Is Lasik appropriate for someone in his 60's who is nearsighted, farsighted and has an astigmatism? What might he expect the outcome to be?

Assuming the patient is otherwise healthy and has no significant ocular pathology, it might be appropriate but this would depend on what the patient is expecting.

If (s)he wants good distance and good near/reading vision, the only way this could possibly be achieved in one's 60s is with a strategy known as monovision, i.e. one eye set for distance and the other set for near. While many nearsighted patients do fine with this, it does involve a compromise in visual performance.

The other issue arguing against LASIK at this age is the natural lens of the eye -not the cornea which is where LASIK works. Any patient in their 60s is already experiencing presbyopia (the cause of the near vision problem while wearing glasses or contacts). This is what the monovision is an attempt to circumvent. Presbyopia is invariably followed by a general discoloration of the lens of the eye which at some point will be bad enough to be considered a cataract. This process is inexorable and will tend to undermine both the quality and stability of even perfect LASIK results.

Often, a less compromised procedure such as PreLex® or RLE (Refractive Lens Exchange) would be better. But this is a more aggressive and more expensive approach, even if a more permanent one

Written by J. Trevor Woodhams, M.D. - Chief of Surgery, Woodhams Eye Clinic