Age-Related Vision Changes: Presbyopia and Cataracts

What Is Presbyopia?

After the age of 40 everyone experiences the beginning effects of presbyopia. Presbyopia is the natural decline in the eye’s ability to see at 40cm or closer. As the years go by, the crystalline lens gets thicker. At the age of 40, the lens has grown thick, becoming less flexible and the ciliary body less effective at making the lens change shape to view objects up close. 

How Presbyopia Affects Near-Sighted Vision

This greatly confuses people who are near-sighted. For near-sighted people when you wear glasses or contacts, it perfectly fixes your distance vision. After the age of 40, near-sighted people need readers or multifocals to see distance and near at the same time. 

The confusion comes when a near-sighted person takes off their distance glasses and can see up close; thus they think something is wrong with the glasses. But the optics are quite simple. 

When you are near-sighted and you wear glasses or contacts, you become emmetropic. The second you take off your glasses; you go back to being near-sighted, which is why near-sighted people can see up close without glasses or contacts. 

How Presbyopia Impacts Far-Sighted Vision

People who are far-sighted notice presbyopia the earliest and can even notice it at age 38 or 39. 

The natural evolution of the eyes is to become more far-sighted and more presbyopic. Far-sighted people are always the first people who want to solve presbyopia with multifocal contacts, only to be greatly disappointed by the level of vision the contacts will yield. 

Multifocal contacts are great for spectacle independence, especially when traveling, being active and for parties. But multifocal contacts are not the perfect solution if you need to stare at a computer all day or do heavy reading. Unfortunately, the best solution for presbyopia that yields the best visual results is to wear glasses. 

The Best Solutions for Presbyopia

Now, only 15 years ago the only two options were single vision distance/single vision near or progressives. 

Ten years ago, a new lens was developed in the US that we call Hoya’s boosted lens. The sync lens is not multifocal, as two focal points are not added to the lens. Instead, Hoya manipulates the base curve of the bottom of the lens to ‘boost’ it. 

This lens is much easier to get used to than a full progressive. All progressives limit your peripheral visual field and give you thousands of focal points of clarity. Sync lens is simple; it corrects distance only at the top, and it boosts near by +0.5, +0.9, +1.3 and +2 on the bottom. If you have ever had a bad experience with progressives, ask about the sync lens.

With presbyopia affecting the masses, a new drug named Qlosi was released on the market. Qlosi is an eye drop that makes your pupils small or miotic. Its purpose is to ‘mask’ or decrease presbyopia for six hours. 

I prescribe this drop to people who want to see during conferences, travel, or events. It’s not meant to eliminate presbyopia, but it can give you some of your accommodation back for a few hours. 

Many people who did intense reading or spreadsheets up close need a +1.00 reader to see small numbers or read small text. The only people who cannot ever take Qlosi are myopes or past myopes that have had LASIK. Qlosi can unfortunately cause retinal holes, tears, and detachments in myopes. If you have any questions, ask your optometrist. 

Types and Symptoms of Cataracts

The other unavoidable age-related eye condition is cataracts. Every person will have a form of cataracts at the age of 55. 

Normally, age-related cataracts are nuclear cataracts, and they are protein-based cataracts that grow the slowest. Posterior subcapsular cataracts are cells that grow the fastest. Cortical cataracts are water based, and they are variable in how aggressively they grow. 

When cataracts grow in, they tend to change the optics of the eyes, which thus changes the prescription of the eye. Between the ages 55-70, we tend to see larger prescription changes because of the cataracts growing in. 

The most common symptoms people experience is blurred vision and glare at night. Once cataracts are diagnosed, you should always see your optometrist once a year to look for changes. 

Most people will need cataract surgery in their upper 70s or lower 80s. Cataract surgery is a short surgery, but because you are awake during the procedure and because the IOL cannot be changed, always ask your optometrist who they recommend. 

To receive a comprehensive eye exam or cataract eye exam in Frisco, Texas, book an appointment online with Avant-Garde Optometry.