Combining presbyopia options

After age 40, the single pair of glasses or contact lenses you previously wore will, generally, no longer give you clear vision at all distances — or at least not without some compromises.

These vision problems are caused by presbyopia, which affects all of us beginning in middle age and reduces our ability to see at all distances.

Many vision correction options are available, such as presbyopia surgery and multifocal contact lenses or glasses. If you need cataract surgery, you also have the option of choosing multifocal intraocular lenses to restore your ability to see at all distances.

In some cases, however, you may need to consider a combination of options to fully address problems caused by presbyopia.

Removing your eyeglasses to read

If you are short sighted or myopic, you have an advantage when you reach your 40s.

Once presbyopia occurs, short sighted eyes still see well up-close — if you remove your glasses. Of course, with your glasses removed, distance vision is blurred. So you will need to put your glasses back on to see clearly across the room.

The amount of short sightedness you have determines how close or far you need to hold an item to see it clearly without your glasses on.

If you are mildly short sighted (with a prescription of -1.50 or -2.00 D, for example) you will see very well at a normal reading distance of 50 to 60cm from your face.

But if you're highly short sighted (let's say -5.00 D or higher), you'll have to bring items much closer to your eyes to see them clearly. If that's the case, you may want to consider the next option.

Multiple glasses with single vision lenses

Though it's certainly less convenient than wearing just one pair of glasses with progressive lenses, bifocals or trifocals, some people over the age of 40, choose to deal with presbyopia by purchasing two or more pairs of glasses with single vision lenses, using different pairs for different tasks.

One pair of glasses usually will contain lenses prescribed for distance vision (driving, watching television, etc.); and a second pair may contain single vision lenses prescribed specifically for computer work, reading or other near-vision tasks.

This option offers some visual advantages:

Single vision lenses prescribed specifically for distance vision or near vision work well if you need to look upward or downward. If you've ever tried to sit back on your recliner or watch TV in bed whilst wearing glasses with progressive lenses, you know that the near part of the lens interferes with your ability to see clearly across the room when your head is tilted back.

Similarly, single vision lenses prescribed for near work are useful for performing car repairs or other tasks where you need to see close-up objects above your head. So there's no need to crane your neck back or prop your glasses up to get into that near zone as you would with a bifocal, trifocal or progressive lens.

Single vision lenses can offer advantages for computer work or reading. Your optometrist can customise the prescription for the exact working distance you prefer, and you get an wide field of view at that distance. (Remembering that they will only help you at that one distance)

For sustained computer work, where bifocals, trifocals or even progressive lenses can cause posture problems that contribute to computer vision syndrome, it is clear that, along with modern design computer lenses, single vision lenses are also an option.

Single vision lenses for distance vision can enhance your peripheral vision and therefore your mobility. Particularly when you enter your 60's and 70's, normal, age-related changes reduce your peripheral vision, and bifocal and trifocal lenses can worsen the problem.

Single vision and progressive lenses give you a much better view of your feet when you're looking down to step off a curb or onto an escalator or a flight of stairs.

(It's very possible that some senior citizens who have fallen may not have done so had they been not been wearing bifocal or trifocal lenses.)

Even if you already wear progressives, it's always good to have a second pair of glasses with single vision lenses as a spare so you're never caught out for reading if you lose your glasses.

Multiple contact lens options for presbyopia

If you wear contact lenses, a simple solution to restoring your near vision when you become presbyopic is to wear reading glasses or progressive lenses with them.

With this solution, there's no compromise in distance vision — just a need to carry around another pair of glasses. Not exciting, but effective.

If you find you can't adjust to multifocal or bifocal contact lenses, this option may be best for you as a contact lens wearer with presbyopia.

Other combination options involving only contact lenses include:

Monovision or modified monovision using contact lenses

Your optometrist can advise you about the various types of contact lenses available for creating better near vision in one eye and distance vision in the other to compensate for focusing problems related to presbyopia. This approach creates monovision or modified monovision, depending on the type of lens used in each eye.

