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LASIK and Personality – the Undiscussed Risk Factor

LASIK is technically successful most of the time. Recently the American Association of Professional Eyecare Specialists, (AAPECS), reported their statistics on LASIK surgery. The results concluded that 55.3 percent of LASIK patients obtained 20/20 or better vision after LASIK surgery, and 92.6 percent of patients obtained 20/40 or better vision after LASIK surgery. While “acuity”, or your “20/20” number is one measure of LASIK success, there are other common risk factors that are usually discussed with the patient prior to surgery. The most common of these risk factors include risk of (1) loss of best corrected visual acuity (2) dryness, (3) glare and (4) risk of needing reading glasses when one is over the age of 40. There are other risk factors discussed as well, but the purpose of this article is to dig deeper and discuss a rarely discussed reason why LASIK results don’t always please the patient, even if the numbers appear perfect.

Everyone has what I call their “Vision Personality”.  For most people who seek LASIK, their vision personality is “myopic“, or nearsighted. Most myopic individuals seeking refractive correction have experienced life where blur occurs at distance until corrected by lenses. They wake up in the morning and fish for their glasses, often shower in a blur and function in a world where objects close to their face are clear. Eye doctors discuss people with “myopic personalities” – people who are extremely myopic may tend to be more shy and withdrawn. Glasses can affect someones personality by acting as something they hide behind, and certain insecurities related to appearance are more prevalent in nearsighted people. Other insecurities may mold the “myopic” personality; safety for example. These are people who might lose their glasses in the ocean and have difficulty discerning which way the beach is. Anxiety exists in active situations that their glasses may fall off leading to an accident of some sort, like in a car or playing sports. Myopic people, through experience, have certain expectations of what they should be able to see and what they shouldn’t. Their reality is that far vision is challenging, and thus are sometimes slower to get to their doctor if their prescription needs a change because in many cases they just “accept” the world is slightly blurry. The opposite is true for them when considering objects at near. Myopic people have eyes like magnifiers when their prescription is off, and are used to seeing clear at near, so if this is taken away from them as in LASIK, which we will discuss further on, they either can’t understand why or are dissapointed because  seems worse than they expected.

Farsighted people with prescriptions high enough for LASIK have the opposite expectations and life experiences from a visual standpoint. Most of them have or had vision much better at distance than at near, and they are pleased when distance is clear and expect blur, eyestrain or both when viewing near objects for extended periods of time. Farsighted people also are used to having shifting vision – many can actively alter their images in terms of blurring them in and out at will, and the loss of this ability after LASIK might be strange and unsettling. The difference with farsighted people is that fixing their farsightedness also fixes their near to some extent, so they experience an improvement in both, whereas nearsighted people who are corrected to see better at far sacrifice some of that natural “magnification” they were used to at near. Ideally, farsighted people should do better than nearsighted people for LASIK, but as the surgery that reduces their farsightedness is less reliable in terms of ultimate “20/20” or acuity outcome, that isn’t always the case.

So what do I mean by “vision personality”? Let’s look at a hypothetical example. Marie is a 39 year old nearsighted woman who has experienced her entire visual life requiring and using glasses for seeing far. After her LASIK surgery her initial reaction is total amazement. For the first time in her life she is viewing the world through her natural eyes and not through a “shield” – contact lens or eyeglass lens. She is amazed at how crisp and clear distance objects are and totally enamored with the idea of her new vision independence. Over the next few months it is often the topic of conversation between Marie and her friends and coworkers. A few months go by, the novelty wears off and the sharpness of the distance vision is noticeably reduced. Marie still feels she sees well, but her brain has adjusted to her “new eyes” and has adapted to it’s new visual status so that “sharpness” that was there initially seems to be less noticeable. About that time Marie starts noticing that certain book or magazine print at near requires some effort to read. She can’t remember ever having to struggle to see near for brief or extended periods of time. Now, without the super-sharp “hyper acuity” experienced in the first few months after LASIK, and what she perceives as worse near vision than before, she starts to bring her LASIK results into question.  She is still enamored with the thought of not being dependent on eyeglasses, but one day while at the drug store she stops to look at the rack of over-the-counter reading glasses and trys a pair on. Voila! (Marie is French, after all!) – “That’s how I used to see at near!”. This realization can often lead to less than perfect satisfaction with the ultimate LASIK result. If someone is in a career or hobby where they are involved in intensive nearwork, this feeling can be amplified, whereas if someone isn’t, it may not bother them at all. Marie’s visual personality, and her expectations were molded out of her experiences as a nearsighted person.

The experienced LASIK manager or co-manager should always discuss the visual experience and how it might impact the patient psychologically with their patients prior to actual surgery.  When my patients return having noticed this slightly or being dissapointed by it, I remind them about our conversation regarding their visual personality;  that they used to be a nearsighted person, and by asking for LASIK have followed through with their desire to be a farsighted person. Farsighted people have certain advantages, but there are disadvantages as well as viewed through the eyes of someone who has lived life as a nearsighted person and when you step into LASIK your expectations should change as well.

In the end, it all comes down to the doctors ability to manage the patients expectations. There are the big items, like potential for dryness and glare, the fact that most people will need reading glasses or computer glasses sometime after the age of 40 after receiving bilateral LASIK for distance etc. A doctor doing a thorough job setting expectations for LASIK patients provides explanation of the finer details of what patients should expect not only in the few months following LASIK, but by altering their visual status from one way to another for the rest of their life.

I am a huge fan of LASIK – it is life changing, but my happiest LASIK patients are those whose expectations are properly managed.

Cheers,
Dr. Glazier

Shady Grove Eye and Vision Care

Rockville and Potomac, Maryland

Copyright 2010 – Dr. Alan N. Glazier, Optometrist in Rockville and Potomac Maryland – All Rights Reserved

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