Laser Eye Surgery for Over-40s: Presbyopia and Reading Vision

Many people don’t realise that laser eye surgery can help with presbyopia. In fact, there are more treatment options today than ever before, and they’re designed specifically to help you see clearly both up close and at a distance. If you’re tired of relying on reading glasses, juggling multiple pairs or struggling with daily tasks, you might be surprised by how well these treatments work.

In this article, I want to walk you through why presbyopia happens, how it affects your everyday life and the different laser and lens-based options available for people over 40. You’ll also learn how each treatment works, how long the results last and what you can realistically expect from blended vision, monovision LASIK and refractive lens exchange (RLE). By the end, you’ll have a clear understanding of how to regain your reading comfort and reduce your dependence on glasses.

What Is Presbyopia?

Presbyopia is the gradual loss of your eye’s ability to focus on near objects. It’s caused by age-related stiffening of the natural lens inside your eye. When the lens becomes less flexible, it can no longer change shape easily to focus up close.

Common early signs include:

  • Needing more light to read
  • Blurry near vision
  • Difficulty focusing on small text
  • Eye strain after reading
  • Holding your phone at arm’s length
  • Switching between near and far focus slowly

Everyone experiences presbyopia eventually. It’s not a disease it’s simply part of your eye’s natural ageing process.

Why Over-40s Start Thinking About Laser Eye Surgery

When your near vision starts to decline, you suddenly find yourself needing reading glasses for tasks you used to do effortlessly:

  • Checking your phone
  • Reading labels
  • Using a laptop
  • Signing documents
  • Sewing or crafting
  • Working in dim lighting

Reading glasses are helpful, but they’re also inconvenient. You may feel like you’re constantly putting them on and taking them off, misplacing them or relying on them more than you’d like.

Laser eye surgery can reduce your dependence on reading glasses by adjusting how each eye focuses giving you clear vision across multiple distances.

Laser Options for Presbyopia Correction

There are several laser treatments available, and the right option depends on your prescription, your lifestyle and how your eyes naturally work together.

Let’s go through the main options.

Blended Vision (Also Called Monovision)

Blended vision is one of the most popular solutions for people over 40. It works by setting one eye for distance and the other eye for near vision.

How blended vision works:

  • The dominant eye is corrected for distance
  • The non-dominant eye is corrected for near work
  • Your brain blends the images from both eyes

Most people adapt very well because the difference between the two eyes is subtle.

Benefits of blended vision:

  • Great overall functional vision
  • Reduced need for reading glasses
  • Clear distance vision
  • Works well for everyday tasks
  • Can be achieved with LASIK, SMILE or PRK

This approach has been used for decades and is still one of the most effective treatments.

Monovision LASIK

Monovision is a more pronounced version of blended vision. Instead of making the difference subtle, one eye is corrected fully for distance and the other is strongly corrected for near work.

Who monovision suits best:

  • People who are comfortable with a clearer distinction between eyes
  • Those who want to maximise near vision without glasses
  • People who don’t mind a small reduction in depth perception

Not everyone adapts to monovision, so surgeons often use contact lenses to simulate the effect before surgery.

PresbyLASIK (Advanced Laser Option)

PresbyLASIK uses a specially shaped laser profile to create multiple “zones” on the cornea, similar to multifocal lenses.

Benefits include:

  • Clearer near and intermediate vision
  • Reduced dependence on reading glasses
  • Good distance performance
  • Works best for healthy corneas

PresbyLASIK is not suitable for everyone, but when it works well, it provides excellent range.

SMILE for Presbyopia

SMILE is typically used for short-sightedness, but some clinics offer modified protocols to create a blended-vision effect.

Benefits:

  • Flap-free procedure
  • Minimal dryness
  • Quick recovery
  • Excellent long-term stability

This option depends heavily on your prescription.

Refractive Lens Exchange (RLE)

RLE replaces your natural lens with an artificial intraocular lens (IOL). It’s the same procedure used in cataract surgery, but performed earlier to correct presbyopia.

RLE is particularly beneficial for people over 45–50.

Why RLE is popular:

  • Long-lasting results
  • Multiple IOL options
  • Treats presbyopia at its root
  • Prevents future cataracts
  • Suitable for people with strong glasses prescriptions

RLE corrects your vision permanently because the new lens doesn’t age like the natural one.

Lens Options for RLE (Choosing the Right IOL)

Your implanted lens determines how you’ll see after RLE.

Types of IOLs include:

Monofocal IOL

Clear distance vision, reading glasses still needed.

Enhanced monofocal IOL

Better intermediate vision (computers, dashboards).

Multifocal IOL

Multiple focal points for near, intermediate and distance.

Trifocal IOL

The most advanced excellent vision across all distances.

