A patient in my Santa Barbara office asked me today about LASIK for farsightedness. Farsightedness is a situation in which you cannot see near or far, but the near vision is even worse than the far vision. It should not be confused with presbyopia, the age related loss of the ability to see up close. Farsighted LASIK (and farsighted PRK) work by reshaping the cornea to effectively make it steeper. With farsighted LASIK, the laser sculpts the sides of the cornea, which is the opposite case from nearsighted LASIK in which the laser sculpts the center of the cornea to effectively flatten it. It is generally felt — and I agree with this — that low to moderate degrees of farsightedness respond much more accurately to LASIK surgery than very high degrees of farsightedness do. While people with very high degrees of farsightedness (above +4 diopters of farsightedness) still can successfully have LASIK, I do not consider these patients to be ideal candidates (remember, these are farsighted cases, not nearsighted cases, which are quite different). In fact, patients with high degrees of farsightedness do not respond as accurately as patients with high degrees of nearsightedness.  The problem for patients with very high degrees of farsightedness is not that the laser is incapable of the correction. Rather, the problem is that changing the shape of the sides of the cornea to such a larger degree tends to stimulate the body’s desire to “fight back” and heal in a way that undoes some of the treatment. This phenomenon occurs much more often above +4 diopters of farsighted treatment. Recently, however, a study from the UK, the USA, and France showed good results with LASIK in patients even with very high degrees of farsightedness and astigmatism. This large study included 830 cases of high hyperopia (farsightedness). All patients had at least one axis of their cornea receive +4 diopters of hyperopic LASIK or higher.  Farsightedness treatments in the study went as high as +8.33 diopters. Again, this is a group that I consider to be less than ideal candidates for LASIK surgery, yet even so, the results were good. Patients were followed for one year and data was available for 785 eyes. Some patients required enhancement procedures to fine tune their results. After the final treatment, distance vision without glasses was 20/20 or better in 67% of cases. The authors concluded that farsighted LASIK for extreme degrees of farsightedness “was found to satisfy accepted criteria for safety, efficacy, and stability.”