As time goes on, one inevitable fact we must face is the need for reading glasses.
As we get older, the lens inside our eye that allows us to focus on objects both far and near loses some of its elasticity. This makes the viewing of near objects difficult — a condition known as presbyopia.
Many people with presbyopia cringe at the idea of wearing bifocals or granny-style reading glasses. Fortunately, these are only two of the many options available for correcting this age-related vision problem.
Contact Lenses for Presbyopes
Multifocal lenses are the most common option employed by eye care professionals (ECPs) for the correction of presbyopia.
As its name implies, a multi-focal lens has more than one focal length: one for reading and the other for distance vision. Some even have a third focal length for intermediate vision such as a tri-focal or progressive lens.
Two things about this lens that many wearers find undesirable are the obvious line and something called an image jump. Viewing through the distance area and changing to view through the reading area can cause the image to “jump” into the reading segment.
So why do some people wear bifocals and other trifocals? Is there an advantage of one over the other? This depends on the person. Often people with advanced presbyopia need that extra help to view images at an intermediate viewing distance that is not quite near not quite far. Others whose visual requirements require the need for intermediate vision such as certain hobbies and work tasks. For those who wish to be a little more discrete about their visual needs, there is the progressive lens.
The progressive lens was introduced over 40 years ago and has become one of the most intricate and advanced lenses on the market. It incorporates a top section for the distance and intermediate channel that transitions into the reading area. This provides the wearer with continuous vision. Lens designs vary in corridor length, width, and depth, as well as reading size and placement.
A drawback of the progressive lens is the limited reading area and the slight blurriness that is located at the lower nasal and temporal periphery of the lens. These blending zones are the areas that combine the many curvatures found on a progressive lens. The blending zones are the unused areas of the lens but these areas can cause a “swimming” feeling for the wearer.
Many progressive lens designs today are created with a softer design. A hard design has a high concentration of blur in the blending zones whereas a softer design spreads out the blur to decrease its intensity.
The first time you put on progressive lenses can be a bit frustrating. Typically, it can take up to a week to fully adjust to these lenses. You must learn to move your head to look at an object as opposed to moving your eyes. Moving the eyes can cause the wearer to look through the reading section when the situation requires viewing through the distance area.
Various styles of bifocal contact lenses are currently on the market with varying designs. One design resembles a lined bi-focal lens, which is called a translating or alternating lens. This design is only available in hard or rigid gas-permeable lenses. Hard lenses are designed to “float” on the tear film that covers the cornea. This allows for the free exchange of tears which is essential for optimal eye health and comfort. The translating design functions by having the wearer look downward to read through the lower portion of the lens, which is the near correction, and straight ahead for distance vision. This setup mimics the action of traditional bifocal glasses but without the visible lines.
Another design is the simultaneous vision lens, which is available in both soft and hard contact lenses. These lenses allow the wearer to see both near and far simultaneously through the same part of the lens. The lens is designed with concentric rings or zones where different powers are placed for near and distance vision. The brain learns to select the correct focus for the viewing situation, although some wearers may experience a period of adjustment where vision may not seem as crisp as with monovision or separate distance and reading glasses.
Monovision is another strategy that involves wearing a contact lens for distance vision in one eye and a lens for near vision in the other eye. This approach can be surprisingly effective, allowing the brain to adapt by using one eye primarily for distance viewing and the other for close work. However, it might not be suitable for everyone, as it can affect depth perception and the ability to perceive fine details. A trial period under the guidance of an ECP is essential to determine if monovision is a good option for the individual.
For those seeking a more permanent solution to presbyopia, there are several surgical options available.
Laser eye surgery, such as LASIK, can be used to create a monovision correction, similar to the contact lens approach. More advanced procedures like conductive keratoplasty (CK) use radiofrequency energy to reshape the cornea for improved near vision in one eye.
Lens implants are another option, where the eye’s natural lens is replaced with an artificial intraocular lens (IOL) designed to provide multifocal vision. This procedure is similar to cataract surgery and can be an effective solution for those who are also experiencing cataracts.
In addition to these corrective measures, making lifestyle adjustments can also help manage the effects of presbyopia. Increasing font size on digital devices, using adequate lighting when reading, and taking regular breaks to rest the eyes can all contribute to reducing eyestrain and discomfort associated with presbyopia.
Presbyopia is a universal condition that affects everyone to some degree as they age, but it doesn’t have to significantly impact your quality of life.
With a variety of corrective options available, from innovative contact lenses and progressive glasses to surgical interventions and lifestyle adjustments, there is a solution that can work for nearly everyone.
It’s important to consult with an ECP to explore these options and find the best solution based on your vision needs, lifestyle, and preferences.