Extended-Depth-of-Focus (EDOF) IOL

Smooth range of vision from distance to intermediate.

Why people choose IOLs for presbyopia:

  • No future age-related decline in reading vision
  • No cataracts later in life
  • Long-term clarity without constant glasses
  • Suitable for people who don’t want monovision

RLE is often recommended for people over 50 because it corrects presbyopia permanently.

Which Treatment Is Right for You?

Choosing the right option depends on:

  • Your age
  • Your prescription
  • Your corneal thickness
  • How your eyes work together
  • Your lifestyle (reading, driving, digital work)
  • Your sensitivity to visual disturbances
  • Whether you want a reversible option

Your surgeon will test your eye dominance, simulate blended vision and analyse your eye’s structure to guide you toward the right choice.

Recovery After Laser Eye Surgery for Presbyopia

LASIK:

Clear vision within 24–48 hours
Return to normal activity quickly
A small adjustment period for blended vision

PRK:

Blurrier initially
Clear vision after several weeks
Best for thin corneas

SMILE:

Fast healing
Minimal dryness
Clearer vision within days

RLE:

Clearer vision after a few days
Stabilises in 4–6 weeks
Reading vision improves gradually

Your recovery depends on your procedure and how your brain adapts to your new focus pattern.

How Long Do the Results Last?

Laser treatments last many years, but your natural lens continues to age except when you choose RLE.

Longevity overview:

  • Blended vision / monovision: 7–15 years depending on lens ageing
  • PresbyLASIK: stable for many years
  • SMILE presets: long lasting
  • RLE: permanent, because the natural lens is replaced

If your reading vision continues to change, small enhancements or lens-based options can help.

Who Is Not Suitable for Presbyopia Laser Surgery?

You may not be suitable if:

  • You have significant dry eye
  • Your corneas are too thin
  • You have corneal disease (e.g., keratoconus)
  • You have uncontrolled diabetes
  • You have severe eye inflammation
  • Your prescription is unstable

In these cases, RLE or alternative options may be recommended.

How to Choose the Best Treatment for Your Lifestyle

If you want fast recovery:

LASIK or SMILE

If you have thin corneas:

PRK or RLE

If you dislike the idea of a corneal flap:

SMILE or PRK

If you want the longest-lasting result:

RLE with a multifocal or trifocal lens

If you want the most natural range:

Blended vision or EDOF IOLs

Your consultation will help tailor the best plan for you.

FAQs:

