Comment The restaurant had tablecloths, dim lighting and large, leather-bound menus with a fanciful script describing the fare. But these otherwise attractive features forced me to hold the oversized menu above the table within arm’s reach to make my selections. My friends at the table laughed as they reached for the reading glasses. Doctors call it presbyopia, a term that has its roots in Greek and means “strong eye,” and it happens to everyone at some point. Some people notice that their near vision starts to blur in their 40s, many of us experience this in our 50s, and almost everyone experiences it after the age of 60. “Your chances 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 look at what happens in the eye to cause the blur. The lens of your eye is located directly behind the colored iris. In young people, the lens is soft and flexible and can change shape to change focus from far to near. As people age, however, “the inner lens loses its elasticity,” says ophthalmologist Brian Boxer Wachler, founder of the Boxer Wachler Vision Institute in Beverly Hills, California. Many children do not get the vision screening they need Change happens gradually, McDonnell says, and the process starts when you’re still a young adult. People don’t get it until they’re in middle age because “we have an adaptive reserve,” he says. This means we start life with internal lenses so flexible that people can manage focus changes even after stiffness sets in. The age at which people first experience vision changes varies widely and can be affected by a person’s activities. For example, people whose work requires close vision may notice their deficit earlier than those who do not face such demands. “We can compensate for things like long arms and large fonts,” says Karolinne Rocha, an ophthalmologist at the Storm Eye Institute at the Medical University of South Carolina in Charleston. Rocha recently reviewed several 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 constrict, causing a pinhole effect, which reduces distortion by limiting your eyes to the straightest and most focused rays of light. Everyone who ages can develop cataracts. Surgery can help remove them. A bag for other lifestyles and environmental factors: High contrast between text and page (or screen) helps reading compared to yellowed pages or restaurant lighting. Fatigue plays a role. People may find it more difficult to focus first thing in the morning or when they are sick. Distance matters, of course, which means you might need those reading glasses when you’re reading a novel, but not when you’re working on the computer. There are also a number of technological and medical fixes. Reading glasses, of course, also called “readers” or “cheaters”, are the first choice for many. They are inexpensive, available at drugstores, and come in a range of strengths. Ratings +1, +1.25, +1.5 are in units of diopter power. (Diopter refers to the focal length of a lens.) McDonnell recommends trying on some glasses of different strengths and reading something — maybe on your phone or 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.” People with nearsightedness may notice the need for reading glasses, while nearsighted people usually take out their regular glasses to read. “I’m going blind. Someone has to help me.” If you already wear corrective lenses of some kind – glasses or contacts – you can consider bifocals or progressive lenses. These are lenses with distance correction on the top and reading correction on the bottom, allowing 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 may take some getting used to as the eyes and brain adjust to giving each eye a separate job. “In 90 percent of the people we test in the office, they adjust very well,” says Boxer Wachler. “In the other 10 percent, it doesn’t work.” An alternative to reading glasses or corrective contact lenses are prescription eye drops, sold under the brand name Vuity and approved by the Food and Drug Administration in 2021 for use. The drops, intended for use once a day, contain a drug called pilocarpine that constricts the pupil to create the pinhole effect, restricting extraneous light rays from entering the eye with their extraneous information. In studies, the drops appeared to improve near vision without affecting distance vision for about six hours. Some people have 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 extra lines of letters on a near vision assessment chart. “That means 70 percent of people saw either no improvement or less than three lines of improvement,” he says. This modest effect may be most helpful for people in the early stages of presbyopia who do not need much corrective help. A second eye drop treatment, still under investigation, is supposed to soften the lens itself. Ophthalmologists may offer surgical procedures to correct presbyopia, such as corneal inlays, LASIK, photorefractive keratectomy, and lens implants. Pandemic stress can cause problems for your eyes. Here’s what you need to know. If you experience changes in your vision, you can purchase a pair of reading glasses. But McDonnell says it might be worth a visit to an eye doctor. “When you start to get to the age of wisdom,” he says, meaning 60, it’s worth getting checked for other age-related eye conditions, such as cataracts, macular degeneration and glaucoma. Ophthalmologists can help advise you about the many options for presbyopia. It’s a global problem that affects quality of life — a topic McDonnell studied a few years ago. But with all the options out there, you should be able to customize a fix that works for you.
