Good Vision: The Middle Years and Beyond

There are some things in life you just can't change. The way age affects everyone's ability to see is one of them. But no one has to take age-related changes in vision lying down. It's possible to fight back and come out a winner with good vision, albeit with help from prescription lenses and a few "tricks up the sleeve."

Presbyopia: The Foe

Presbyopia is the vision condition that lurks around the corner in everyone's future. It is caused by a decrease in focusing ability of the eyes which actually begins about age 10 but doesn't become noticeable until sometime between ages 40 and 50. Then presbyopia hangs around for life.

Telltale signs are a tendency to hold reading material at arm's length; difficulty reading in dimly lit environments; tired eyes or headaches after concentrating on reading, a computer screen or other close work; and blurred vision at the normal reading distance.

Presbyopia happens because the eye stops growing at about age 10 but the flexible lens inside doesn't. Cells crowd together and the lens becomes less and less flexible until it can't do its job of bending to focus on close work. As presbyopia progresses, it eventually also affects the distance vision of people who are farsighted. By age 70, the lens just won't flex at all.

Optometrists can readily solve the presbyopia problem with prescription glasses or contact lenses. The good news is that there are a lot of great lens choices today.

It's a good idea to look at lens options, even though the final decision can't be made until the optometrist conducts a thorough examination and evaluates the person's specific vision needs. Eye care needs become more complex with age. The optometrist also needs to consider the way a person uses his or her eyes for work and recreation. Some people need more than one pair of glasses for different purposes. Here are the choices:

Reading Glasses
Have one prescription for close work throughout the lens. A choice for those with good distance vision or who wear contact lenses for distance seeing. Look up from reading or close work while wearing these glasses, however, and the world's a blur. Half-lenses (we're talking bottom half) suit some folks.

Non-prescription Reading Glasses—magnifying-lenses in a frame.
If looking for inexpensive glasses to read a menu or theater program, these can fill the bill. But they're sprinters, not long-distance runners. They can prove unsatisfactory when asked to handle a day's work or a night with a good book because their one-size-fits-all optical centers don't line up with everyone's eyes and because most people need a different lens prescription for each eye. Many people also have astigmatism, which further complicates the matter.

Multifocals
These contain two (bifocals) or three (trifocals) prescriptions in one lens. These have long been the workhorses for the 40+ crowd. Lots of lens designs are possible to meet varied needs. A contemporary example is the wide-band trifocal for computer users.

Progressive Addition Lenses
These gradually change lens power from top to bottom. Offer versatility with no telltale bifocal/trifocal lines or disconcerting jumps between lens powers. They're widely popular in Europe and gaining acceptance in the United States. For successful wear, choose an optometrist who has considerable experience in prescribing PALS.

Bifocal Contact Lenses
These contain two prescriptions in one lens. Some are like bifocal glasses, with the distance prescription on top and the near one on the bottom. Others have the near prescription completely around the edge of the lens and the distance portion in the center. They are available in both soft and rigid gas permeable lenses. For successful wear, find an optometrist who has considerable bifocal contact lens experience.

Monovision
This is a contact lens focused for near vision. It is worn on the non-dominant eye. If a distance vision prescription is also needed, it's worn on the dominant eye. Sounds strange but it works for lots of people.

Tricks Up The Sleeve

Lenses are essential but people can also help themselves to better vision as they grow older by learning and using these tricks."

Inch Ahead
Measure and report to your optometrist the distance between your eyes and your desktop, workbench, computer screen or other work area. You want your lenses focused for your working distance. You may need special occupational glasses. If your employer doesn't cover the cost, it may be tax deductible as a business expense.

Be Flexible
Make your work environment flexible with adjustable chairs, computer equipment, copy holders and lighting. Incorporate the same flexibility into home work and recreational areas.

Lighten Up
The average 60-year-old needs seven times as much light as the average 20-year-old. Increase bulb wattage or move lamps closer. Be sure home stairs and halls are well lighted. Use night lights. Carry a flashlight when outdoors at night.

Gear Up
Talk with your optometrist and get the right eye wear for your sport. Get the proper eye safety equipment, too. Give yourself the advantage with such aids as rearview mirrors for bicycles and polarizing sunglasses for boating and water sports. For visibility when walking, jogging or cycling, wear retro reflective trim on clothing at night and fluorescent hunter orange clothing or vests during the day.

Tune Up
By age 70, vision changes can affect driving ability. An anti-reflective coating on glasses can make handling headlight glare easier. Keep your eyes moving when behind the wheel, frequently glancing at the rearview mirror and to the sides. If needed, confine night driving to familiar or well-lighted streets. Wear sunglasses for daytime driving. Avoid frames with wide side pieces that may block side vision. Enroll in an older adult driving program.

Wear Shades
To help guard against the possible development of cataracts and macular degeneration in later years, start wearing sunglasses now with maximum ultraviolet protection. That means lenses that block 99 to 100 percent of both UV-A and UV-B.

Manage Menopause
Hormonal changes related to menopause can cause dry eye conditions, creating problems for contact lens wearers. Artificial tears or estrogen replacement may help.

Watch Drugs
Ask your doctor, pharmacist or optometrist about how your prescription and non-prescription-drugs may affect your vision. Keep all your doctors, including your optometrist, informed about the drugs you are taking and any side effects you notice.

Go Pro
Get a thorough eye exam regularly. That means every year or two after age 40 and every year from age 61 onward.