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The restaurant had tablecloths, little lighting and large, leather-bound menus with a fantastic script describing the kitchen. But these otherwise appealing features forced me to keep the large menu on the remote table to choose my choices. My tablemates 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 begins to blur at age 40, many of us experience it at age 50, and virtually everyone treats it after age 60.
“Your odds 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 manage presbyopia. But first, let’s see what happens to the eye to cause blur.
The lens of your eye is just behind the colored iris. In young people, the lens is soft and supple and can change shape to change the focus from far to near. As people age, however, “the internal 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 comes gradually, McDonnell says, and the process begins when you’re still a young adult. People don’t realize it until middle age because “we have accommodation accommodating,” he says.
This means that we start life with internal lenses so flexible that people can handle changes of focus even after hardening begins. The age at which people experience vision changes for the first time varies greatly and can be influenced by a person’s activities. For example, people whose work requires a close look may notice their deficit sooner than those who do not face these demands.
“We can make up for it with things like long arms and big fountains,” says Karolinne Rocha, an ophthalmologist at the Storm Eye Institute at South Carolina Medical University in Charleston. Rocha has recently reviewed several treatments for presbyopia.
Working or reading with a brighter light can also help. “It’s giving more light to the retina at the back of the eye,” Boxer Wachler says. Bright light also causes the pupil to contract, favoring a hole effect, which reduces distortion by limiting the eyes to more straight and focused rays of light.
Anyone who ages can suffer from cataracts. Surgery can help remove them.
A bag of other lifestyles and environmental considerations: a high contrast between the text and the page (or screen) helps to read compared to the yellow pages or the lighting of the restaurant. Fatigue plays a role; people may find it harder to concentrate early in the morning or when they are sick. Distance matters, of course, which means you may need these reading glasses when reading a novel, but not when working on the computer.
There are also a lot 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 have a variety of 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 different strength glasses and reading something, maybe on the phone or in a magazine.
Choose the lowest reading power that allows you to focus while reading, says Boxer Wachler.
Presbyopia, says Rocha, “may be the first sign of aging for people with perfect vision.” Hyperopia people may notice the need to wear reading glasses, while nearsighted people usually take off their usual reading glasses.
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If you already wear corrective lenses of some kind (glasses or contact lenses), you can consider bifocal or progressive lenses. These are lenses with distance correction at the top and reading correction at the bottom, which allow people to change their focus by adjusting the part of the lens they are looking at.
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 a while to get used to as your eyes and brain adjust to give each eye a different job.
“In 90 percent of the people we test in the office, they fit in really well,” Boxer Wachler says. “At the other 10 percent, 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 to be used once a day, contain a drug called pilocarpine that contracts the pupil to create the pinhole effect, limiting the entry of strange rays of light into the eye with its strange information.
In studies, the drops were shown to improve near vision without affecting far vision for about six hours. Some people 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 percent were able to read three additional lines of letters on a near vision assessment chart.
“That means 70 percent of people didn’t see any improvement or less than three lines of improvement,” he says.
This modest effect may be more helpful for people in the early stages of presbyopia, who do not need much corrective help.
A second treatment with eye drops, still under investigation, aims to soften the lens.
Ophthalmologists can offer surgical procedures to fix presbyopia, such as corneal inlays, LASIK, photorefractive keratectomy, and lens implants.
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If you experience changes in your vision, you can buy a pair of reading glasses. But McDonnell says it might be worth a visit to an ophthalmologist.
“When you start reaching the age of wisdom,” he says, that is, at age 60, it’s worth checking for other age-related eye conditions, such as cataracts, macular degeneration, and glaucoma. Eye doctors can help advise you on the many options for presbyopia.
It is a universal problem that affects quality of life, an issue that McDonnell studied a few years ago. But with all the options available, you should be able to customize a solution that works for you.