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Long-sightedness Q&As

Published by Bupa's health information team, January 2009.

Answers to questions about long-sightedness

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

My child has a squint because of long-sightedness. What can be done about it?

The two main treatments for a squint caused by long-sightedness are wearing glasses and wearing an eye patch. If a squint is picked up early and treated, most children do very well and have good sight in both eyes in the long term.

Explanation

Around five in every 100 children develop a squint and most of these are caused by long-sightedness. Children can see things that are close up by over-focusing their eyes. If a child is also long-sighted, it means they have problems seeing things that are close to them so they need to focus even harder. Over-focusing can cause blurred vision. To stop this from happening your brain can switch off the sight in one eye. When this happens, your eye has a natural tendency to turn inwards - this is how most squints develop. This can also lead to what is called a 'lazy eye' where sight doesn't develop properly in the eye with the squint. If not corrected, this can lead to permanent sight loss.

Most children start to develop a squint between about 10 months and two years old, although it can develop in children up to the age of seven. You might see your child squinting when they are looking at their toys or something close to them such as a book. It's not always easy to spot so in some places in the UK children have their eyes tested before they start school. If you think your child might have a squint, don't ignore it. Speak to your GP, health visitor or school nurse for advice.

The two main treatments for a squint caused by long-sightedness are wearing glasses and wearing an eye patch. If a squint is picked up early on and treated, most children will eventually end up with good sight in both eyes. However, if a squint isn't picked up until after the age of about seven, lack of treatment can have a permanent effect on sight.

Your child will be tested for glasses and it's very likely that he/she will need to wear a pair. Your child will need to wear them all the time, which can sometimes be difficult. Some children say they can see better without the glasses - this is because their eyes have become used to over-focusing without them. In time, if your child keeps wearing the glasses, his/her eyes will learn to relax and let the glasses focus for them. Most children need glasses and nothing more to correct their squint.

If your child has a lazy eye, he/she will probably need to wear a patch over the good eye. This makes the lazy eye work harder to focus and in time will improve the sight in that eye. Patches are always worn under glasses.

Your child will be seen by an orthoptist (a health professional specialising in sight problems connected to the movement of the eye, for example measuring squints and improving the vision in lazy eyes). He or she will monitor your child's progress together with an ophthalmologist (a doctor specialising in eye health and surgery). Your child may be offered surgery to correct his/her squint, but not until every effort has been made to try other methods such as wearing glasses or an eye patch.

Further information

  • Royal National Institute of Blind People (RNIB)
    0845 766 9999
    www.rnib.org.uk

Sources

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Can you tell me more about laser surgery?

Laser surgery permanently changes the shape of the cornea in your eye which means that after the operation you should be able to see well without wearing glasses or contact lenses. There are three main kinds of laser surgery for long-sightedness and your surgeon will help you choose the best one for you. After the operation most people find their sight becomes stable and their long-sightedness goes within a few months.

Explanation

Your cornea is the clear layer that covers the surface of the eye in front of your iris - the coloured part. Laser surgery for long-sightedness works by making the areas on the outside of your cornea flatter than the part in the middle, which refocuses light and helps you to see things that are close up more clearly. The instruments used for laser surgery don't actually enter your eye so the risk of infection or damage is very low.

Laser surgery for long-sightedness is safe and works well but it's not suitable for everyone. Laser surgery may not be right for you if:

  • your sight has changed a lot in the previous two or three years
  • you have other eye conditions such as cataracts or glaucoma
  • you have certain medical conditions including diabetes or rheumatoid arthritis

Your surgeon will be able to advise you.

There are three main kinds of surgery for long-sightedness. These are:

  • photorefractive keratectomy (PRK)
  • laser epithelial keratomileusis (LASEK)
  • laser in situ keratomileusis (LASIK)

All three types of laser surgery work equally well and there is no real difference in how well you're able to see once you have recovered from surgery. All three kinds of surgery are quite similar and involve making changes to your cornea.

Before you have surgery you will need to see an ophthalmologist (a doctor specialising in eye health and eye surgery) who will examine you to make sure surgery is right for you and to decide which type would suit you best. At this first appointment your surgeon will carry out a number of tests looking at the structure of your eye, how well you see in low light and how your eye is shaped. If you wear contact lenses, it's important to go without them for a few days before your appointment so your surgeon can see how your eyes are in their usual state. If you wear soft lenses, you shouldn't wear them for a day before your appointment. If you wear gas permeable or hard lenses, you need to leave them out for seven days before your appointment. You will be given eye drops which could make everything blurred for a while, so check with your surgeon whether you will be able to drive home.

Laser surgery is a quick operation - you will probably be at the clinic for about an hour. Take someone with you who can make sure you get home safely. Don't wear make-up and bring sunglasses with you to wear when you leave. You will need to remove your contact lenses for a few days before your surgery, as you did before your first appointment. If you don't remove your contact lenses before surgery, your surgeon may not be able to do the operation.

Your surgeon will give you local anaesthetic eye drops so that you won't feel anything during the operation. The surgery takes just a few minutes and you will be awake throughout. After surgery your surgeon will give you eye drops to prevent infection and to reduce any redness and swelling. You will need to use these for about the next week. You will be asked to wear a plastic eye shield for the next 24 hours and then every night for a week to protect your eye. You will also be asked to use artificial tears for some time after your operation - how long this is will depend on your eyes and the surgery you had. Your surgeon will be able to advise you.

