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The restaurant had tablecloths, dim lighting, and large, leather-bound menus with fancy script detailing the fare. But these otherwise attractive features forced me to keep the huge menu above the table at arm’s length to make my selection. My friends at the table laughed as they reached for their reading glasses.
Doctors call it presbyopia, a term rooted in Greek meaning “old eye,” and it happens to everyone at some point. Some people notice that their near vision starts to blur in their 40s, many of us experience it in our 50s, and virtually everyone experiences it after age 60.
“Your chances are 100 percent,” 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 treat presbyopia. But first, let’s look at what happens in the eye to cause the blurring.
The lens of your eye is located just behind the colored iris. In young people, the lens is soft and flexible and can change shape to switch focus from far to near. As we age, however, “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 notice until they’re middle-aged because “we have a reserve to accommodate,” he says.
This means we start life with internal lenses that are so flexible that people can manage changes in focus even after hardening has begun. The age when people first experience vision changes varies widely and can be influenced by a person’s activities. For example, people whose work requires close vision may notice their deficit earlier than those who do not face such demands.
“We can compensate with things like long arms and large fonts,” says Carolyn Rocha, an ophthalmologist at the Medical University of South Carolina’s Storm Eye Institute in Charleston. Rocha recently reviewed various treatments for presbyopia.
Working or reading in brighter light can also help. “This puts more light on the retina at the back of the eye,” says Boxer Wachler. Bright light also causes the pupil to constrict, promoting the pinhole effect, which reduces distortion by limiting your eyes to the straightest and most focused rays of light.
Anyone who ages can get cataracts. Surgery can help remove them.
Take a bag with other lifestyle and environmental considerations: High contrast between text and page (or screen) aids reading compared to yellowed pages or restaurant lighting. Fatigue plays a role; people may find it harder to focus first thing in the morning or when they are sick. Of course, distance matters, which means you might need these reading glasses when you’re reading a novel, but not when you’re working on the computer.
There are also numerous technological and medical fixes. Reading glasses, of course, also called “readers” or “cheaters”, are the first choice for many. They are inexpensive, available at drugstores, and come in a variety of strengths. Ratings of +1, +1.25, +1.5 are in units of diopter power. (Diopter refers to the focal length of the lens.)
McDonnell recommends trying on a few glasses of different strengths and reading something—perhaps on your phone or in a magazine.
Choose the lowest reading power that allows you to focus while reading, says Boxer Wachler.
Presbyopia, Rocha says, “can be the first sign of aging for people with perfect vision.” Farsighted people may notice a need for reading glasses, while nearsighted people usually take off their regular glasses to read.
“I’m going blind.” Someone needs to help me.
If you already wear corrective lenses of some kind – glasses or contact lenses – 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 they peer through.
Another option is the monovision approach. This means correcting one eye for distance (usually the dominant eye) and correcting the other eye for reading. It can take some getting used to as the eyes and brain adjust to giving each eye a separate job.
“For 90 percent of the people we test in the office, they adapt very well,” says Boxer Wachler. “In the other 10 percent, it doesn’t work.”
An alternative to reading glasses or corrective contact lenses are prescription eye drops sold under the brand name Vuity 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 effect of a pinhole, limiting the entry of external light rays into the eye with their external information.
In studies, the drops have been shown to improve near vision without affecting distance vision for about six hours. Some people report headaches as a side effect.
But the benefits were limited, Boxer Wachler says. Of those who used the drops daily for a month, 30 percent were able to read three additional rows of letters on a near vision chart.
“That means 70 percent of people see no improvement or an improvement of less than three orders of magnitude,” he says.
This modest effect may be most beneficial for people in the early stages of presbyopia who do not need much corrective help.
A second eye drop treatment, which is still being studied, is supposed to soften the lens itself.
Ophthalmologists may offer surgical procedures to correct presbyopia, such as corneal inlays, LASIK, photorefractive keratectomy, and lens implantation.
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If you experience changes in your vision, you can buy a pair of reading glasses. But McDonnell says it may be worth seeing an eye doctor.
“When you start reaching the age of wisdom,” he says, referring to the 60s, it’s worth getting screened for other age-related eye diseases, such as cataracts, macular degeneration and glaucoma. Eye doctors can help advise you about the many options for presbyopia.
It’s a universal problem that affects quality of life, a subject McDonnell studied several years ago. But with all the options available, you should be able to customize a fix that works for you.
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