Age-related close-up vision loss- or Presbyopia– is a well-described and predictable process that will be first noticed in individuals in their 40s-50s. The condition manifests with the inability to see clearly objects held within arm’s length. It is the most common vision problem in those over the age of 65.
The word presbyopia means “old eye” or “old sight” in Greek. Although considered a normal part of aging, it can be frustrating for most individuals not only because it signals advancing age but it also often requires reading glasses and corrective lenses.
This brief article will serve to shed light on the condition and show you alternatives to reading glasses. It will further highlight strategies you can adopt in order to protect your vision as you age.
In 2015 it was estimated that 1.8 billion people in the world suffered from this condition and this figure is projected to rise to 2.1 billion by 2020.
In the US, presbyopia is on the rise and is estimated that 123 million people will be affected by presbyopia by 2020.
Before we discuss presbyopia further, do not confuse it with farsightedness- or hyperopia, which is not age-related but manifests with similar symptoms. However, the reasons behind these symptoms are different and hyperopia may affect individuals at any age including children.
What Causes Presbyopia?
Presbyopia is a result of the hardening of the lens inside the eye, a process resulting from changes within the proteins that make up the lens. Furthermore, the muscles surrounding the lens become less compliant as you age. Normally, the lens functions to focus light on the retina by changing shape, this is called accommodation. The closer an object is the harder the muscles around the lens flex to make it rounder. Hardening makes this process ineffective resulting in poor near vision.
Although considered an age-related condition, there are several other factors that may increase your chances of developing presbyopia. These include; excessive alcohol consumption, a poor diet, eye trauma, diabetes, diseases of the heart and blood vessels and multiple-sclerosis, etc.
What are the signs and symptoms of presbyopia?
- Difficulty reading small print or reading up close- thus requiring to hold reading material farther away
- Blurred vision when reading up close.
- Visual fatigue when working on tasks that require close-up vision.
- Headaches and eye strain
Protection & Treatment options; How do I rid myself of reading glasses?
While prevention is part of standard practice in modern health care, there is very little if at all one can do to prevent this age-related deterioration of vision. There’s no proven technique for preventing presbyopia but the following practices can be adopted to improve eye health.
- Have regular eye exams are important for the early detection of any changes in vision.
- Wear sunglasses to protect against UV radiation.
- Use adequate lighting when reading.
- Prevent eye injury by using protective eyewear when engaging in hazardous work or sports.
Even though there is little known in terms of prevention, there are several corrective options that easily improve visual acuity. Well-known treatment options include the more popular reading glasses, progressive lenses, and bifocal lenses. These three options require an individual to wear some form of spectacles. But what if one does not want to put on spectacles? Are there other alternatives?
Yes, there are plenty of other options on the market.
Alternatives to Spectacles
This is a prescription lens that will require regular review to update the prescription as you age. Contact lenses can be multifocal, bifocal, or monovision. Multifocal contact lenses allow for variations in power allowing correction of near, intermediate, and far vision.
Bifocals have prescriptions for near and far vision on the same lens. These two options are designed for individuals with both presbyopia and another vision problem such as far- or short-sightedness.
Lastly, monovision lenses are such that you wear a lens for near vision on one eye and another for distance vision on the other eye. The brain will usually adjust as needed to allow processing of vision.
If both reading glasses and contact lenses are not your favorite choices, then surgery may be an option. There are several options available on the market. These surgical procedures can be broadly categorized into corneal inlays, lens implants, and refractive surgery.
Corneal inlays involve the insertion of a small ring into the cornea of one eye. The ring is placed in the center where light enters akin to a pinhole camera. The Kamra corneal inlay is a popular option in this category, having been FDA approved for the U.S in 2015. It is a 15-minute procedure that is suited for individuals whose only vision problem is presbyopia. Healing time following the procedure is usually between 24-48 hours, no stitches are used.
The second option is lens implants (lens replacement surgery). This is a permanent procedure in which the natural lenses of both eyes are removed and replaced with artificial intraocular lenses (IOL). This option is especially suitable for individuals with presbyopia and farsightedness at the same time. Like corneal inlays, the procedure takes 15 minutes and can be done on an outpatient basis. Each eye is operated on separate occasions 7-10 days apart.
Lastly, there is refractive surgery in which one eye is corrected for near vision by changing the shape of the cornea. It is similar in principle to monovision contact lens and like lens implants is a permanent procedure. There are several options in this category including Laser-assisted in-situ keratomileusis or LASIK, the most popular refractory surgery in the U.S. Other alternatives include LASEK, photorefractive keratectomy, and conductive keratoplasty. The latter option has not gained much popularity among eye surgeons as the correction may diminish over time for some people.
Are there any natural alternatives to prevent or treat presbyopia?
Several vitamins, minerals, and enzymes may improve eye health and potentially delay or slow down the inevitable age-related vision changes. It is noteworthy that the nutrients listed below, have been studied in depth for the prevention and treatment of conditions such as age-related macular degeneration and cataracts. They do however give an indication and proof of principle as to their possible application in the prevention and treatment of presbyopia.
Beta carotene & Vitamin A
Yellow and red-fleshed fruits and vegetables are known to contain beta carotene which when consumed convert to Vitamin A. Vitamin A is generally excellent for eye health especially the retina. There are no studies directly linking Vitamin A and presbyopia, nonetheless one cannot go wrong with such a beneficial nutrient.
Is a powerful antioxidant and has been shown to protect from age-related macular degeneration, an age-related condition affecting the retina. Moreover, it has been shown to lower the risk of developing cataracts. The latter protective effect on the lens indicates that it may offer possible protection against the age-related degeneration of the lens.
Like Vitamin C, vitamin E has beneficial effects on eye health showing a reduction in cataracts in those individuals with a high dietary intake.
Lutein is a naturally occurring carotenoid. Daily supplementation with 20mg lutein was found to improve vision in dim light. Foods that contain lutein include green leafy vegetables like spinach, kale, and eggs.
Omega 3 fatty acids
Found in fish such as salmon and sardines. It is a well-known anti-inflammatory, meaning it regulates the body’s response to injury or disease. It is known to be preventive for age-related macular degeneration. Being an anti-inflammatory, it has the potential to slow down the age-related protein changes that are characteristic of presbyopia.
CoQ10 plays several roles in the body, including acting as an anti-oxidant in the protection of lipids, proteins, and DNA. It is detectable in the retina and tends to reduce with aging. Studies have shown that it is beneficial in slowing down the progression of macular degeneration. As a potent anti-oxidant, it may be beneficial at protecting the degenerative protein changes that occur in the lens thus protecting against presbyopia.
Zinc plays the role of ‘transporting’ vitamin A from the liver to the retina. As we age the levels of zinc tend to diminish making us prone to visual problems. Supplementation may be necessary and you may need to consult your doctor to explore your options.
Are there any drug treatments for presbyopia?
The use of pharmacological agents remains an active and promising area of research. It is attractive as it’s a non-invasive alternative, however, unlike surgery, it does not offer a permanent solution. Topical drug treatments have been analyzed showing improved near vision without affecting far vision. There are currently no FDA-approved pharmacological agents for presbyopia but the research is promising.
What does the future hold for presbyopia treatment?
Stem cells are another interesting area of research. It is growing steadily when it comes to the treatment of eye conditions especially those involving the lens. A few promising studies have been reported where stem cells were used to regrow the natural lens after it had been removed during cataract surgery. Such studies offer further proof of principle for the possibility of applying similar technology to the management of presbyopia by growing ‘new’ lenses and using those in place of artificial lens implants.
The jury is still out on the potential applications of stem cell therapy for treating presbyopia and these are exciting times indeed.