More than reading glasses – new options for ‘old’ eyes



The restaurant had tablecloths, dim lighting, and large leather-bound menus with an imaginative script describing the ride. But these otherwise attractive features forced me to hold the oversized menu above the table at arm’s length to make my choices. My table mates chuckled as they reached for their reading glasses.

Doctors call it presbyopia, a term rooted in Greek meaning “old eye,” and it happens to everyone at some point. Some people notice that their near vision starts to blur in our 40s, many of us experience this in our 50s, and practically everyone has to deal with it after age 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 treat presbyopia. But first, let’s see what happens in the eye to cause the blurriness.

The lens of your eye sits directly behind the colored iris. In young people, the lens is soft and flexible and able to change shape to change focus from far to near. As people age, “the internal lens loses its elasticity,” says ophthalmologist Brian Boxer Wachler, the founder of the Boxer Wachler Vision Institute in Beverly Hills, California.

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The change happens gradually, McDonnell says, and the process begins when you’re still a young adult. People don’t notice it until they’re middle age, because “we have an accommodative reserve,” he says.

That means we’re starting life with internal lenses that are so flexible that people can manage focus changes even after the stiffening kicks in. The age at which people first experience changes in vision varies widely and can be influenced by a person’s activities. For example, people whose work requires good vision notice their shortcomings earlier than those who do not face such demands.

“We can compensate for this with things like long arms and large fonts,” said Karolinne Rocha, an ophthalmologist at the Storm Eye Institute at the Medical University of South Carolina in Charleston. Rocha has 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 contract, promoting a pinhole effect, which reduces distortion by confining your eyes to the straightest and most focused rays of light.

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A grab bag with different lifestyle and environmental considerations: 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 harder to concentrate first thing in the morning or when they are sick. Distance matters, of course, which means you may need those reading glasses if you’re reading a novel, but not if you’re working at the computer.

There is also a large number of technological and medical solutions. Reading glasses, also known as “readers” or “impostors” of course, are the first choice for many. They are inexpensive, available at drug stores, and come in a variety of strengths. The ratings of +1, +1.25, +1.5 are in units of diopter strength. (Diopter refers to the focal length of a lens.)

McDonnell recommends trying on a pair of different prescription glasses and reading something — maybe on your phone or in a magazine.

Choose the lowest reading power that allows you to concentrate while reading, says Boxer Wachler.

Presbyopia, says Rocha, “may be the first sign of aging for people with perfect eyesight.” Farsighted people may find that they need reading glasses, while nearsighted people usually take off their regular glasses to read.

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If you already wear some type of corrective lenses — glasses or contact lenses — you may want to consider bifocals or multifocals. These are lenses with distance correction at the top and reading correction at the bottom, allowing people to change their focus by adjusting the part of the lens they are looking through.

Another option is the monovision approach. That means correcting one eye for distance (usually the dominant eye) and correcting the other eye for reading. It can take some getting used to as the eyes and brain adapt to give each eye a separate task.

“In 90 percent of the people we test in the office, they adapt very well,” says Boxer Wachler. “It doesn’t work for the other 10 percent.”

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

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, Boxer Wachler says. Of those who took the drops daily for a month, 30 percent were able to read three extra lines of letters on a close-up rating card.

“That means 70 percent of people saw 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 don’t need much corrective help.

A second eye drop treatment, still under investigation, would soften the lens itself.

Ophthalmologists may offer surgical procedures to repair presbyopia, such as corneal inlays, LASIK, photorefractive keratectomy, and lens implants.

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If you experience changes in your eyesight, you can buy reading glasses. But McDonnell says it might be worth seeing an eye doctor.

“As you start to reach the age of wisdom,” he says, by which he means you’re 60, it’s worth getting checked for other age-related eye conditions like cataracts, macular degeneration, and glaucoma. Ophthalmologists can advise you on the many possibilities of presbyopia.

It’s a universal problem that affects quality of life – a topic McDonnell studied several years ago. But with all the options out there, you should be able to customize a solution that works for you.