What factors should I consider in deciding whether to undergo LASIK for low myopia?

Hi Aloysius

For people with low myopia like yourself, the important things to consider are as follows:

1. How much less than 200 degrees is it? eg 50 degrees? or 175 degrees?…

2. How much do you depend on glasses/contact lenses? If you wear glasses/contact lenses a lot of the time, do you consider that to be an inconvenience?

3. What are your daily activities like, and are there any sports or hobbies you do where glasses or contact lenses get in the way?

4. What is your age?

Just to expand a bit on the above, when myopia is of a very low degree, especially if it is less than 100 degrees, the perceived benefit may sometimes not be considered worth the risk and expense of surgery. This is because the degree of blurring is often quite mild in such people. Once it gets above 100 degrees or so, many or most people will feel quite dependent on glasses for many activities in their life.

For point number 2, some people with low degrees of myopia do not bother with glasses or contacts a lot of the time, because they may have adapted to the blur and find that it does not bother them much. If that is the case, or if glasses or contact lenses suit the person just fine, then there is no need for any refractive surgery.

Point 4 really has to do with presbyopia, or 'Lao Hua'. This is a problem that affects everybody once we get to the age of 40 years and above. If a person is already 40 years of age and above, then removing the myopia in both eyes means that there will be need to wear reading glasses for near visual work immediately afterwards.

Note that LASIK does not cause presbyopia, nor does LASIK make it happen any faster than it naturally would anyway.

Also, note that myopic people get presbyopic as well.

The difference is that low myopic people can take off their glasses to read when they get presbyopic. But people who have had LASIK done cannot 'take off their LASIK' to read, ie reading glasses become necessary if myopia is removed in both eyes.

So for people who are above 40 years old and have low myopia, they have to consider how they would like to manage the presbyopia. If they like to take their glasses off to read, then perhaps they should not have LASIK done. On the other hand, they can consider a compromise like monovision (LASIK to correct one eye for distance vision and the other eye for near vision), or they can have LASIK done to correct the myopia and then wear reading glasses for near afterwards.

There is no right or wrong answer, and ultimately the decision is up to the individual, based on various factors such as the points I've brought up above.

Low myopia may cause enough blurring of vision to some people, and if there is desire to improve eyesight and reduce dependence on glasses, there is no reason to object to seeking laser eye correction, as long as you know your choices.

I once treated a patient with myopia as low as 50 degrees in combination with the same amount of astigmatism. The patient's eyesight improved by one line and it was a happy ending for the patient.

Some people suffer from "night myopia" when the degree seem to increase at night in dark places, due to the natural pupil dilation under such lighting conditions. So what is low power may actually be somewhat higher when tested in different conditions.

You may want to ask yourself about what you hope to achieve with regards to your eyesight.

One avid football player I treated years ago was already 41 year old when he had LASIK done for his low myopia (about 150 degrees). His aim at that time was to improve his game as he got very fed up with glasses and contacts by then. I counseled him fully regarding the pros and cons of LASIK in his situation. He knew what he was doing, got his wish and was much happier on the football field.

Hope this helps!
Dr Han

Senior Consultant, Ophthalmologist

Should one do LASIK surgery is an important question but one that can only be answered after analysing one’s own needs and expectations. In reality, the role of a refractive surgeon is not to encourage you to have LASIK surgery per se but rather he or she is most useful to you after you have decided based on your current situation if being free of spectacles or contact lens adds significant value to your life.

To be clear, if you are very happy with your glasses and contact lens, then one could argue that LASIK may not add much to your quality of life. In fact, different people will come to a decision to have LASIK surgery for various reasons. Some hope to improve their work performance with better unaided vision, others do so for specific type of sports or interests. The need to do some self-analysis applies regardless of whether your prescription is high or low.

Suffice to say, LASIK or other forms of laser vision correction (LVC) like PRK and ReLEx SMILE can correct myopia levels of -2 D or “200 degrees”. Our role as refractive surgeons are to analyse your eyes and your overall health to advise if you are a suitable candidate for LVC in terms of both safety and visual results.

Thinking of Lasik in a low myope is no different from deciding on refractive surgery for anyone else. Its best to choose an ophthalmologist that you trust to give you considered and tailored advice to your complete examination findings.

Even the choice of procedure should also depend on your planned activities after the surgery, tolerance and preference for pain-free recovery (Femto, SMILE), rapid recovery time (Femto, SMILE), minimal dry eye symptoms, glare and haloes (lowest for implantable collamer lens, then SMILE, then Femto, or surface ablation), and lastly your tolerance for a corneal flap (No flap for SMILE, surface ablation).

As mentioned earlier, you should make your decision together with a trusted ophthalmologist who has access to your detailed examination results, and is able to offer you all the options mentioned above for you to consider.

Best of luck!
ESG