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If you are over 40, you have probably noticed some changes in your vision. That is, you find seeing things up close more difficult. If you are nearsighted you find you have to remove your glasses to read. If you are farsighted you have to wear your glasses, hold your reading material further away, and make sure the lighting is good. If you have never worn glasses you have probably bought a pair of generic reading glasses at your local pharmacy or department store.

The ability to see at near without reading glasses or bifocals is called accommodation. As a person ages their ability to accommodate decreases. The medical term for this loss of accommodation is Presbyopia.

Accommodation occurs because the lens inside your eye can move. As the natural lens matures it loses its ability to move. Presbyopia is a natural occurrence usually starting at age 40 and worsening until age 70.

What are the options for correcting Presbyopia? The deficit in presbyopia is the lens. Thus, replacing the deficient lens would be the most rationale solution. The Crystalens, intraocular lens implant (IOL), is the only IOL that can move within the eye. The movement of the Crystalens is not as great as the natural lens of a teenager but the Crystalens can usually restore a person’s accommodation to the level of a 30 year old and make one much less dependent on reading glasses and bifocals. However, clear lens extraction and Crystalens insertion entails significant costs and risks. Thus, most people chose to wait for Crystalens surgery until their natural lens has not only lost the ability to accommodate but has also become difficult to see through (a cataractous lens.) Cataract surgery is covered by most insurance companies and this significantly lowers the cost of the Crystalens procedure.

A more popular solution for presbyopia correction is Laser Vision Correction for Monovision (LVCMV). In LVCMV a person’s dominant eye is corrected to see clearly for distance vision and the non-dominant eye is corrected to see clearly for near vision. This approach works for those over 40 who are nearsighted, farsighted, astigmatic or just presbyopic. As with all LVC procedures, the surgery is performed in the office and entails much less risk than clear lens extraction with the Crystalens. If you have not already done so, please read the pages on LVC Overview, LASIK and ASA pages.

What are the disadvantages of LVCMV? A person may not be able to adapt to having one eye work for distance and the other for near. They may feel a sense of imbalance that is troubling. Fine depth perception needed for near work will be compromised because both eyes will not be in focus at near. Of course, one could always wear glasses to balance the two eyes for specific needs: driving at night, working on detailed work at near, or reading extremely fine print. What are the advantages of LVCMV? If one adapts a person would rarely have to put on a pair of glasses.

If Laser Vision Correction for Monovision (LVCMV) seems like something you would like to try, but you not quite sure about how you would adapt, consider a trial of monovision contact lenses. This would simulate the effect of LVCMV without committing to surgery

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Which should I choose? ASA or LASIK? >>