  1. Can laser eye surgery really fix presbyopia after 40?
    Yes, laser eye surgery can significantly improve presbyopia by adjusting how each eye focuses at different distances. Your surgeon can create blended vision or monovision so that one eye sees clearly up close while the other sees well at distance, allowing your brain to merge both images for comfortable day-to-day vision. Many people over 40 find they can reduce or almost eliminate their dependence on reading glasses after treatment, especially when the procedure is tailored to their visual habits, work demands and level of presbyopia.
  2. How do I know if blended vision or monovision will work for me?
    Your suitability depends on how easily your brain adapts to having each eye set to a slightly different focus point. Surgeons often use a contact lens trial to simulate the effect, allowing you to experience the difference before committing to surgery. During this trial, you’ll get a sense of how well you can read, drive and switch focus throughout the day. If you feel comfortable and natural while using the trial lenses, it’s usually a good sign that blended vision or monovision LASIK will work well for you after surgery.
  3. Will laser eye surgery affect my night vision or cause glare?
    Modern laser systems are designed to minimise issues like glare, halos or starbursts by customising the shape of the cornea based on your unique optical pattern. Many people actually notice clearer night vision after treatment because existing aberrations are smoothed out. However, if you already struggle with night driving or have enlarged pupils, your surgeon will assess your risk carefully and may recommend a lens-based option like RLE instead of laser. Most patients adapt well, and any mild symptoms in the early weeks usually fade as the eyes stabilise.
  4. What’s the difference between laser treatments and RLE for presbyopia?
    Laser treatments reshape the cornea to improve near vision, while refractive lens exchange replaces your ageing natural lens with an artificial one that doesn’t deteriorate over time. Laser eye surgery is ideal if your corneas are healthy and your lens still functions reasonably well, but RLE becomes the more effective choice once the natural lens begins to stiffen more noticeably, typically after age 45–50. Because the artificial lens used in RLE doesn’t age, the results are long-lasting and also prevent cataracts in the future.
  5. How long will it take for my reading vision to feel natural again after surgery?
    The adjustment period depends on the treatment you choose. With LASIK or SMILE, most people see clearly within a couple of days, but blended vision may take a little longer for your brain to fully integrate. PRK takes several weeks to settle because the surface of the eye needs more healing time. RLE usually gives clear vision within a few days, though fine near vision continues to sharpen over several weeks as your brain adapts to the new lens. This adaptation stage is normal and part of achieving stable, comfortable reading vision.
  6. Is presbyopia surgery painful or uncomfortable?
    Laser eye procedures like LASIK, PRK and SMILE are not painful because numbing drops are used, though you may feel gentle pressure or a slight cooling sensation from the laser. PRK has a longer and more uncomfortable recovery because the surface layer of the eye needs to heal, while LASIK and SMILE involve minimal discomfort. RLE is also painless during the procedure due to anaesthetic drops, and most patients describe the recovery as mildly sensitive rather than painful. Any discomfort is usually manageable with simple lubricating drops.
  7. Can I still need glasses after presbyopia surgery?
    Most people find they use reading glasses far less often or not at all, but occasional use is still normal, especially for very small print or extended close work. The goal of these treatments is functional freedom, not necessarily perfect near vision at every distance. Your long-term dependence on glasses also depends on the option you choose. Blended vision and monovision offer strong day-to-day performance, while RLE with multifocal or trifocal lenses provides the widest range of vision with the least reliance on spectacles.
  8. Is there a chance the results will fade over time?
    Laser results can remain stable for years, but your natural lens continues ageing, which means near vision may gradually decline again later unless you choose RLE. Blended vision can last 7–15 years before a small enhancement may be needed, depending on how quickly your lens stiffens. PresbyLASIK and SMILE usually offer long-term benefits, but RLE gives the most permanent solution because it removes the ageing lens entirely. Your surgeon will help you choose based on whether you prefer a long-lasting or fully permanent correction.
  9. What if I have dry eyes or a thin cornea?
    Dry eyes and thin corneas can limit which laser procedures are suitable for you, but they don’t automatically rule out treatment. People with thin corneas often do well with PRK because it doesn’t require creating a flap. Those with dry eyes may benefit from SMILE, which causes minimal disruption to the corneal nerves responsible for tear production. If your dry eye is more advanced, your surgeon may treat it first or recommend a lens-based procedure like RLE to avoid worsening your symptoms.
  10. How do I know which presbyopia treatment is best for my lifestyle?
    Your surgeon will assess your daily routines, visual demands, hobbies and priorities to recommend the most suitable option. For example, if you want fast recovery and minimal downtime, LASIK or SMILE is usually ideal. If you spend long hours reading, sewing, or doing close work, you may prefer monovision or a multifocal IOL through RLE. People who want a permanent solution with no future changes often choose RLE, while those who want a reversible setup may prefer blended vision through laser. The best treatment is the one that aligns with both your eye health and the way you use your vision every day.

Final Thought: Restoring Your Reading Vision

Presbyopia can feel frustrating, especially when it begins to affect the everyday tasks you once did effortlessly. But with today’s advanced laser and lens-based techniques, you truly have more options than ever to regain comfortable reading vision and reduce your dependence on glasses. Whether you’re leaning towards blended vision, monovision, or a longer-lasting solution like RLE, the key is choosing an approach that supports both your visual needs and your lifestyle.

If you’re considering laser eye surgery in London and want to know if it’s the right option, you’re welcome to reach out to us at Eye Clinic London to book a consultation. Our team will guide you through your choices, assess your eye health thoroughly and recommend a personalised plan that helps you see clearly at every distance again.

References:

  1. Agarwal, A. & Thornell, E. (2022), ‘Early Outcomes of Two Treatment Modes of PresbyLASIK: Monocular vs. Micro-Monovision’, Journal of Refractive Surgery, 38(10), pp. https://pubmed.ncbi.nlm.nih.gov/36345532/
  2. Pajic, B., Massa, H. & Baenninger, P.B. (2017), ‘A Novel Laser Refractive Surgical Treatment for Presbyopia: Optics-Based Customization for Improved Clinical Outcome’, Ophthalmology / Refractive Surgery, Journal, https://pubmed.ncbi.nlm.nih.gov/28608800/
  3. Grzybowski, A. & Schmickler, S. (2023), ‘Presbyopia: What We Do Know and What We Do Not’, Journal of Clinical Medicine, 12(3), article 794. https://www.mdpi.com/2077-0383/12/3/794
  4. De Gracia, P. et al. (2025), ‘Pharmacological Modulation of Pupil Size in Presbyopia’, Journal of Clinical Medicine, 14(17), article 6040. https://www.mdpi.com/2077-0383/14/17/6040
  5. Patel, Ilesh R.F. et al. (2007), ‘Presbyopia: prevalence, impact, and interventions’, Community Eye Health, (or relevant journal), 20(63), pp. https://pmc.ncbi.nlm.nih.gov/articles/PMC2040246/