It actually depends on age. Base on your story, I assume that you are nearing presbyopia. The decision on when and how much to correct depends a lot on each individual needs. I would prefer to discuss with you in detail on this. However, in general, I would correct patients who does not have existing presbyopia fully, ie eliminate their myopia and astigmatism. These patients tend to prefer good vision in both eyes as they have not experienced the inconvenience of presbyopia yet. However, this means that they will require reading glasses when their presbyopia sets in, just like a normal person.
LASIK cannot treat presbyopia fully. I would consider performing monovision LASIK for my patients who are both myopic and presbyopic. Basically, this means that we leave one eye slightly myopic. As everyone uses both eyes to see, they will be able to see distance objects well with the fully corrected eye and near objects with the slightly myopic eye. However, not everybody likes monovision, as such I will examine these patients in detail and even test to see if they like monovision.
In your case, if you are indeed nearing 40 years old (ie presbyopic age) we can consider a trial of monovision to see if you are suitable. In which case, if we can perform monovision LASIK on you, we may be able to treat your myopia, astigmatism and at the same time, delay the onset of presbyopia. But it would really help if I can examine and discuss the pros and cons of monovision LASIK with you. Performing LASIK now or later does not affect the surgical outcome.
As for your friend with bloodshot eyes, I suspect she underwent bladeless LASIK using the Intralase femtosecond laser platform. This is an older platform which needs to apply pressure on the sclera of the eye (ie the white part of the eye) during the LASIK procedure. As such, sometimes, this results in the rupture of fine blood vessels there, leading to subconjunctival haemorrhage (ie bleeding at the white part of the eye). Currently, there are newer lasers which do not apply pressure on the sclera and thus, do not cause such unsightly side effects. I usually use the newer Visumax femtosecond platform which does not cause this problem.
Yes, we will need to assess each potential LASIK patient thoroughly. We have to ensure that the patient has sufficient corneal thickness and that their corneas are normal before performing LASIK.
During LASIK, we will use a small instrument to help the patient keep their eyes open. So, even if the patient has a tendency to blink, his/her eyes will still be open during surgery. I have not had any patients who were able to close eyes during LASIK. Furthermore, the actual laser procedure is usually less than 30 seconds and most patients are able to control their blinking tendency for this short period of time.
You are most welcome. Most patients will experience some degree of discomfort after LASIK, usually lasting 4 hours. Most patients tend to have difficulty keeping their eyes open during this period and may tear excessively. Some patients will feel some irritation in their eye, something like feeling that there is an eyelash in their eyes. Very few complain of pain which affects them greatly. In general, after 4 hours, most patients are very comfortable and are able to do most normal activities.
Post-surgery blood shot eyes used to be the norm with the older femtosecond laser machines. However, this is no longer the case. Femtosecond lasers are needed to perform bladeless LASIK. Blood shot eyes are the result of the use of older femtosecond laser platforms which needs to apply pressure on the sclera of the eye (ie the white part of the eye) during LASIK procedure. As such, sometimes, this results in the rupture of fine blood vessels there, leading to subconjunctival haemorrhage (ie bleeding at the white part of the eye). Currently, there are newer lasers which do not apply pressure on the sclera and thus, do not cause such unsightly side effects. I usually use the newer Visumax femtosecond platform which does not cause this problem. Thus, the occurrence of bloodshot eye may depend on where a person undergoes LASIK and the femtosecond laser platform used.