometric Association.

Facts About Presbyopia. (October 2010). National Eye Institute.

Presbyopia. (December 2017). Mayo Clinic.

Farsightedness. (June 2018). Mayo Clinic.

LASIK Quality of Life Collaboration Project. (September 2018). U.S. Food and Drug Administration.

Updates and Challenges in Refractive Lens Exchange. (March 2018). Touch Ophthalmology.

Hyperopic Refraction Correction by LASIK, SMILE, or Lenticule Implantation in a Non-Human Primate Model. (March 2018). PLOS One.

Presbyopia: The State of Surgical Correction. (March 2018). Review of Cornea & Contact Lenses.

The Pros and Cons of Clear Lens Exchange. (August 2014). Optometry Times.

Presbyopic IOLs: Choosing Wisely. (January 2018). Review of Ophthalmology.

Lasik Surgery: Is It Right for You? (March 2017). Mayo Clinic.

What Should I Expect Before, During, and After Surgery? (July 2018). U.S. Food and Drug Administration.

Farsightedness. (2021). National Eye Institute.

Hyperopia (farsightedness). (2021). American Optometric Association.

Presbyopia. (September 2020). Mayo Clinic.

Alternative Refractive Surgery Procedures. (September 2017). American Academy of Opthamology.

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