Mar 1, 2017 5 min read

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The newsprint in the Observer-Reporter looked like it was smudged. Or at least that’s what Alicia Jankowski of Houston thought when the letters looked increasingly fuzzy in her morning paper. “I had to really work at focusing on it,” says the Houston resident. “It was just all of a sudden. I had perfect vision until age 40, then I used readers for years. Now I’m preparing for my third prescription change in glasses.”

The changes in her vision made working as a dental assistant and her side photography business increasingly difficult. “I had to have prescription safety glasses made for use at work,” she says. “I had to spend extra time with the optometrist to get the reading section of the bifocal to be large enough.” Away from work, Jankowski progressed through higher magnification levels of reading glasses then saw an eye doctor. “What a surprise to find out I needed bifocals,” she remembers. “It was a real pain to learn to use progressive lenses. The biggest challenge is not being able to just move your eyes back and forth when reading a book. You have to move your entire head to keep that tiny sweet focus spot.”

Ask anyone over the age of 40 if they need larger fonts on their computers or phones or have trouble reading menus and you’re likely to get a knowing nod. Those are signs of presbyopia, which worsens with age. “The eye is not able to focus light directly onto the retina due to the hardening of the natural lens,” explains Dr. Paul Caimano, ophthalmologist with Washington Eye Center. “Aging also affects muscle fibers around the lens, making it harder for the eye to focus on up close objects.”

Eyeglasses are the simplest means of correcting presbyopia. Bifocals have higher focusing power in the lower portion allowing you to read and see properly at distance through the top. Readers don’t require a prescription and can help with magnification. Dr. Erik Happ is director of neuro-ophthalmology at Allegheny General Hospital and also sees patients at Southwestern Pennsylvania Eye Center in Washington. He says readers are still the gold standard, despite their inconvenience. “There have been some fleeting options tried surgically, but none have ever seemed to catch on or show promise,” he says. “Some people do use mono-vision, which is wearing one contact for distance and one for near. Typically, the non-dominant eye is used for near. We also now have multifocal contact lenses.”

Dr. Caimano warns this option is not for everyone saying, “The down side is you really do not have clear vision at either distance or near because you are taking away binocular vision and replacing it with monocular.”

Cabinetmaker Tony Nicolella of Washington has a unique vision challenge. “At 54, my eyes have changed a lot,” he says. “I’m unique that I don’t have to wear reading glasses, but I do if I wear contacts. Then I have two sets of lenses on.” If he doesn’t wear contacts or glasses to see better far away, his reading vision up close is fine. But once he puts on glasses to drive or see far away, his near vision declines.

“I used to read with contacts in, but now I have to wear reading glasses over the contacts if I wear contacts,” says Nicolella. “It’s easier to just wear glasses and look under/over them to see up close. Being a cabinet worker doing fine detail, I need to see up close quite often. I never could get used to bifocals. It’s weird to wear contacts and carry cheaters.”

While presbyopia is an annoyance that comes with age, three diseases prove a serious risk to vision in aging patients:

• Diabetes – the leading cause of blindness and visual loss in the United States. Early symptoms include blurred vision, sudden loss of vision and floaters in the field of vision. Diabetics are 40 percent more likely to develop glaucoma and 60 percent more likely to develop cataracts.

• Glaucoma – the second leading cause of blindness. More than 2.7 million Americans over age 40 have glaucoma and everyone is at risk. Glaucoma damages the eye’s optic nerve and can cause blindness if left untreated. Getting a comprehensive dilated eye exam is the only way to catch it early.

• Age Related Macular Degeneration (AMD) – the leading cause of vision loss among people over 50. AMD damages a spot near the center of the retina. AMD can be hereditary, but studies show a diet rich in leafy green vegetables, omega 3 fatty acids, vitamins C and E, zinc, copper, beta carotene and lutein may help.

Cataracts are clouding of the eye lenses that affect vision and affect more than half of Americans by age 80. Think of clear glass becoming like amber stained glass slowly over time. You can’t prevent them, but surgery can replace the cloudy lens. “Often the patient’s refractive error can be corrected with this implant lens, so the need for prescription glasses can sometimes be eliminated,” says Dr. Happ. “We also now have advancements in cataract surgery that allow us to use multifocal implant lenses that can be used for both near and distance vision.”

How can we care for our eyes as we age? “Get periodic eye exams including looking at the retina and optic nerve,” says Dr. Happ. “Too many people just go get glasses and don’t necessarily get a full exam.”

Dr. Caimano recommends you do that between ages 40-50. “Diabetes and glaucoma can both be prevented if caught and treated early,” he says. “AMD is more age and gene-related, however we can now preserve vision when caught early.”

Both also recommend taking a multivitamin antioxidants, beta-carotene and lutein and protecting eyes from excessive sun exposure with sunglasses and hats.