I had a number of ophthalmologist colleagues and have considered the surgery numerous times myself but have ultimately considered not doing it, although I am much younger than 40. From what I've heard from them and in my own research as well, many "good" or "responsible" ophthalmologists rarely consider doing the surgery to those 40+ for a number of reasons. Most surgeons will not even operate if your vision has not been stable for a number of years and you are able to demonstrate that your eyes are otherwise healthy and pass tear-film breakup tests (which also get harder to pass with age). Getting ICL or getting IOLs (as your would for cataracts) "early" is another possible option, even if you do not have any significant opacities or a cataractous lens yet. If you are not a contact lens user that is also a potential thing you can try, it is more freeing in some ways but also have their own limitations.
One thing to also consider is that any refractive surgery has the potential to add significant high order aberrations to your vision. It can also significantly affect vision in low lighting conditions and make night myopia worse versus glasses/contacts (could be a problem for driving) even if your day vision appears much improved. They are able to minimise this to an extent with modern techniques and wavefront imaging but it does not affect everyone the same as there is also a neurological component to how we process and deal with visual aberrations, and possible side effects include seeing persistent glare, halos, and so on, and the potential side effects and difficulty to adjust to these only gets harder with age. If you are already starting to notice your vision is getting worse or presbyopia is kicking in, that is possible indicator you might not be a good candidate. Another overlooked side effect are issues with dry eye due to the incision going into a plane that potentially damages the nerve plexus in that area (SMILE specifically is a bit less risky for this, but it can still occur- and there are some other disadvantages to smile). "Dry eye" perhaps does not seem that bad when you say it out loud but it can be extremely debilitating and cause even further eye and vision problems down the line and may require multiple drugs and eyedrops you need to take for the rest of your life to cope with. Not to scare you away, but just wanted to mention it because many of these side effects are perhaps mentioned but their lifelong implications are not well explained or even understood by many professionals that perform dozens, even approaching a hundreds of these procedures a week. If you are one of the unlucky ones to get these problems it will be something you should be prepared to have to live with for life, and it can change your life to varying degrees, even if you get cataract surgery and still need to use glasses later on.
One of the biggest reasons I did not the the surgery personally is because I am already suffering from a number of other eye problems including fairly bad chronic dry eye disease, problems with my cornea and impairment from high order aberrations (unrelated to any surgery), and they are already so debilitating enough for me to not even consider making them worse just to be free of glasses/contacts. So I already have a taste of the potential side effects from refractive surgery albeit from from other condition(s) and absolutely do not want more of it. But like anything understand that side effects can also be fairly minimal and there are many millions of people that are perfectly happy with the procedure and it makes their life much better. Or the change to their vision is worth some other inconvenience if they do get side effects. But, be aware there are hidden minority of patients that have greatly regretted the procedure and I've even heard a number of accounts of those who were suicidal and have even taken their own life because they could not cope with the visual disturbances of the side effects. Problems may not manifest themselves immediately but could get exacerbated by age and other unforseen conditions. You only have one pair of eyes and vision is the most critical of all human senses.
