Welcome to the midlife version of Simon Says, a nearly universal condition known as presbyopia, which translates roughly to "elderly eye" (as if crow's feet weren't enough). It usually starts in your early 40s, as the lens of the eye stiffens, losing its ability to focus and making it difficult to see objects up close, explains Ruth D. Williams, M.D., president-elect of the American Academy of Ophthalmology. There are four million new cases a year, and the number will keep growing as the population ages, with people holding their books and menus farther and farther from their eyes.
While presbyopia comes on gradually, it may feel very sudden: One day even squinting isn't enough to make out a text-message, or you can't thread a needle. An ophthalmologist or optometrist can make the official diagnosis — and determine what to do about it — by having you read the eye chart while looking through lenses.
If you've never had eye trouble before, you may do fine with nonprescription reading glasses (the kind you can buy in drugstores). But as you struggle to see objects that are closest to you, you'll likely need your vision corrected professionally. And if you enter midlife with an existing vision issue, you may now need a new prescription — possibly progressive lenses, which give you multiple corrections within one lens (unlike the old bifocals, which only corrected for far and near distance).
So, if you haven't had your eyes examined recently, make an appointment. You should have a baseline exam by age 40, says the American Academy of Ophthalmology, and then schedule follow-up checks as often as your doctor recommends.
If you're one of the more than 35 million lucky Americans who have a Flexible Spending Account (FSA), this is the perfect time for that exam (and any new lenses and frames). While the IRS now allows employers to extend the spending deadline till March 15, the grace period is optional, so you may have only until December 31 to use up your funds. Here, to start, the vision problems that commonly strike at midlife and, based on the latest research, the best ways to solve them.
The Problem: Your new reading glasses seem fine at the drugstore, but once you get home, they aren't strong enough.
The Fix: Bring a book or your knitting or use the fine print on a pill bottle for your own eye test. "The letter charts in stores are fairly generic," says Diane Charles, an optician in Redmond, WA. "You may not be able to gauge how well you can make out the things you need to see in your own life." Also, off-the-rack readers may not work for you. "Most people need separate prescriptions for each eye," says Charles.
The Problem: Even though you're wearing your glasses, you can't make out the computer display clearly.
The Fix: Higher-tech lenses. Up to 90% of people who work on computers all day suffer from eyestrain, blurriness, and other symptoms of "computer vision syndrome," reports the American Optometric Association.
If you're using bifocals or progressive lenses, you may also suffer muscle strain as you crane your neck to use the narrow "middle band" within your prescription. You can have multifocals made so more space is allotted to computer distance. Also, many companies have introduced digitally produced progressive lenses (depending on the manufacturer, they may be described as "free-form," "digitized," "digitally surfaced," or "HD"), which can provide a wider field of vision than the 80% that older progressive models do. In a study at the University of California, Berkeley, School of Optometry, 95 people spent one week using progressive lenses and one week using the new free-form kind; the majority reported that the free-form ones gave them a significantly wider field of undistorted vision. Another option: a pair of glasses just for the computer.
The Problem: You love your prescription sunglasses for driving, but you can't tell if the fuel gauge is on "E" or "F."
The Fix: Progressive sunglasses. "People don't automatically think they'll need readers when they're driving," says Dr. Williams. "But you have to look at the speedometer and your navigation system." And when you get your new shades, ask for lenses that block out 99% to 100% of both UVA and UVB radiation and screen out at least 75% of visible light — these filters help prevent premature aging of eyes, which can lead to cataracts.
The Problem: You've worn contacts forever, but suddenly they're painful and scratchy.
The Fix: Moisturizers for your eyes. Dry eye, which is linked to hormonal changes like menopause, affects 22% of women, one large study found. Often, the problem is so subtle, lens wearers may just describe their eyes as gritty or tender, explains Christine W. Sindt, O.D., a contact lens expert at University of Iowa Hospital. There's a wide range of artificial tears, both OTC and prescription, and there are easily inserted punctal plugs doctors can use (like a bathtub stopper) to block tear ducts from draining.
Lifestyle changes can also help, says Dr. Williams. She suggests using a humidifier at home and setting car heaters to "feet only" mode. Get plenty of omega-3 fatty acids, too: A study of more than 32,000 women at Brigham and Women's Hospital found that those who ate more tuna were less likely to have dry eyes than those who ate less or none. Or you can take omega-3 supplements (Dr. Williams recommends 1,000 mg twice a day). Research is still preliminary, but in a recent French study, patients with mild to moderate dry-eye syndrome seemed to show improvement when they took omega-3 supplements for three months (the participants' regimen also included vitamins and zinc, as well as omega-6).
The Problem: You recently switched from off-the-shelf reading glasses to prescription. They work fine most of the time, but not with your iPad.
The Fix: Push your glasses up. People who use store-bought readers tend to wear them low on their noses, explains Shirley Earley, president of the Opticians Association of America. But "real" glasses, especially progressives, are usually fitted higher on the face, so they may take getting used to. If you still have trouble, ask your optician for a refitting; bring your iPad, so she can see where you hold it.
The Problem: When you drive at night, you get glare and weird halos.
