Best Buys for Better Vision

Age-proof your eyes with these new ways to see clearer.

by Beth Levine
Photograph: Photo: Plamen Petkov

Reading in bed at night has always been my favorite ritual, but lately it’s been getting complicated. First I remove my contact lenses, prescription strength 8.0. (For those who don’t know what that means: If I am not wearing corrective lenses and you see me operating any kind of machinery larger than a toy truck, get out of the way immediately.) Then I put on my bifocals: top half for myopia (trouble seeing distant objects), bottom half for presbyopia (difficulty focusing on near objects). After a while, I find the bottom half doesn’t provide a wide-enough field for easy scanning of book pages. That’s when I take off those glasses, put on my regular glasses (for myopia only) and place my reading glasses (for presbyopia only) over them. It works for a bit, and then the whole thing gets tiring and frustrating, so I take off both pairs and pull the book closer and closer until it touches my nose.

Can we say audiobooks?

What’s Going On
Vision changes as we grow older. After you turn 40, you will gradually become presbyopic: The lenses of your eyes start becoming less elastic and lose their ability to focus on near objects. At this point you begin holding menus as far away as possible. When you reach your sixties, you may hit another vision snag: cataracts, a clouding of the lenses that can make driving more difficult—especially at night.

Reading at arm’s length is fine . . . but if even octopus arms wouldn’t be long enough for you to read the fine print on drug or cosmetic labels or the sometimes poorly lit type on all the new tech gizmos, you may find yourself, as I do, handing everything over to your ­teenager to read: “Tell me what it says and don’t be a wiseass.”

What to do? If wearing two pairs of eyeglasses at once doesn’t ring your chimes, there are other options. Because, let’s face it, eventually your teen is going to move out.

If You Want . . .  Glasses
What’s Out There: Progressive Lenses
Tired of shifting between reading anddistance glasses? Dislike the lines on bifocals and trifocals? For many people, progressive lenses offer an improvement. Instead of providing just two or three lens powers, as bifocals and trifocals do, these graduated lenses are multifocal, which makes it possible for you to see from a range of viewing distances. Your ophthalmologist can prescribe progressive lenses depending on your needs—wider intermediate zones if you do a lot of computer work, or more power for near vision if you read a lot, and so on. And if you considered progressives but thought they were ugly, it’s time to reconsider. “Frames used to be large and somewhat unattractive so they could fit in all powers of lenses. But in the past few years, manufacturers have figured out how to create compact designs that provide larger distance zones in smaller frames,” says Harpreet Gill, MD, senior staff physician in the ophthalmology department at Henry Ford Health System. What’s still unattractive: the big bite that customized progressives may take out of your wallet. (More generic lenses may cost roughly the same as trifocals and bifocals.) Only you can decide if the improvement is worth the price.

What’s New: Superfocus
These glasses allow you to quickly switch between focusing on near things and looking at far things. So do progressives; the difference is, with progressives you adjust for distance by switching your eyes around to various spots in the lens, but with Superfocus, it’s the lens that moves. There are actually two lenses: the outer one is removable; the inner one contains a rigid layer behind a flexible membrane, with clear optical fluid in between. You alter the focus, a little or a lot, by sliding a bar on the bridge of the glasses. This pushes the liquid, and that changes the shape of the flexible lens. Superfocus glasses cost about $900 and are odd looking enough that you may not want to wear them on a job interview. But when you’re at home or work, they save you the hassle of switching your glasses all the time (assuming you can find them when you want to). For a list of participating Superfocus vendors, go to superfocus.com.

If You Want . . .  Contacts
What’s New: Contact Lenses That Are Progressive or Bifocal
In progressive contacts, distance vision falls in the center of the lens, and intermediate and near vision are in the more peripheral zones of the lens. (However, this can be customized. If you prefer, the center can be made for near vision, and distance put on the periphery.) Bifocal contact lenses are just like bifocal glasses—the top is for distance, the bottom for close work. A possible downside: The bottom of the bifocals is made heavier so they won’t spin in your eyes (as do regular contacts), but that weight annoys some users, says Sandra Belmont, MD, founding director of the Cornell Laser Vision Center at New York–­Presbyterian Hospital.

If you have been unable to wear flexible contact lenses because of astigmatism (an irregularly shaped cornea that makes it hard to focus), toric contact lenses, which correct for the uneven cornea, are now available as progressives or bifocals.

If You Want . . .  Surgery
What’s Out There: Laser Vision Correction (think LASIK and PRK)
Mostly done to permanently improve long-distance vision in patients under 40, these painless surgical procedures use an excimer laser to reshape the cornea. If you are over 40 and have presbyopia, you can opt for monovision, in which one eye is corrected for near vision and the other for distance vision. The brain then “selects” the image it wants. But not everyone can adapt to monovision correction, so before deciding on surgery, you may want to try contact lenses with the two different focuses (close and far) for a day or two to see if that might work for you. Most doctors will provide you with the trial lenses at no extra cost.

The best candidates for Lasik and PRK are people older than 18 with stable prescriptions, normal eye exams, no uncontrolled autoimmune diseases and no visually significant cataracts, says Belmont. If you’re pregnant, postpone eye surgery until after the delivery.

“Dry eye can sometimes be seen in patients after Lasik surgery but very rarely after PRK,” says Belmont. The procedures usually cost $2,000 to $2,500 per eye, which most health insurance policies don’t cover.

If You’re Ready For . . .  A Last Resort
What’s Out There: Lens Implants
The eye surgeon implants a synthetic lens that either replaces your natural lens or is put in front of it. This is serious surgery that comes with many risks and no promises. But if you have tried everything else and still have trouble seeing, it might be worth discussing this option with your ophthalmologist. There are two types of lens implants: intraocular and phakic.

With intraocular lens implants, your natural lens is removed and replaced with a presbyopia-correcting multi­focal synthetic lens. The typical patient has cataracts, but this surgery is occasionally done on people who don’t want to use reading glasses or contact lenses. “Contact lenses can be multifocal, but the problem is, they may move around on the eyes. By contrast, when multi­focal lenses are put inside the eyes, they stick and don’t move,” says D. Rex Hamilton, MD, director of the UCLA Laser Refractive Center at the Jules Stein Eye Institute and associate clinical professor of ophthalmology at the university. The surgery carries a small risk of eye infection, and possible complications include less sharp color contrast.

Phakic lens implants are placed in your eye on top of your natural lenses. These are generally used for people with such severe myopia that they are not good candidates for Lasik, but a recent study in the United Kingdom found that phakic implants may work well for people with moderate forms of nearsightedness: A year after the procedure, patients who received the implants could see as well as those who’d had Lasik. In addition, among those with moderate to severe myopia, the phakic-lens patients had higher satisfaction scores. The caveat: “These lenses can cause glaucoma or cataracts, inflammation and infection,” says Gill. Since this is a relatively new procedure, exact complication rates are still being determined.

Eye surgery is definitely not on my to-do list. But if you’ll excuse me, I believe there is a pair of progressive lenses out there with my name on it, and not a moment too soon: My son just left for college.

First Published Tue, 2010-09-28 13:46

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