More and more older people are opting for laser vision correction.
In this article, you will learn all about laser eye surgery for older people: suitability criteria, reasons for exclusion, suitable methods, advantages and age-related risks.

So that you can decide on the right laser eye surgery option for you – according to your age.

Is laser eye surgery still possible at an advanced age?

Yes, laser eye surgery is also possible at an advanced age and can offer many benefits.
Modern laser technologies and advanced procedures have significantly improved the safety and effectiveness of vision correction, making them a suitable option for older patients as well.
These procedures can correct visual defects such as short-sightedness, long-sightedness and astigmatism while improving patients’ quality of life through improved vision and independence from glasses or contact lenses.
In particular, patients who do not have serious eye conditions and are in good overall health can benefit from these advanced laser eye treatments.

Eligibility criteria for older patients undergoing laser eye surgery

General health and eye condition

General health

• State of healthOlder patients should be in good general health.
  Chronic illnesses such as untreated diabetes or autoimmune diseases can impair healing after the procedure and must be thoroughly clarified in advance.
• Taking medicationThe use of certain medications may affect suitability.
  It is important to inform the ophthalmologist of all medications, as some medications may affect healing or the outcome of the procedure.

Eye condition

• Corneal healthThe cornea must be healthy and sufficiently thick to allow safe laser treatment.
  Diseases such as keratoconus (a progressive thinning of the cornea) often rule out laser treatment.
• No serious eye diseasesPatients should not have advanced eye conditions such as glaucoma, cataract or retinal disease.
  These conditions must first be treated or considered before laser treatment can be considered.

Stability of visual acuity

The stability of visual acuity is a key factor in the suitability of laser eye treatment, especially for older patients.
Stable vision means that the patient’s spectacle or contact lens values have not changed significantly over a certain period of time, usually at least one year.

Advantages of stable vision

• Improved predictabilityStable visual acuity allows for more accurate planning and execution of the laser procedure, leading to better and more stable results.
• Reduced need for follow-up correctionsPatients with stable vision have a lower risk of needing an additional correction after the procedure.

Exclusion criteria for laser eye surgery

When assessing suitability for laser eye treatment in the elderly, there are certain exclusion criteria that need to be considered.
Here is a short list of the most common exclusion criteria:

Advanced eye diseases:

• Cataract (cataract)Patients with advanced cataracts often require lens replacement instead of laser treatment.
• Glaucoma (glaucoma)Increased intraocular pressure and damage to the optic nerve can have a negative effect on the outcome of the laser procedure.
• Retinal diseasesDiseases such as diabetic retinopathy or retinal detachment rule out laser treatment.

Insufficient corneal thickness:

• Patients with a very thin cornea may not be suitable for LASIK or similar procedures because there is not enough tissue to perform a safe correction.

Keratoconus:

• Progressive thinning and deformation of the cornea precludes laser treatment, as the structure of the cornea is already impaired.

Diabetes:

• Patients with poorly controlled diabetes have a higher risk of healing complications and infections after the procedure.

Autoimmune diseases:

• Diseases such as rheumatoid arthritis or lupus can impair healing and increase the risk of postoperative complications.

Dry eyes:

• Severe cases of dry eyes can be aggravated by laser treatment.

What role presbyopia plays in laser eye surgery

Presbyopia is a natural part of the ageing process and affects almost everyone from the age of around 40.
It is caused by the loss of elasticity in the lens of the eye, which leads to difficulties in seeing close up.
This plays a crucial role in the planning and implementation of laser eye treatments for older patients.

There are now special laser eye procedures (PresbyMAX) that are suitable for people with presbyopia.
Multifocal solutions are used that make reading glasses superfluous.

Laser eye surgery suitable for older patients

Femto-LASIK

Femto-LASIK is an advanced laser eye surgery procedure for the correction of visual defects such as short-sightedness, long-sightedness and astigmatism.
Here is a brief explanation of how it works:

1. Creation of the corneal flapA femtosecond laser, which generates extremely short pulses of light, is used to cut a precise, thin corneal flap.
   This laser enables a very precise and controlled incision, which increases the safety and precision of the procedure.
2. Reshaping of the corneaThe flap is carefully folded to the side to expose the underlying corneal tissue.
   An excimer laser is then used to reshape the cornea and correct the visual defect.
3. Reattachment of the flapAfter reshaping, the corneal flap is folded back and reattaches to the cornea without sutures.
   Healing is quick and most patients experience a significant improvement in their vision the very next day.

