When we all get into our 40s and 50s, we can find ourselves moving our arms in and out like an accordion to read documents, labels, and our cellphones. This difficulty or change in our near vision in our more mature years is known as Presbyopia. As Dr. Grewal always says, it happens to all of us as we get wiser!
Behind the iris (coloured part of the eye), we have a structure called the crystalline lens (lens). When we are first born, the lens is flexible, and accommodates to the distance at which we are viewing something by changing its shape. The lens slowly starts to lose its flexibility over time, partially due to changes in some of the proteins that make up the lens, and partially due to its continual increasing thickness.
As the lens loses its flexibility, it feels as though our range of vision is slowly pulling away from us. Whether we have worn glasses or contact lenses our whole lives or not, this change in the lens’ ability to accommodate will happen to all of us. If we have never worn glasses or are hyperopic (already farsighted), we will find ourselves holding things out farther to read up close, with or without our glasses. For those that are myopic (nearsighted), it becomes increasingly easier to see up close by removing our glasses.
Over time, as more and more flexibility is lost, it becomes more difficult to see not just up close, but also intermediate distances like the computer and the dashboard in the car.
Treatment for Presbyopia
Glasses, contact lenses and elective refractive surgery are all options for treating presbyopia.
With respect to glasses, there are various options available. One can have separate near vs distance glasses. This can be a great option if you spend large amounts of time dedicated to tasks at a particular distance. Bifocal (“2 focal points”) spectacle lenses are not as commonly recommended in today’s era of technology; these lenses have the distance correction separated from the near correction by a sharp demarcation or line, and do not provide a zone for intermediate viewing like the computer. Trifocal (“3 focal points”) lenses do have an intermediate zone, but what Dr. Grewal recommends are Multifocal or Progressive Addition Lenses. There are no harsh lines separating distinct focal distances; instead, multifocal lenses have a zone that gradually (progressively) changes from your distance power to your reading power. This provides a smooth range of vision that includes intermediate zones like the dashboard in your car, desktop computer, and laptop, in addition of course to handheld reading material and smartphones. If you are a multitasker, this lens option can be quite convenient.
Contact lenses for presbyopia have come a long way. We have daily, biweekly, and monthly disposable options in contact lenses that will allow you to see far and near, known as multifocal contact lenses. Whether you want to wear contact lenses every day, for sports, or just want to have the option of wearing them on special occasions, there are plenty of options available. Going to the theatre or a concert after dinner out with friends? Multifocal contact lenses can allow you to read a menu and see that performance without carrying (multiple pairs of) glasses with you.
Refractive surgery is also an option for presbyopia management. LASIK or laser surgery can be used to create what we call monovision – where one eye sees predominately in the distance, and the fellow eye is treated to see better up close. Special inlays like the Kamra inlay, can be surgically implanted in to one eye to help it focus better at near working distances, by changing how light is focused (like a camera). The crystalline lens can be removed and replaced with an artificial implant to allow for near and distance viewing.
All of these treatment options can be discussed with Dr. Grewal at your visit; she will work with you to find the right (combination of) option(s) based on your day-to-day needs and lifestyle. Schedule your visit today!