The Fix: Coated lenses. In a recent survey of drivers who wore glasses or contacts, 48% said that glare or light sensitivity got to them at night, with 61% bothered by oncoming headlights and 28% troubled by halos. Digital progressive lenses combined with an antireflective coating improve night vision, making it sharper and cutting glare. You can also choose antireflective coating alone. This ultrathin film reduces light reflection from the surface of your lenses, cutting glare and allowing the lenses to transmit more light. Beyond helping with driving, an antireflective coating improves your vision when you're reading with a lamp or on an e-reader or computer.
For contact lens users, there are aspheric lenses, which have a special lens curvature (sometimes called "premium lenses," they also carry a higher price tag). In one study at the University of Iowa National Advanced Driving Simulator, drivers wearing aspheric lenses had significantly improved ability to see oncoming cars compared with a group who wore the conventional variety. Problems with night vision, such as halos around lights, aren't just a driving challenge. They could indicate early cataracts or glaucoma, so it's important to see an eye doctor if you have these issues.
The Problem: You've tried contacts, but they didn't work because of your astigmatism.
The Fix: One of the new toric lenses. Astigmatism, which is blurry vision caused by an abnormally curved cornea, can now be corrected with toric contacts, which have two curvatures — one to correct for nearsightedness or farsightedness (depending on your problem) and one for the astigmatism, explains Sindt. Until recently, there were only a limited number of toric lenses, but today many brands are available, including some made with new, more comfortable materials such as silicone hydrogel. If you decide to go with toric contacts, make sure you put aside enough funds in next year's FSA: They may run between $500 and $700 a year, reports all about vision.com, a consumer website, compared with about $220 to $260 a year for regular contacts replaced at average (not daily-use) rates.
$ave on Eyewear
As you move through your 40s and 50s, rapidly changing prescriptions and multiple pairs of specs can have you seeing red. To keep costs down:
• Stagger Purchases: Even if your eyes have changed, you don't necessarily need to buy new glasses. "Ask your doctor how the new prescription compares to what you're using," says Lynn Gordon, M.D., Ph.D., professor of ophthalmology at UCLA. "Then together you can decide if you need to upgrade or can wait. Maybe you'll buy new sunglasses this year and reading glasses next."
• Shop Online: If you're willing to give up the expert fitting that comes from a shop, Internet sites (search for "online glasses") offer amazingly low prices and stylish choices. For a vintage look, GH Fashion Director Jasmine Chang recommends warbyparker.com; styles cost about $100 (for frames and lenses). To order online, you'll need to send in a recent prescription that includes pupillary distance.
• Find Frames On Ebay: You'll discover designer names like Oakley, Coach, and Dolce & Gabbana, as well as vintage eyewear. Some online opticians on eBay fill prescriptions, too. Otherwise, take the frames to your local optician.
And when you replace old glasses, think about donating your castoffs to Lions Clubs International, which distributes used frames and lenses to needy people around the world. For info on finding a local drop box or for mailing instructions, go to lionsclubs.org.
High-Tech (And High-Priced) Glasses
Two new models may change the way you see the world.Superfocus glasses are fully adjustable. With a quick slide of the focus mechanism, you can see the TV across the room or the tiny type on the remote. Prices start at about $700; for more info, go to superfocus.com. EmPower glasses correct for distance vision, but you can activate reading mode, which changes the molecular structure of transparent liquid crystals in each lens. You can make the switch by touching a corner of the frames or set it to occur automatically when tiny accelerometers sense you are looking down. EmPower glasses cost about $1,200; for more info, go to lifeactivated.com.
As more and more baby boomers hit the "can't see in the distance, can't see up close" phase of their lives, doctors are developing new surgical approaches to help. One technique that enjoyed popularity several years ago — conductive keratoplasty (CK) — turned out to be a disappointment. While it produced good results at first, the improvement was only temporary, says Kraig Scot Bower, M.D., director of refractive surgery at the Wilmer Eye Institute of Johns Hopkins Hospital in Lutherville, MD. In time, patients' vision went back to what it had been before.
However, LASIK, the traditional laser surgery that's been used for many years to correct for nearsightedness and farsightedness, can help with midlife vision challenges. Essentially, the surgeon tweaks the adjustment so that you get corrections for whatever you most need — reading, driving, typing on a BlackBerry. "LASIK treatments are getting better and better," says Dr. Bower. You can also try a monovision approach that corrects your dominant eye for distance vision and your nondominant one for near vision. It sounds tricky, and there is some blurriness with distance vision, but "many patients do extremely well with this," says Dr. Bower.
Before you go ahead, though, it's a good idea to test how much the blurriness bothers you and how well you'll adapt by using monovision contact lenses. Don't make up your mind till you've worn the lenses at least a month, advises Andrea Thau, O.D., associate clinical professor at the SUNY College of Optometry in New York City.
Some doctors also offer monovision corrections using implanted lenses. Even though this technique is a good option for patients needing lens replacements because of cataracts, using it simply to correct for presbyopia is "controversial," says Dr. Bower. "When you're removing a clear lens that didn't need replacing, you have to consider the risks versus the gains."
Originally published on July 20, 2012