How quickly you recover and how long it takes for your eyesight to adjust depends on what kind of surgery you have. Most people have very little pain or discomfort after their operation and go back to work and their usual activities within a few days. Whatever procedure you have you will need to wear tinted glasses with ultraviolet protection for three months after your operation. It might take up to two weeks before you're able to drive - your surgeon will advise you.

If you have PRK surgery, it will usually be between one and three months after the surgery that your sight becomes stable and your long-sightedness goes. If you have LASIK or LASEK, this usually happens sooner - within about a month of your operation. However, you may find that the process of change is much slower and it can take up to nine months before your long-sightedness disappears. It's important to know that not everyone gets the improvement in their sight that they expect after laser surgery.

Further information

Sources

  • Photorefractive (laser) surgery for the correction of refractive errors. National Institute for Health and Excellence (NICE), 2006. www.nice.org.uk
  • A patients' guide to excimer laser refractive surgery. The Royal College of Ophthalmologists. www.rcophth.ac.uk, accessed 26 June 2008
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What are the risks of laser surgery compared to wearing contact lenses?

The main risk with contact lenses is infection but this can be prevented by looking after your lenses and your eyes properly. Laser surgery may not give you the improvement in your sight that you expect and there is a small risk of new eye problems and infection. Your surgeon can advise you about what might be best for you.

Explanation

Every operation has risks as well as benefits. It's important to think carefully about whether laser surgery is right for you and whether the benefits outweigh the risks compared to wearing contact lenses. Your optometrist or surgeon will be able to give you more information.

People usually wear contact lenses because unlike glasses they can't be seen. Many people find they are able to see better with contact lenses compared to glasses because the lenses sit directly on the eye. This means there are no spaces around the lenses that aren't in focus, unlike with glasses.

There are many different kinds of contact lens available, some you use daily and then throw away, others you clean each night and use again. Some contact lenses can also be worn for longer periods of time. It's important to have regular check-ups with your optometrist to make sure your eyes are healthy and that you're using the best lenses for your needs.

The main risk with contact lenses is infection. If you go to sleep with your contact lenses in, you have a greater risk of eye infection than if you take them out. Gas permeable lenses and daily disposable lenses have a very low risk of infection. In order to prevent infection it's important that you care for and store your lenses properly. You can help reduce the risk of an eye infection by:

  • disinfecting re-usable lenses in between using them - this usually means soaking them in a special solution overnight
  • never using the same disinfecting solution twice - always throw it away after you have used it
  • rinsing your storage case and leaving it open to dry every day
  • using a new storage case every month
  • cleaning your storage case once a week using a clean toothbrush and contact lens solution
  • not sleeping in your contact lenses unless your optometrist or surgeon has told you to
  • always washing your hands before you touch your lenses
  • seeing your GP or optometrist immediately if you have red or sore eyes and you think you might have an infection
  • only using contact lens solution to clean your lenses rather than tap water or saliva
  • not wearing your contact lenses when you go swimming if you aren't wearing goggles

Laser surgery for long-sightedness is safe and works well but it's not suitable for everyone. It doesn't always work completely the first time and you may need to have the operation done more than once.

You can have laser surgery on both eyes at the same time. It's worth bearing in mind that although the risk of serious side-effects to both eyes is very rare, it does sometimes happen. This means you could have permanent sight problems affecting your ability to work, read or drive. Your surgeon should talk to you about surgery, tell you about the benefits and risks and make sure that you understand them. The main benefit of laser surgery is that you should be able to see well without wearing contact lenses or glasses. Some of the main risks are listed here.

  • Surgery may not give you the improvement in your sight that you had expected. In general, research shows that laser surgery works well for most people who are long-sighted. However, you may find that your sight is worse than before surgery when you wore glasses or contact lenses. One piece of research shows that if you're long-sighted, having LASEK rather than PRK will give you significantly better results. Talk to your surgeon about which type of surgery might be best for you.
  • Some people who have laser surgery develop other sight problems after the operation, most of them to do with seeing at night. You might find that you can't see very well in dim light, that objects have a halo of light around them at night or that sometimes you have problems with glare. Some people also find that their sight is hazy. These problems can affect your ability to drive at night but usually only last for four to six weeks. However, a few people find they have long-term problems. LASIK has the lowest risk of these problems.
  • A small number of people get an infection in their cornea following LASIK surgery. This is about the same number of people who get infections from wearing contact lenses.
  • During LASEK and LASIK surgery a cut is made across your cornea to make a flap which is attached to the rest of your cornea on one side only. This doesn't always work perfectly and any problems can mean your sight may not be as good as you expected. Sometimes problems with the flap of cornea mean you have to have the operation done again at a later date.
  • Ectasia is a medical term which means that the middle part of your cornea starts to bulge outwards. It happens because too much of the cornea is removed during surgery making it too thin. This can be a serious problem and may mean you lose the sight in that eye. Ectasia happens to about two in 1,000 people who have laser surgery.

Further information

Sources

  • Contact lens care. The College of Optometrists. www.college-optometrists.org, accessed 26 June 2008
  • Photorefractive (laser) surgery for the correction of refractive errors. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
  • A patients' guide to excimer laser refractive surgery. The Royal College of Ophthalmologists. www.rcophth.ac.uk, accessed 26 June 2008
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: January 2009

 

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