My general advice to anyone doing any sort of elective surgery like this is of course to get second or third opinions and do your due diligence, even if it is to the point of playing devils advocate to dissuade yourself from getting it despite really wanting to get it. Ask your professional hard questions, what kind of success rates they encounter in their own practice, ask for explicit details of side effects and what are the treatment options and prognosis is for them and so on, do not allow any doctor to handwave these. My advice to you is to search up pictures of what high order aberrations look like, what bad night myopia, halos and starbursts can look like (especially at night). Search forums like reddit for stories of people talking about their LASIK side effects or bad LASIK experiences, search reddit for people talking about managing chronic dry eye symptoms, what their day to day struggles are like and so on. Good experiences may outnumber the bad, but just be aware of them. I personally know spectacle-wearing ophthalmologists who won't even take the risk to have a trusted friend and colleague perform this surgery on them for many of these reasons, yet have performed the procedure many hundreds or even thousands of times themselves. In the case of genuine cataracts, surgery is more or less a no-brainer because virtually every potential side effect is more desirable to the alternative of being fully or partially blind. But if your quality is life and state of vision OK now, the "juice may not be worth the squeeze". An IOL is a likely thing you may need a bit later in life and LASIK has the potential to affect the quality of that too. Or maybe LASIK could be the best thing that ever happened to you and you should have got it 15 years sooner
One thing to also consider is that any refractive surgery has the potential to add significant high order aberrations to your vision. It can also significantly affect vision in low lighting conditions and make night myopia worse versus glasses/contacts (could be a problem for driving) even if your day vision appears much improved. They are able to minimise this to an extent with modern techniques and wavefront imaging but it does not affect everyone the same as there is also a neurological component to how we process and deal with visual aberrations, and possible side effects include seeing persistent glare, halos, and so on, and the potential side effects and difficulty to adjust to these only gets harder with age. If you are already starting to notice your vision is getting worse or presbyopia is kicking in, that is possible indicator you might not be a good candidate. Another overlooked side effect are issues with dry eye due to the incision going into a plane that potentially damages the nerve plexus in that area (SMILE specifically is a bit less risky for this, but it can still occur- and there are some other disadvantages to smile). "Dry eye" perhaps does not seem that bad when you say it out loud but it can be extremely debilitating and cause even further eye and vision problems down the line and may require multiple drugs and eyedrops you need to take for the rest of your life to cope with. Not to scare you away, but just wanted to mention it because many of these side effects are perhaps mentioned but their lifelong implications are not well explained or even understood by many professionals that perform dozens, even approaching a hundreds of these procedures a week. If you are one of the unlucky ones to get these problems it will be something you should be prepared to have to live with for life, and it can change your life to varying degrees, even if you get cataract surgery and still need to use glasses later on.
One of the biggest reasons I did not the the surgery personally is because I am already suffering from a number of other eye problems including fairly bad chronic dry eye disease, problems with my cornea and impairment from high order aberrations (unrelated to any surgery), and they are already so debilitating enough for me to not even consider making them worse just to be free of glasses/contacts. So I already have a taste of the potential side effects from refractive surgery albeit from from other condition(s) and absolutely do not want more of it. But like anything understand that side effects can also be fairly minimal and there are many millions of people that are perfectly happy with the procedure and it makes their life much better. Or the change to their vision is worth some other inconvenience if they do get side effects. But, be aware there are hidden minority of patients that have greatly regretted the procedure and I've even heard a number of accounts of those who were suicidal and have even taken their own life because they could not cope with the visual disturbances of the side effects. Problems may not manifest themselves immediately but could get exacerbated by age and other unforseen conditions. You only have one pair of eyes and vision is the most critical of all human senses.
My general advice to anyone doing any sort of elective surgery like this is of course to get second or third opinions and do your due diligence, even if it is to the point of playing devils advocate to dissuade yourself from getting it despite really wanting to get it. Ask your professional hard questions, what kind of success rates they encounter in their own practice, ask for explicit details of side effects and what are the treatment options and prognosis is for them and so on, do not allow any doctor to handwave these. My advice to you is to search up pictures of what high order aberrations look like, what bad night myopia, halos and starbursts can look like (especially at night). Search forums like reddit for stories of people talking about their LASIK side effects or bad LASIK experiences, search reddit for people talking about managing chronic dry eye symptoms, what their day to day struggles are like and so on. Good experiences may outnumber the bad, but just be aware of them. I personally know spectacle-wearing ophthalmologists who won't even take the risk to have a trusted friend and colleague perform this surgery on them for many of these reasons, yet have performed the procedure many hundreds or even thousands of times themselves. In the case of genuine cataracts, surgery is more or less a no-brainer because virtually every potential side effect is more desirable to the alternative of being fully or partially blind. But if your quality is life and state of vision OK now, the "juice may not be worth the squeeze". An IOL is a likely thing you may need a bit later in life and LASIK has the potential to affect the quality of that too. Or maybe LASIK could be the best thing that ever happened to you and you should have got it 15 years sooner
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