For patients over age 60 with significant degrees of hyperopia, a refractive lens exchange (RLE) tends to be the preferred procedure. Surgery on the cornea such as LASIK is far more challenging because of the need to steepen the cornea and add dioptric power. Perhaps LASIK would work well for about 2 diopters of hyperopia, but since this patient has a refraction of +3.50 for distance vision (and +5.75 for near vision) the RLE is the better choice. Performing RLE for hyperopic patients was pioneered by Dr Robert Osher and he received much criticism for it, as he explains in our podcast. This patient is also presbyopic so the surgeon chose a J&J Tecnis Synergy multi-focal IOL to address that. What is your limit for performing hyperopic LASIK? And at what point do you consider RLE surgery for your patients?