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Doctors call it presbyopia, a term derived from Greek meaning “old eye,” and it happens to everyone at some point. Some people notice that their near vision begins to blur in their 40s, many of us experience it in our 50s, and virtually everyone deals with it after the age of 60.
“Your chances are 100 percent,” says Peter McDonnell, ophthalmologist and director of the Wilmer Eye Institute at Johns Hopkins University in Baltimore.
The good news is that there are many ways to deal with presbyopia. But first let’s see what is happening in the eye to cause the blurring.
The lens of your eye sits just behind the colored iris. In young people, the lens is soft and flexible and can change shape to shift focus from distance to near. However, as we 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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The change is gradual, McDonnell says, and the process begins when you’re still a young adult. People don’t notice it until middle age because “we have an adaptive reserve,” he says.
That means we start life with internal lenses flexible enough that people can handle focus changes even after stiffening has started. The age at which people first notice vision problems varies widely and can be influenced by a person’s activities. For example, people whose work requires close vision might notice their deficit earlier than those who are not exposed to such demands.
“We can compensate for that with things like long arms and big typefaces,” 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 contract, promoting a pinhole effect that reduces distortion by confining your eyes to the straightest and most focused rays of light.
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A grab bag 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 part; People may have a harder time concentrating in the morning or when they are sick. Distance matters, of course, which means you might need these reading glasses if you’re reading a novel, but not if you’re working on a computer.
There are also a variety of technological and medical fixes. Reading glasses, also called “readers” or “cheats”, are of course the first choice for many. They’re cheap, 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 a lens.)
McDonnell recommends trying on a few different prescription glasses and reading something — maybe 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 find they need reading glasses, while nearsighted people typically remove their regular glasses to read.
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If you already wear corrective lenses – glasses or contacts – you should consider bifocals or progressive lenses. These are lenses with distance correction at the top and reading correction at the bottom that allow people to change their focus by adjusting the part of the lens they’re looking through.
Another option is the monovision approach. This means correcting one eye for distance (usually the dominant eye) and the other eye for reading. It can take some getting used to as the eyes and brain get used to assigning each eye a specific task.
“90 percent of the people we test in the office adapt very well,” says Boxer Wachler. “It doesn’t work for the other 10 percent.”
An alternative to reading glasses or corrective contact lenses are prescription eye drops, sold under the brand name Vuity, which will be approved for use by the Food and Drug Administration in 2021. The drops, intended for use once a day, contain a drug called pilocarpine, which contracts the pupil to create the pinhole effect, blocking extraneous rays of light from entering the eye with their extraneous information.
Studies have shown that the drops improve near vision without affecting distance vision for around six hours. Some people have reported headaches as a side effect.
But the benefits were limited, Boxer Wachler says. Of those who took the drops daily for a month, 30 percent were able to read three extra rows of letters on a near vision rating chart.
“That means 70 percent of people saw either no improvement or less than three lines of improvement,” he says.
This modest effect is perhaps most useful for people in the early stages of presbyopia who don’t need much corrective help.
A second eye drop treatment, which is still being studied, is said to soften the lens itself.
Ophthalmologists may offer surgical procedures to correct presbyopia, such as: B. Corneal inlays, LASIK, photorefractive keratectomy and lens implants.
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If you notice changes in your vision, you can buy reading glasses. But McDonnell says it might be worth seeing an eye doctor.
“When you start reaching the Age of Wisdom,” he says, meaning the ’60s, it’s worth getting screened for other age-related eye diseases like 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 solution that works for you.
