Most of us feel more Mrs Merton than superstar wearing specs. But if you're a reluctant glasses wearer, or dread the day you'll need them, take heart, your chances of managing without are getting better all the time.

Over the past few years, a revolution has been going on in eyecare. Thanks to new materials and better production processes, contact lenses are now available in a bewildering variety of types, while laser microsurgery, introduced just over 10 years ago, is becoming ever-more sophisticated and bringing astigmatism, far sightedness and extreme short sight that earlier methods couldn't cope with, under correction.

In contact lenses, soft multi-focals are the most recent new arrivals, designed to overcome those problems reading the small print that affect us all as we pass the big 40.

These lenses have the advantage of offering near and distance vision in all directions, no need to look down for near work, or up for distance. Until recently they've only been available as contacts in 'hard' form, which not all lens wearers can cope with. Now, for the first time, there are several types of 'soft' multi-focals on the market, which not only give new choices to lens wearers but also to those without any previous sight problems who need reading glasses but don't want them.

'There's a whole generation approaching their 40s and 50s who've been wearing contacts since they were 20 and want to carry on avoiding spectacles when they need extra correction for reading as they age,' says Judith Morris, director of London's Institute of Optometry.

But is there any danger in such long-term use? The major disadvantage of soft lenses is that they deprive the cornea of its oxygen supply, unlike hard or gas permeable lenses which move more and allow oxygen in. 'The eye's need for oxygen is a very individual matter,' says Morris. 'Some corneas cope however badly you treat them, while others feel stifled and search for an oxygen supply from the blood stream.' Oxygen deprivation encourages the growth of blood vessels into the cornea, which over time cause vision to become milky and cloudy. 'Such changes can only be spotted by an eye examination, and in severe cases, if not treated in time, a corneal graft can be needed. A check every six months, even if everything seems fine, is essential,' says Morris.

The perfect material is soft and comfortable to wear, yet doesn't deprive the cornea of its essential oxygen supply. Materials like silicone, which allows oxygen exchange, are added to lenses to increase permeability. Such lenses may offer the advantages of extended wear without the risks of long-term oxygen deprivation or infection associated with extended wear in the past. However, highly permeable materials can cause lenses to clog up with protein more quickly, and manufacturers are still trying to find a balance between the comfort of the soft lens and the permeability of the hard types.

High water content lenses, normally soft lenses, are made of very permeable material. These absorb water, but when left in air may shrink, become very brittle and need to be hydrated. People working at VDUs all day and in dry, air-conditioned environments may find their eyes become very dry, and need rewetting solutions to prevent the surface of the lens drying out.

However happily you may have worn contacts, sometimes eyes decide they've had enough. The eye tends to get drier as we age, and as the surface of the white of the eye becomes less smooth, contacts can become a nuisance to wear. 'I see many in their 30s and 40s who are finding it difficult to keep going with contacts,' says David Gartry, consultant ophthalmic surgeon at Moorfields Eye Hospital, who performs photo refractive keratectomy (PRK) and Lasik - excimer laser in situ keratomileusis - surgery.

In the UK, PRK is the more established treatment, introduced in 1989 with more than 30,000 procedures to date. Lasik, developed in 1991 and a relative newcomer here, clocked up around 3,000 operations in the UK, although in the US it is fast overtaking the older laser method. While PRK removes minute slivers of the surface of the cornea (1/4000th of a millimetre per laser pulse), Lasik makes more substantial corrections to the cornea possible, because it first lifts a surface flap on the cornea and then lasers the deeper layer of tissue.

Lasik offers quicker healing and less scarring of the cornea, which means more reliable results and less discomfort for the patient. However, in the UK PRK remains the favoured method for correcting low levels of short-sightedness, up to -3 dioptres, with Lasik preferred for myopia of -4 to -12.

Most surgery is done for short sight. Far-sightedness is more difficult because more of the cornea needs to be removed. For problems of +2 or +3 PRK can work well, and Lasik can tackle up to +4 or +5, but over this, it's not recommended. Another technique recently introduced into the UK by the private Ultralase Group claims to do away with the need for reading glasses. It places four tiny plastic implants into flaps along the white of the eye, around the cornea. These are said to take up the slack in the ageing muscles. But David Gartry warns: 'This is an experimental technique. I would be very wary of disturbing that part of the white because of the risk of disrupting the blood supply, which is potentially very dangerous.' So far, success rates for Lasik surgery have been impressive: 'With PRK, patients have a 90% chance of restoring their vision to a perfect 0; with Lasik, which we use to treat more extreme vision problems, we're hoping it will be around 95%,' says Gartry.

The rate is around £1,200 per eye for Lasik and £800 for PRK. For many it's a price worth paying. 'There's no doubt that the surgery makes a huge difference to quality of life,' says Gartry, 'The improvements can be stunning.'

• A patient's guide to excimer laser photoreactive surgery, cost £5, is available from Royal College of Ophthalmologists, 17 Cornwall Terrace, London NW1 4QW.

Flap and zap - how vision is restored surgically

Lasik (laser in situ keratomileusis) combines surgery to create a thin, hinged corneal flap with excimer laser treatment. The eye is numbed with anaesthetic drops, and a fine surgical blade that has been described as a high-tech bacon slicer, is used to slice a corneal flap. This is lifted and turned to one side, and a series of laser pulses used to remove corneal tissue.

There can be a mild sensation of tapping on the eye, but otherwise it's painless. The flap is replaced and normally settles firmly into place within three to five minutes. There is no need for stitches.

There's normally minor discomfort afterwards, but vision begins to improve within 12 hours and is normally good within two days. One patient drove home 400 miles the day after his operation.

Complications include minor over-correction or under-correction of vision, and a small risk of infection. Research suggests that in up to 4 per cent of cases, eyesight may be worsened, or may not be improved enough to dispense with glasses after the first operation.