Alternatives to Glasses for Presbyopia
For most people, age-related farsightedness is a fact of life after 40, but reading glasses may not have to be. Here are a few other options to discuss with your eye doctor.
For some people with presbyopia (age-related farsightedness), reading glasses can be a fun fashion accessory. For others, especially people who aren’t used to wearing glasses, having to keep up with readers can be a pain.
Luckily, some people may not have to wear reading glasses after all. These four alternatives won’t work for everyone but may be worth discussing with an eye doctor as an option for bringing the words on a page into focus.
Monovision contact lenses have different strengths to allow each eye to function independently, says Robert C. Layman, OD, president of the American Optometric Association and owner of Pinnacle Eye Group in Lambertville, Michigan.
In other words, one eye will be corrected so you can see up close, and the other one (usually your dominant eye, as determined by your eye doctor) will be corrected so you can see far away — if you happen to be nearsighted and need corrective lenses for distance. If distance vision isn’t a problem for you, you may need just one lens, for up-close vision.
Monovision works because the brain is able to choose which eye is necessary to see whatever you’re looking at clearly. If you’re watching a movie, for example, your distance eye will do all the work of seeing. If you’re reading, your other eye will take over.
It’s effective for around 90 percent of people, says Brian Boxer Wachler, MD, director of the Boxer Wachler Vision Institute in Beverly Hills, California. If you try it, though, be patient: Your brain likely will need a little time to make the adjustment before monovision will work for you.
A corneal inlay is a device about the size of the tip of an eraser that’s implanted in the cornea of one eye, usually the nondominant one. It works by increasing the depth of focus in that eye and decreasing the need for reading glasses without significantly affecting distance vision, Dr. Layman explains. He adds that this works best for people who are farsighted but can see clearly at a distance.
Surgery to insert a corneal implant is minimally invasive and performed under local anesthesia. The surgeon will create a pocket in the cornea by making a tiny slit with a laser. They will then slip the inlay into the pocket or under it, according to the American Academy of Ophthalmology (AAO). The procedure takes only 10 to 15 minutes.
Some people who have corneal inlays experience vision problems — namely, glare, halos, and trouble seeing at night or reading in low light. There is also the potential for more serious side effects, including scarring, clouding, thinning of the cornea, swelling, and inflammation, according to the AAO. Corneal inlays can be removed if they cause persistent problems or don’t work as well as hoped.
Cataract surgery, in which a cloudy lens is removed and replaced with an artificial one, is sometimes an opportunity to correct presbyopia, as the replacement lens (or lenses, if both eyes are involved) can be made to correct vision problems. “Cataracts usually develop at the same time as presbyopia, so once the cataract is bothersome enough, intraocular lens (IOL) transplant options could be considered,” Layman says.
There are several types of IOL transplants, two of which may be used for age-related farsightedness. The most common is monofocal, in which one artificial lens corrects for either near vision or distance vision. Multifocal IOL transplants are designed to correct vision at various distances, including close up — but often cause halos or glare around lights.
IOL transplants work well for most people, Layman says, but sometimes there are complications, including bleeding, infection, swelling, and, in rare cases, a detached retina or vision loss.
Prescription eye drops to treat presbyopia “work by making the pupil smaller, which results in an increased depth of focus and improved vision while looking at close objects,” Layman says. You’ll need only one drop — recently approved by the U.S. Food and Drug Administration for adults with age-related farsightedness — per eye. If you wear contacts, you’ll need to apply the drops and wait 10 minutes before inserting the lenses.
It takes only about 15 minutes for the drops to take effect, and there are a few potential side effects, including redness, headaches, and trouble seeing in low light, so they may not be a good option for driving at night. The risk may be worth it to you, though, because the drops can be effective for up to 10 hours, meaning you can leave your readers on the bedside table on days you’d prefer not to wear them.
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