Oct. 25, 2005 -- Like death and taxes, it happens to just about everyone: Presbyopia, or age-related vision loss.
As we age, the lenses of our eyes become thick and stiff, making it harder to focus and see up close. This affects nearly 100 percent of people over age 45, according to the National Library of Medicine.
But rather than wearing reading glasses, many middle-aged and older adults are exploring options from special contact lenses to surgery, said Dr. Deepinder K. Dhaliwal, chief of the Refractive Eye Surgery Department at the University of Pittsburgh Medical Center.
"There is a lot of motivation to turn back the clock, people are more active and they feel young and want to look young," says Dhaliwal. "They don't want to assume the role of an older person. Everyone calls them 'granny glasses' -- that's something patients don't want to do."
But, first off, if you're starting to notice that it's difficult to see up close, it's time for an eye exam, said Dr. Susan MacDonald, director of Comprehensive Ophthalmology at the Lahey Clinic Medical Center in Burlington, Mass.
"You need to get a thorough eye exam to make sure there's no other issue, because this can be a sign of an eye disease or a sign of a systemic disease such as diabetes," MacDonald said.
If the exam reveals no other problems but presbyopia, it's time to discuss treatment options, she said. The first and simplest solution is reading glasses, which can be purchased at pharmacies. There are also bifocal lenses for people who already wear eyeglasses for distance vision.
However, this option doesn't work well for people who dislike glasses or who need to see up close without glasses, Dhaliwal noted.
"It's frustrating for women especially because they can no longer put on eye makeup and see the little things that you used to see," she said.
In that case, the next step is to wear a single contact lens for "monovision." All people have a dominant eye, and just like being left-handed or right-handed, it's typically the right eye. It's naturally set for distance viewing.
So, if a person has good distance vision, placing a contact lens in the non-dominant eye that focuses on close-up vision will allow them to see both near and far. It takes some time for the eyes to get used to this new way of seeing, noted Dr. Barrie Soloway, director of Vision Correction at New York City's Eye and Ear Infirmary.
"Some patients, they'll put (the contact lens) in and say, 'This is making me dizzy.' But monovision tends to get better over time. We have the best supercomputer in the world behind our eyes. If you can let the brain forget that it sees strange, it will process out all that bad stuff," Soloway said.
Still, if that's not a desirable option, there are several surgeries a patient can consider. One of the most widely used is conductive keratoplasty surgery, a short, safe procedure that involves applying radio frequency energy applied to the eye to shrink the collagen in the cornea, or the clear outer covering of the lens and pupil.
Doing so steepens the surface of the cornea, bending the light beams that hit the eye, which allows the eye to focus up close.
Like Botox for wrinkles, "CK is something that may have to be repeated, but it does have good results," MacDonald said.
A more invasive option is a "lensectomy," where the stiff lens is removed and replaced with an artificial one. This is already done for people who develop cataracts, or cloudy lenses, another common eye condition among older adults. New but expensive "multi-focal" lenses allow for both distance and near vision.
"This can be done on patients who don't have cataracts, but the risk-benefit ratio becomes an issue. You're doing a lens-based surgery, with the potential problems of infection," said Soloway, noting that the risk is low, but still something to consider.
Still, Dhaliwal said that it's often an appealing option for people who have presbyopia and the income to afford the surgery, which can cost about $4,000 to $5,000 for each eye. Not only will they never need surgery for cataracts, they'll also be able to see up close and at a distance.
"This is becoming much more popular. People have disposable income more and more often and they want the freedom and the option," she said.
In the coming years, other surgical options may become widely available, such as the insertion of implants in the sclera, or the white part of the eye. This, in theory, relaxes the muscles that control the lens, allowing it to focus. This method is still undergoing testing in clinical trials.
In the meantime, before you consider any eye surgery, MacDonald says it's important to know your surgeon's track record.
"It's surgery and anytime we're operating on your eye, we're putting your eye at risk," MacDonald said. "It's something to have a really lengthy discussion with your surgeon about. Questions of whether they're monitoring the outcomes of their patients, how long they've been doing surgery, and the success rate."