More than reading glasses – new options for ‘old’ eyes

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The restaurant had tablecloths, dim lighting, and large leather-bound menus with a fancy script outlining the fare. But those otherwise attractive features meant I had to hold the oversized menu above the table at arm’s length to make my choices. My table mates laughed as they grabbed their reading glasses.

Doctors call it presbyopia, a term rooted in Greek and meaning “old eye,” and it happens to everyone at some point. Some people notice that their near vision starts to blur in our 40s, many of us experience it in our 50s, and pretty much everyone deals with it after 60.

“Your chances are 100%,” says Peter McDonnell, an ophthalmologist and director of the Wilmer Eye Institute at Johns Hopkins University in Baltimore.

The good news is that there are many ways to manage presbyopia. But first, let’s see what happens in the eye to cause the blur.

The lens of your eye sits just behind the colored iris. In young people, the lens is soft and flexible and able to change shape from far to near. However, as people age, “the inner lens loses its elasticity,” says ophthalmologist Brian Boxer Wachler, founder of the Boxer Wachler Vision Institute in Beverly Hills, California.

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Change happens gradually, McDonnell says, and the process begins when you’re still a young adult. People don’t realize this until they’re middle-aged because “we have an accommodating reserve,” he says.

This means we’re starting life with internal lenses so flexible that people can handle focus changes even after hardening begins. The age at which people first experience vision changes varies greatly and can be influenced by a person’s activities. For example, people whose jobs require close vision might notice their deficit sooner than those who don’t face such demands.

“We can compensate with things like long arms and big fonts,” says Karolinne Rocha, an ophthalmologist at the Storm Eye Institute at the Medical University of South Carolina in Charleston. Rocha recently reviewed various treatments for presbyopia.

Working or reading in brighter light can also help. “It gives more light to the retina at the back of the eye,” says Boxer Wachler. Bright light also causes the pupil to constrict, promoting a pinhole effect, which reduces distortion by limiting your eyes to the straightest, most focused light rays.

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A purse of other lifestyle and environmental considerations: High contrast between text and page (or screen) makes it easier to read compared to yellowed pages or restaurant lighting. Fatigue plays a role; people may find it harder to concentrate in the morning or when they are sick. Distance matters, of course, which means you might need these reading glasses for reading a novel, but not when working at the computer.

There are also a multitude of technological and medical solutions. Reading glasses, of course, also called “readers” or “cheaters”, are the first choice for many. They are cheap, available in pharmacies and come in several strengths. Ratings of +1, +1.25, +1.5 are in diopter strength units. (Diopter refers to the focal length of a lens.)

McDonnell recommends trying on a few glasses of different strength and reading something – maybe on your phone or in a magazine.

Choose the lowest reading power that lets you concentrate while reading, says Boxer Wachler.

Presbyopia, says Rocha, “may be the first sign of aging for people with perfect vision.” Farsighted people may notice the need for reading glasses, while nearsighted people usually take off their usual glasses to read.

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If you already wear corrective lenses of any kind – glasses or contacts – you may want to consider bifocals or progressive lenses. These are lenses with distance correction at the top and reading correction at the bottom, allowing people to change their focus by adjusting the part of the lens through which they look.

Another option is the monovision approach. This means correcting one eye for distance (usually the dominant eye) and correcting the other eye for reading. This may take some getting used to, as the eyes and brain adapt to give each eye a separate job.

“Ninety percent of the people we test in the office do very well,” says Boxer Wachler. “In the remaining 10%, it doesn’t work.”

An alternative to reading glasses or corrective contact lenses are prescription eye drops, sold under the Vuity brand and approved by the Food and Drug Administration in 2021 for use. The drops, intended for use once a day, contain a drug called pilocarpine which constricts the pupil to create the pinhole effect, preventing foreign light rays from entering the eye with their foreign information.

In studies, the drops have been shown to improve near vision without affecting distance vision for about six hours. Some people have reported headaches as a side effect.

But the benefits were limited, says Boxer Wachler. Of those who used the drops daily for a month, 30% were able to read three additional lines of letters on a near vision assessment chart.

“That means 70% of people saw no improvement or less than three lines of improvement,” he says.

This modest effect might be more helpful for people in the early stages of presbyopia, who don’t need much corrective help.

A second eye drop treatment, still being studied, is said to soften the lens itself.

Ophthalmologists can offer surgeries to correct presbyopia, such as corneal inlays, LASIK, photorefractive keratectomy, and lens implants.

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If you notice changes in your vision, you can purchase a pair of reading glasses. But McDonnell says it might be worth seeing an eye doctor.

“When you start to reach the age of wisdom,” he says, i.e. in your 60s, it’s worth getting checked for other age-related eye conditions such as cataracts, macular degeneration and glaucoma. Ophthalmologists can advise you on the many options for presbyopia.

It’s a universal problem that affects quality of life – a topic McDonnell researched a few years ago. But with all the options available, you should be able to customize a fix that works for you.

Luz W. German