Your optometrist may choose to use single vision lenses for both eyes (monovision) or a multifocal lens on one or both eyes (modified monovision), with one lens "weighted" toward distance vision and the other for near.

Though you still may need reading glasses or progressive lenses on a limited basis, monovision or modified monovision contact lenses may give you better distance vision than multifocal lenses alone, while still providing adequate near vision for most of your routine daily activities.

Different contact lenses at different times

 Regardless of which contact lens option you choose, you may have the greatest success and satisfaction if you use different options at different times.

For example, for that round of golf, regular (full distance correction) contact lenses on both eyes will give you the sharpest distance vision so you can enjoy your game. And in bright sunlight, your near vision should be adequate enough for you to see your scorecard without the need for reading glasses.

But for dining out in the evening, you may find that monovision or modified monovision lenses are better because they enable you to read a menu or bill without reading glasses. These types of contact lenses usually also give you excellent vision across the table and even across the room.

If you find monovision contacts give you excellent indoor vision but don't offer sharp enough visual acuity for driving at night, your optometrist can prescribe glasses that you can keep in your car and wear over your contacts to optimise your vision for the drive home.

Combination solutions if you are interested in surgery

In some cases, a combination of surgical and non-surgical solutions is the best way to go when presbyopia sets in.

The most common combination solution is LASIK and glasses. Even if you have your LASIK surgery when you are in your 20's or 30's, you'll need something to read with when you hit your mid-40s. Presbyopia spares no one!

Other combination options include:

LASIK with a single contact lens for near vision

This may be a good option for social events, where you want acceptable vision both far away and up close without having to carry glasses with you.

You'll be able to see in the distance with one of your LASIK-corrected eyes, while using the eye with the contact lens for near vision. This combination creates monovision. (One-day disposable contact lenses are great for this: you can just throw the lens away at the end of the night.)

Monovision LASIK combined with glasses 

Most people who have monovision LASIK (one eye corrected for distance and the other for near) benefit from glasses with either single vision lenses progressives or modern computer lenses to enhance their near vision for close-up activities.

Your optometrist can prescribe lenses to balance the vision in your two eyes so they are both corrected for the same specific distance, such as the distance to your computer screen or for reading.

For the best results, measure how far away you like your computer screen, how far from your nose you are most comfortable holding a book when reading, etc. Take separate measurements for reading in your favourite chair and reading in bed — they will be different!

Bring these measurements to your eye test, and your optometrist can tailor lenses to optimise your vision for these activities. Though this may sound cumbersome, you'll find that the proper lenses will make reading and working on your computer less tiring and therefore more enjoyable.

Multiple vision correction surgeries

Sometimes a combination of surgical procedures is the a good choice for dealing with presbyopia. For example, if you had LASIK in your 30's, but now you're in your mid-40's and your near vision is getting fuzzy, PRK (photorefractive keratectomy) or CK (conductive keratoplasty) on one eye could help you see better up close by creating monovision.

Corneal refractive surgeries like LASIK, PRK and CK can also be performed after cataract surgery to sharpen both your distance vision and your near vision. These follow-up procedures are especially helpful if some astigmatism remains after cataract surgery and you are a good candidate for monovision.

If you have cataracts, your eye surgeon may recommend one or more types of refractive intraocular lenses (IOLs) to restore your vision at all distances after cataract surgery. In some cases, an accommodating IOL may be recommended for one or both eyes to help you regain near focusing ability.

In other cases, a multifocal IOL that provides distance vision may be used for one eye, and one that provides better near vision may be recommended for your other eye.

If you are contemplating cataract surgery, ask your surgeon for more information about these premium refractive IOLs and which solution might be best for you.

Managing your expectations

Whatever choices you make, recognise that all presbyopia solutions involve some degree of compromise. No currently available spectacle lenses or surgical techniques can completely restore the dynamic focusing flexibility your eyes had before presbyopia.

But that doesn't mean you have to subscribe to a one-size-fits-all mentality. Being adaptable is the key — and understanding that multiple solutions exist for all your over-40 vision needs.

To decide which option is best for you, find an optometrist near you and schedule an appointment.

Page published on Wednesday, 18 March 2020