If you’re around 40 and have noticed that you need to hold small print farther and farther away to read, your mind is not playing tricks on you and clearly your arms aren’t getting shorter. But your ability to focus up close may be getting weaker. And this may be happening simply because you’re getting older. You may be dealing with a very common eye condition known as presbyopia — which means “aging eye” in Greek.
While this age-related condition has no cure, it can be managed in many ways. It may be as easy as getting eyeglasses or contact lenses. Surgery is another option. But usually the first step is to have an eye exam with an ophthalmologist or optometrist.
The American Academy of Ophthalmology (AAO) recommends adults have a complete eye exam at age 40, which is when early signs of disease or changes in vision appear. Some adults should see an eye care specialist sooner if they have an eye disease or risk factors, such as diabetes, high blood pressure or a family history of eye disease. AAO recommends people who are 65 and older to have their eyes checked every year or two.
“An eye care specialist can diagnose and determine whether you have presbyopia, which is very common, or another condition that could be more serious,” says Daniel Coden, MD, an ophthalmologist at Scripps Memorial Hospital La Jolla. “Should you notice any changes in your vision, it is very important to see your eye professional to rule out any serious problem.”
Presbyopia is associated with the process of refraction in the eye.
Refraction is the bending of light as it passes through one object to another. In the eye, the cornea and lens bend or refract the rays of light that come through the pupil, so that they focus directly on the retina at the back of the eye. The retina converts the light into messages that are sent through the optic nerve to the brain, where they are interpreted as the images we see. But as the lens of the eye ages, it becomes harder and less flexible and loses its ability to precisely focus light onto the retina. Instead, it focuses light behind the retina, which blurs close vision. Aging also weakens muscle fibers within the eye, making it more difficult to focus on close objects. A refraction assessment will determine if you have presbyopia.
Nearly everyone experiences some degree of presbyopia after age 35. In addition to difficulty reading small print or seeing objects close to you clearly, symptoms may include headaches and eye strain. “The symptoms vary in severity,” says Dr. Coden. “Some people may notice considerable changes in their close vision, while others may not notice as significant a difference.”
People who have other vision problems, such as nearsightedness (myopia), farsightedness (hyperopia), and blurred vision due to irregular corneal shape (astigmatism) can also develop presbyopia.
The exam should include dilation of the eye, a painless procedure which enables the eye care professional to examine your retina for age-related eye diseases. In addition, you will be asked to read small print at a close distance to help determine the degree of presbyopia and how to address it.
Eyeglasses designed for close work (often called readers or cheaters) are the most common solution for presbyopia.
Reading glasses are sold at many drug and department stores in varying strengths and no prescription is required. “Still, it’s a good idea to have your ophthalmologist or optometrist determine which strength is best for you before you purchase them,” Dr. Coden adds. “Even a slightly weaker or stronger prescription than necessary may cause eye strain or headaches.”
People who already wear eyeglasses may be able to switch to bifocals, which have two different prescriptions in one lens that are separated by a visible horizontal line. The top part of the lens corrects for distance vision, while the lower part is for close vision.
Progressive bifocals are a bit different. They offer a gradual transition between the two prescriptions. and do not have visible horizontal lines.
Contact lens wearers may just need reading glasses or may wear a lens for distance vision in one eye — usually your dominant eye — and a lens for close vision in the other, a process called monovision.
Some people choose surgery to reduce or eliminate their dependence on eyeglasses or contacts.
Refractive surgery involves the reshaping of the cornea and is another way to improve or correct your vision if you have presbyopia. The most widely used is laser surgery or LASIK, where a laser is used to reshape the cornea.