You may not need glasses when you’re young, but as you age, you may find yourself reaching for a pair. The urge typically develops one day while looking at a menu, a newspaper, or an exit sign on the freeway.
So why does it happen, and can we do anything to change it?
Presbyopia is part of the aging process. Just as your body may begin to lose flexibility as you get older, your eyes also lose the flexibility they once had.
When our eyes are in their prime, we typically take our vision for granted. But seeing is a complex affair, and it’s a very sophisticated organ that delivers the images.
One part of the eye that contributes to our sight is called the lens. Unlike a camera lens (which focuses on details by adjusting the distance between two glass discs), the lens of your eye actually changes shape, becoming flatter or more curved depending on whether the objects you’re looking at are near or far.
However, as our eyes grow older, their once-dynamic lenses start to stiffen. As a result, they lose the ability to view things up close.
Solving the Problem Via SpectaclesDifficulty reading small print is a telltale sign of presbyopia, but the condition doesn’t just impact jobs that require reading. A study published in a 2018 edition of The Lancet looked at tea pickers in India who were older than 40 years of age. This randomized study is known as the PROSPER trial, which stands for productivity study of presbyopia elimination in rural-dwellers. Researchers found that providing workers with reading glasses increased the daily weight of tea picked by nearly 22 percent compared to the control group.
When it comes to treating presbyopia, wearing glasses remains the most common approach. Basic reading glasses are found in most drug stores and can be purchased for only a few dollars. It’s affordable to own several pairs, which can be placed in the car, office, living room, or any location where you might have to read fine print, pick tea, or do some other detail-oriented task.
Glasses serve as a magnifying glass to assist your eye in doing what it no longer can on its own. The basic design of spectacles has been around for a few hundred years, but simpler prototypes existed much earlier. Monks in the Middle Ages, for example, used glass spheres to read manuscripts.
Eye DropsGlasses are tried-and-true and for years had been the only option for dealing with presbyopia. But a number of alternatives are now available.
Vuity is a very dilute solution of the chemical pilocarpine hydrochloride. The drops work by reducing the pupil size, making it easier for the eyes to see up close. Recommended use is once per day for adults with mild to moderate presbyopia, but even with this small dosage, there are some cautions. The drug's maker, Allergan, warns that Vuity may cause temporary dim or dark vision and urges those who use it to take care while driving at night or performing hazardous activities in poor lighting.
Temporary problems when changing focus between near and distant objects may also occur. However, some of the more worrisome side effects include sudden onset of flashing lights, floaters, or vision loss.
Exercise and LifestyleAging is a fact of life, but can we keep it from taking such a strong toll?
People can regain some of the strength and flexibility of their aging bodies by eating healthy food and exercising regularly. But can such habits preserve or perhaps even improve our vision as well?
Dr. Saenz says there are obstacles to aging eyes that make it difficult.
“The problem in presbyopia is not the muscle, it's the replication of the skin-like cells in the lens,” he said. “Currently, there is no way to stop these cells from replicating or these bonds from forming.”
“This may be the reason why in the south we see presbyopia a few years sooner than for patients in the north,” Dr. Saenz said.
Other supplements often recommended for eye health include lutein, zeaxanthin, and bilberry.
Periods of rest and relaxation are always important for good health, so consider giving your eyes a well-deserved break once in a while as well. Dr. Grossman mentioned one easy habit that you can try to put into practice.
“I advise adhering to the 20/20/20 rule of every 20 minutes, looking 20 feet away for 20 seconds to relax the eyes,” Dr. Grossman said.
Another way to give your up-close vision a break is to manage your screen time and spend some hours away from your favorite devices.
“They can damage the eye silently over a period of time,” Dr. Grossman said.
Surgical SolutionsSurgery is a newer option for addressing presbyopia, and the most common technique is LASIK—a procedure used to reshape the cornea (a part of the eye beneath the lens) using lasers. However, success depends on several factors.
LASIK can’t help bring the lens of your eye the flexibility it once had, but it can provide an option to improve near vision. Dr. Saenz explained one common strategy using LASIK for presbyopia that involves shaping one eye for better near vision and leaving the other eye dedicated to distance-vision duties.
The results can take some getting used to, and not everyone can comfortably make the adjustment. And even those who can adjust may eventually need glasses anyway.
“As you age, and the lens gets harder, you will need to wear glasses for up close again,” Dr. Saenz said. “Now, many patients are okay with this, because for 80 percent of activities, they aren't wearing glasses, it's just for the tiny objects up close.”
Dr. Saenz’s preferred surgical technique for presbyopia is a newer procedure. It’s called laser lens treatment, or refractive lens exchange.
The procedure involves a laser that's used to break up the lens cells that have hardened over time. Next, the patient receives an intraocular lens placed just beneath the surface of the eye.
“The lens used most commonly is a trifocal lens, and this allows patients to see at distance, intermediate (computer range), and up close,” Dr. Saenz said. “This is a diffractive lens, meaning the No. 1 side effect will be circles on the lights at night, but your brain adapts over a three- to six-month period.”