(BlackDoctor.org) — When you’re getting older there are a few things you can fake. You can cover your gray hair with dye, you can whiten your teeth, and you can even camouflage your wrinkles with makeup. But your eyesight is a whole other story.
One of the truest signs of aging is discovering that you need to hold menus and newspapers at arm’s length in order to read them. This usually means that presbyopia has set in, a condition in which the lens of the eye loses its ability to focus, making it difficult to see objects up close. This type of farsightedness is associated with aging and gets worse before reaching a plateau. The focusing power of the eye depends on the elasticity of the lens. This elasticity is gradually lost as people age. The result is a slow decrease in the ability of the eye to focus on nearby objects.
People usually notice the condition around age 45, when they realize that they need to hold reading materials farther away in order to focus on them. Presbyopia is a natural part of the aging process and affects practically everyone.
Blurred close vision that leaves eyes tired and strained is an early hint of presbyopia’s arrival. After reading or doing other detail work, you may find it hard to see distant objects clearly; the problem may be more pronounced after reading in poor light, or in the evening when you are tired. The condition occurs regardless of whether you are nearsighted, farsighted or astigmatic. However, presbyopia often affects farsighted people at a younger age than those who are myopic (nearsighted). If you’re nearsighted, you may be able to overcome presbyopia when it first develops simply by taking off your glasses to read. Eventually, however, as your presbyopia worsens and the lens of your eye becomes stiffer, you may need corrective lenses or other measures to cope with this common condition.
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Corrective lenses. The most common remedy for presbyopia is optical correction, a.k.a. reading glasses. If you already wear corrective lenses, you might consider bifocals, trifocals or progressive lenses, which combine several levels of adjustment to correct both distance and close-up vision problems.
Some people use two pairs of glasses—one for distance and one for close work. Many drugstores and supermarkets carry magnifying reading glasses that may help. Consult your ophthalmologist about an appropriate strength before purchasing a pair, and never buy reading glasses in lieu of having an eye examination.
You can also get prescription contact lenses that correct the vision in one eye for reading and the other for distance—a technique called monovision. Multifocal contact lenses (combining several levels of adjustment, as found in reading glasses) are also available. Whichever type of lens you choose, you may need frequent changes in prescription, because presbyopia often becomes progressively worse until about ages 60 to 65, when it stabilizes.
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Surgical monovision. One option for people 40 to 60 years old with presbyopia but otherwise healthy eyes is surgical correction to produce monovision, in which one eye is corrected for close-up vision, leaving the other for distance vision. This approach doesn’t fix the stiffened lenses that are the underlying cause of presbyopia, but it can eliminate the need for bifocals or multiple sets of glasses, and it may even enable you to read without glasses.
Doctors use various procedures to make the correction. Laser surgery techniques include LASIK, photorefractive keratectomy (PRK) and laser thermal keratoplasty (LTK), each of which reshapes the cornea or the area around it to provide correction. (The technique used depends on your particular circumstances.)
If you choose laser surgery and never had focusing problems until presbyopia developed, the surgeon will correct one eye so you can see up close, leaving the other eye with your natural ability to see far. If you’re both myopic and presbyopic, the doctor can correct your nondominant eye for near vision and your dominant eye for distance. It may take several surgeries to get the desired result, and the results may not be lasting.
Another technique used for monovision is conductive keratoplasty (CK). This method is similar to laser surgery but doesn’t actually use a laser. Instead, CK uses short bursts of radio waves to shrink and reshape the cornea. One limitation is that it can take a few months before the full benefits are apparent. CK may also carry a slight risk of causing astigmatism.
Monovision isn’t for everyone. It is vital that your eyes are healthy, even if you have presbyopia; no other eye defects, such as cataracts, glaucoma or corneal problems can be present. Some people may find it too difficult to adjust to having different focusing abilities in each eye. If you’re considering having this surgery, the FDA advises you to try monovision with contact lenses first, to find out whether you can adjust to having each eye focus differently.
Lens-replacement surgery. Improvements in the lenses used for cataract surgery have also provided another surgical option for people with presbyopia—albeit one that is an “off-label” use, meaning it’s not FDA approved, and one that is controversial. Variable-focus, implantable lenses enable people who undergo cataract surgery to see objects at various distances. Some ophthalmologists are now implanting these lenses in people without cataracts in order to correct presbyopia. This requires that your natural lenses be removed first, as is done in cataract surgery.
It’s important to keep two things in mind before undergoing this surgery for presbyopia. First, it will not be covered by insurance unless you have cataracts, and the cost can be as high as $5,000 for each eye. Second, many ophthalmologists are reluctant to perform this procedure in people without cataracts because of the risks and lack of information about long-term safety and effectiveness.
Anterior ciliary sclerotomy. Another procedure that is not FDA approved for presbyopia, but is sometimes performed, is anterior ciliary sclerotomy. In this procedure, the ophthalmologist makes a series of incisions in the sclera, the white outer layer of the eyeball, to provide more room for the lens to change shape with age. The theory behind this approach is not proven, and few studies have been published about its safety or effectiveness.
