February 2, 2006
What You See Isn’t Quite What You Get
I am at my desk, trying to read papers and look at my computer screen. Sounds simple, right? Ha. This entails putting on my reading glasses when I want to look at the papers. But then to see the computer screen I need to flip the glasses up and use only my contact lenses (contacts so strong, I might add, that I should have X-ray vision). Up, down, up, down, up, where are the glasses now? My son points out that they are on the back of my head. And I have a splitting headache.
Everyone's vision changes with age. The big shift is the one I'm struggling with: presbyopia, a hardening of the eye's focusing lens.
"When the lens of the eye loses its elasticity, it can't adjust to the proper shape for near vision," said Dr. Marguerite McDonald, clinical professor of ophthalmology at Tulane University School of Medicine. And new technology makes it even tougher, as we struggle to focus on items at a variety of distances -- everything from the minibuttons on our cell phones to the flashing digital signs on highways.
But the technological revolution has brought medical innovations as well.
You Never Needed Glasses Before, and You Don't Want Them Now!
For the past decade, nearsighted people who didn't want to wear glasses or contact lenses have been able to correct their myopia with LASIK surgery. But when it came to presbyopia, the laser procedure presented some challenges, leaving most middle-aged folks with no alternative but reading glasses. Less than two years ago, however, the FDA approved a procedure for treating presbyopia that uses radio waves to reshape the eye. Called conductive keratoplasty (CK), the whole correction takes roughly three minutes, and recovery time is about a day. (The cost -- from $1,500 to $2,500 -- is generally not covered by insurance.)
Here's the unusual thing about CK: The procedure is performed on only one eye. The other eye, which sees distances well, is left alone. The brain selects the image -- near or far -- that it wants. "Most people's brains are good at this, but some are not," says Dr. Robert Maloney, associate clinical professor of ophthalmology at UCLA. How can you tell beforehand whether your brain will cooperate? You wear a contact lens for one week to simulate the effect.
The risks of CK are minimal. Approximately 10 percent of patients need a touch-up to adjust their vision. Also, you may notice a glare when you drive at night (special glasses that force the eyes to work together can take care of that). And the procedure is not permanent; you may need to have it redone every few years as your presbyopia progresses.
You Wear Glasses for Nearsightedness, but Now You Can't Read Small Print
You've got three options: a separate pair of prescription reading glasses; bifocals, which give you both distance and close-up correction, or progressives, which, along with distance and near correction, also give you something in between. But you may find progressive lenses skimpy in that midrange zone, especially if you use a computer a lot. One solution: glasses calibrated for the distance that you sit from your screen.
You Don't Want to Give Up Your Contacts
That would be me. But my lenses just aren't doing the job up close anymore. Some people can get by with nonprescription (magnifying only) reading glasses, which they wear with their contacts. But, again, this combo may not work at the computer. I've solved the problem (at least for now) with a pair of cute drugstore half-glasses that I wear with my contact lenses; this way, I can see through the glasses when I look down to read and over them when I need to look up at the screen.
Monovision contacts are another option, with one lens corrected for far vision, the other for near. They take some getting used to and, as with CK, they don't work for everyone. There are also bifocal contacts -- you get near and distance correction in both of the lenses.
You'd Love to Wear Contacts, but You Have Astigmatism
This is an irregularly shaped cornea (the clear, outermost layer of the eye); until recently, the only way to correct for it was with glasses or hard (and hard-to-wear) contact lenses. But new toric lenses have two curvatures -- one for the astigmatism and one for your nearsightedness -- and can be made from the same soft materials as regular contacts.
Keeping Your Eyes Healthy
• Have Regular Checkups
You need an exam every two years; make it annual starting at age 40, when your risk of developing serious problems goes up. Glaucoma (an increase in pressure within the eye) can arrive suddenly and, if left untreated, lead to blindness. Who should perform the exam? If you have a family history of eye disease, an ophthalmologist (an M.D.); otherwise, an optometrist is OK, McDonald said.
• Stop Smoking
You'll cut your chances of developing both cataracts (clouding of the lens) and age-related macular degeneration (AMD), a disorder that destroys central vision.
• Wear Sunglasses Whenever You're Outside During the Day
And make sure they offer 100 percent ultraviolet protection; UV exposure can contribute to AMD, cataracts, and other disorders.
• Eat Right
Lutein, that mysterious element touted in "senior vitamins" (and found naturally in dark green leafy vegetables), may cut your risk of AMD. If you are not getting enough of the good stuff in food, take 10 to 20 milligrams a day in vitamin form, said Dr. Lylas Mogk, medical director of the Visual Rehabilitation and Research Center at Henry Ford Health Center, in Detroit.
"I Can See Clearly Now..."
Lillian Fazzi, a Los Angeles-based fashion designer and mother, is singing that old song. Until a few years ago, the 40-something Fazzi had perfect vision. Then presbyopia set in, and she found it difficult to see up close. This posed problems at work ("I couldn't thread a needle") and at home ("I had trouble reading to my son"). Fazzi, who didn't want the inconvenience of glasses, consulted ophthalmologist Dr. Robert Maloney.
Maloney thought she'd be an ideal candidate for CK, which corrects for presbyopia. First, though, she had to see whether she could adjust to monovision -- using one eye for distance, the other for up close.
A week's trial with a single contact lens convinced her it would work: "I could see beautifully, though I found the actual lens uncomfortable."
In December 2003, Fazzi underwent the procedure in Maloney's office. First he placed numbing drops in her eye; she felt a very slight pressure -- from the probe that transmits the radio waves -- "and in three minutes, it was all over," Fazzi recalled.
Recovery was just as easy -- no bed rest, just antibiotic and moisturizing drops. Within three days, she had started to see more clearly, and at the end of a week, she could see perfectly. The only downside: Fazzi does have some glare when driving at night; she eliminates it by wearing special glasses.
"It's amazing," she said. "I sew. I read. I look at the paper--and I don't even think about it."
Beth Levine is a writer whose essays have appeared in Redbook, Woman's Day, Family Circle, the Chicago Tribune, USA Weekend and Newsday.