Femto-LASIK can also be a suitable method of vision correction for older patients.

For older patients who may not be suitable for LASIK, there are alternative procedures such as lens surgery with multifocal intraocular lenses, which also offer very good results in correcting visual defects and presbyopia.

More about Femto-LASIK

Trans-PRK

Trans-PRK (Transepithelial Photorefractive Keratectomy) is an advanced procedure for the correction of visual defects such as myopia, hyperopia and astigmatism.
It differs from other procedures in that it is minimally invasive and the top layer of the cornea (epithelium) is removed with an excimer laser instead of ablating it manually.

1. Removal of the epitheliumAn excimer laser removes the top layer of the cornea, the epithelium, directly.
   This is done in one step, which reduces the risk of mechanical complications.
2. Reshaping the corneaAfter removing the epithelium, the excimer laser reshapes the cornea to correct the refractive errors.
3. HealingAfter laser treatment, the epithelium regenerates itself within a few days.
   The healing process is supported by wearing a therapeutic contact lens, which protects the eye and promotes healing.

More about Trans-PRK

Advantages of laser eye surgery in old age at a glance:

Improved quality of life

• Independence from glassesOlder people benefit considerably from being able to see clearly without glasses or contact lenses.
  This makes many everyday activities easier and improves their quality of life.
• Making everyday tasks easierTasks such as reading, driving, watching TV and cooking become easier and more enjoyable thanks to improved vision.

Reduced dependence on visual aids

• Less switching between glassesMany older people need different glasses for different tasks (e.g. reading and watching TV).
  Laser eye surgery can reduce or eliminate this need.
• Comfort and convenienceNo need to constantly wear and change glasses, which is particularly beneficial for older people with limited mobility or fine motor skills.

Safety and mobility

• Improved mobilityWith better vision, older people feel safer when walking, especially in unfamiliar or poorly lit environments.
• Fall preventionGood eyesight can help to recognize tripping hazards and thus reduce the risk of falls, which can lead to serious injuries in old age.

Long-term cost efficiency

• Savings on visual aidsAlthough the initial costs for laser eye surgery can be high, the ongoing costs for glasses, contact lenses and their care products are eliminated in the long term.
• Fewer visits to the doctorWith stable vision correction, fewer visits to the ophthalmologist are necessary, saving time and money.

Convenience and simplicity

• Travel comfortTraveling becomes easier as older people no longer have to worry about carrying glasses and contact lenses.
• Less care routineEspecially beneficial for older people who have difficulty handling contact lenses or cleaning and caring for their glasses regularly.

Adaptation to age-related changes

• Combined correction of visual defectsModern laser eye procedures such as PresbyMAX can simultaneously correct presbyopia and other visual defects, which is particularly beneficial for older patients.
• Permanent solutionThe results are usually stable in the long term, which means that older people can enjoy their improved vision for many years.

Age-related risks and side effects of laser eye surgery

Although laser eye surgery offers many benefits, there are specific risks and side effects that need to be considered in older patients.

1. slowed healing

• Longer recovery time: With increasing age, the healing processes of the body, including the eyes, slow down.
  This can lead to a prolonged recovery time after the procedure.
• Increased risk of infectionOlder patients may have a higher risk of post-operative infections as the immune system may work less efficiently.

2. existing eye diseases

• Cataract (cataract)Many older people develop cataracts.
  An existing or incipient cataract can affect the results of laser eye surgery, and lens surgery may be the better option.
• Glaucoma (glaucoma)Increased intraocular pressure and damage to the optic nerve can increase the risks and side effects of laser eye surgery.
• Age-related macular degeneration (AMD)This disease impairs central visual acuity and can have a negative impact on the results and safety of laser eye surgery.

3. dry eyes

• Worsening of the symptomsOlder patients are more prone to dry eyes.
  Laser eye surgery can exacerbate this problem, which can lead to persistent discomfort and an increased need for eye drops.

4. deterioration in the quality of vision

• Halos and glareOlder patients are more likely to report halos, glare and other visual disturbances after the procedure, especially in poor lighting conditions.
• Contrast sensitivityThe ability to recognize contrasts may be impaired after the procedure, which may affect vision at dusk or at night.

5. follow-up treatments and corrections

• Increased likelihood of subsequent correctionsDue to age-related changes in the eyes, it may be necessary to make additional corrections after the initial procedure.

Progression of other visual problemsEven after successful laser eye surgery, age-related visual problems such as presbyopia can develop further, which may result in the need for further surgery or adjustments to visual aids.