Why can’t I see up close anymore? Presbyopia and how it affects our vision.

Presbyopia is the age-related change of the eyes that results in the inability to focus on near objects or reading things up close. This is part of the normal aging process that happens to everyone’s eyes. Unfortunately, at this time there is nothing to slow down this change, but there are certain studies and clinical trials in progress to test new medications.
 

The natural lens inside the eye is located just behind the iris, the colored part of the eye. The lens is attached to the ciliary body (a muscle), by little fibers called zonules. When we want to look at something up close, the muscle inside the eye flexes and the zonules shift the lens changing its shape. After the lens changes shape, we can see and focus on things that are near. And to see far again, the reverse happens. We relax the muscle in the eyes, the zonules pull on the lens again and the shape of the lens changes to focus on the distance. This is done automatically by our nervous system, and you typically don’t have to think twice about it!
 

Starting around age 40, the lens inside the eye begins a gradual degeneration as it slowly turns into a cataract. Similar to our hair turning white as we age, its out of our control. As the lens ages it becomes more stiff and rigid and loses its flexibility, and thus we lose the ability to focus on things up close. Over the next two decades our near vision will continue to worsen until around age 60. As this happens, you will need an increasingly stronger reading power in your lenses. Presbyopia sucks, but don’t worry there are plenty of options out there to help. Let’s “see” what we can do about it.
 

Over-the-counter readers: They’re inexpensive, they can be purchased almost anywhere, but they’re a hassle and they’re always getting lost. On for near, off for distance. On the top of your head, on the end of your nose, around your shirt collar. On, off, on, off, on, off… They’re easy and annoying, but they are an option.
 

Progressive Addition Lenses (PALs): These are the latest technology for glasses. They have the distance at the top of the lens and “progressively” increase in reading power towards the bottom. They are an effective way to be able to see near and far at the same time without having to remove your glasses. They even have a benefit of midrange (computer), unlike traditional lined bifocals.
 

Multifocal contact lenses: These utilize a unique design inside of the contact lens that allow wearers to be able to see near and far with the same lens. There are multiple different lens design options that your optometrist may choose from, and some may “gel” better with your eyes than others.  In most cases you will need to try several different lenses or combinations to figure out the best fit for your vision and comfort.  
 

Monovision: This setup uses one eye for distance and one eye for reading. This can be achieved with contact lenses, LASIK surgery, and even lens extraction surgery, or a monocle if you’re into that sort of thing. There will be a loss of depth perception and a slight loss of acuity since your eyes always see better together.
 

Eye drops: There are new pharmaceutical eye drops that work by activating the iris and ciliary body and constricting the pupil. Whenever we look at something up close our pupils constrict.  Just like a camera lens, a smaller aperture size allows for a greater depth of focus. These drops last roughly 8 hours and shouldn’t be used after a certain time period since they may have a negative impact on our nighttime vision. Our pupils dilate when it’s dark in order to allow more light to enter the eye, and these drops prevent that from happening.
 

Clear lens extraction / Cataract surgery: This surgical procedure removes the clear natural lens or cloudy cataract in the eye and replaces it with an implant that closely matches your glasses prescription. There are options and upgrades to help improve your vision for both distance and reading.
 

Presbyopia isn’t new, but it may be new to you. You don’t have to suffer with eye strain, headaches, squinting, holding your reading material as far as your arms will go, or making the font size on your digital device so large that everyone around you can read it. There are plenty of options out there and your optometrist will be happy to discuss what may work best for you and your lifestyle. The only thing holding you back is you. So, if you haven’t had your eyes checked lately, schedule an examination, and explore the possibilities to regain your near vision back!