More than just reading glasses – new options for “old” eyes


The restaurant had tablecloths, low lighting, and large leather-wrapped menus with fancy text describing the fare. But these attractive features forced me to keep a large menu at the table at arm’s length to make my choices. My fellow table mates laughed as they reached for 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 fade in our 40s, many of us have this in our 50s and almost everyone deals with it after the age of 60.

“Your odds are one hundred percent,” says Peter McDonnell, MD, 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’s going on in the eye to create the blurriness.

The lens of your eye is located just behind the colored iris. In young people, the lens is soft, flexible, and able to change shape to switch one’s focus from far to near. As people 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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McDonnell says the change happens gradually, and the process begins when you’re still a young adult. People don’t notice until they’re middle age because “we have a decent reserve,” he said.

This means we start life with highly flexible intraocular lenses so that people can manage focus changes even after sclerosis has begun. The age at which people first experience vision changes varies greatly and may be affected by a person’s activities. For example, people whose work requires close vision may notice their disability sooner than those who do not experience such demands.

“We can compensate with things like long arms and big lines,” says Carolyn Rocha, MD, 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 help, too. “It gives more light to the retina at the back of the eye,” Boxer-Washler says. The bright light also causes the pupils to constrict, enhancing the pinhole effect, reducing distortion by limiting your eyes to straighter, more focused beams of light.

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Environmental and other lifestyle small bag: 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 difficult to focus on first thing in the morning or when they are sick. Distance matters, of course, which means you may need those reading glasses when reading a novel but not when working at the computer.

There is also a range of technological and medical solutions. Reading glasses, also called “readers” or “cheaters,” are the first choice for many. It’s inexpensive, available in drugstores, and has a range of strengths. Degrees +1, +1.25, +1.5 in diopters of force. (The diopter indicates the focal length of the lens.)

McDonnell recommends trying a few different strength glasses and reading something — perhaps on your phone or in a magazine.

Choose the lowest reading strength that allows you to focus while reading, says Boxer Wachler.

Presbyopia “can be the first sign of aging for people with perfect vision,” Rocha says. Far-sighted people may notice the need for reading glasses, while nearsighted people take off their regular 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 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 may take a little getting used to as the eyes and brain adapt to give each eye a distinct function.

“In 90 percent of the people we tested in the office, they coped well,” Boxer Wachler says. “In the remaining 10 percent, it’s not working.”

An alternative to reading glasses or corrective contact lenses is prescription eye drops, which are sold under the brand name Vuity and approved by the Food and Drug Administration in 2021 for use. The drops, which are intended to be used once a day, contain a drug called pilocarpine that contracts the pupil to create a pinhole effect, limiting intrusive rays of light entering the eye with their intrusive information.

Studies have shown that the drops improve near vision without affecting far vision for about six hours. Some people report headaches as a side effect.

Boxer-Washler says the benefits have been limited. Among those who used the drops daily for one month, 30 percent were able to read three additional lines of letters on a near vision assessment chart.

“This means that 70 percent of people saw no improvement or fewer than three lines of improvement,” he says.

This modest effect may be very beneficial for people in the early stages of presbyopia, who do not need much corrective assistance.

A second eyedrop treatment, still under investigation, is claimed to lubricate the lens itself.

Ophthalmologists may offer surgical procedures to repair presbyopia, such as corneal fillings, LASIK, refractive 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 may be worth a visit to an ophthalmologist.

“When you start to reach the age of wisdom,” he says, “meaning you’re in your 60s, it’s worth getting screened for other age-related eye conditions like cataracts, macular degeneration, and glaucoma.” Eye doctors can help advise you about the many options for presbyopia.

It is a global problem that affects quality of life – a topic that McDonnell has studied for several years. But with all the options available, you should be able to customize the fix that works for you.

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