Presbyopia – Reading Difficulties

Ever heard of presbyopia? If you’re over the age 40, you have probably noticed changes in your vision. Most noticeably, would be changes in your near vision. This is called Presbyopia. It is the normal age-related loss of near focusing ability.

When you develop presbyopia, you may find that you need to hold books, magazines, newspapers, menus and other reading material at arms length in order to focus clearly. Near work, like writing or sewing may cause headaches, eye strain or you may feel tired.


What Causes Presbyopia?

Presbyopia is caused by an age-related process. It is due to the loss of elasticity and hardening of the natural lens inside your eye. As a result the eye has a harder time focusing up close. It differs from astigmatism, short-sightedness or far-sightedness, which are related to the shape of the eyeball and are caused by genetic and environmental factors.

Treatment Options for Presbyopia

The best way of treating presbyopia is with eyeglasses. Surgery is the other option.

Eyeglasses with bifocal or multifocal (progressive) lenses are the most common correction for presbyopia. Bifocal lenses have 2 focus points:

  1. The upper portion of the spectacle lens is designed for distance vision,
  2. The lower portion of the lens is designed for near vision.

The two portions of the eyeglasses are separated by a line.

Multifocal (progressive) lenses have a more gradual vision change between the two prescriptions, with no visible line between them.

Reading glasses are another choice. Unlike bifocals or multifocals, which you would wear all day, reading glasses are worn just during close work.

If you wear contact lenses, your optometrist can prescribe reading glasses, which you wear while your contact lenses  are in.

Multifocal contact lenses are also an option. These contact lenses work just as multifocal eyeglasses would, giving you clear vision at all distances.

Monovision is an option where one eye is corrected for distance and the other is corrected for near.

Your optometrist will discuss the best option for you.

The natural lens in your eye continues to change as you get older. Therefore, your presbyopia prescription will need to be increased over time as well. Your optometrist will prescribe a stronger correction for near work as you need it.

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    Age-Related Macular Degeneration

    Age-related macular degeneration often called ARMD is very common cause of vision loss and blindness among the elderly. It is the degeneration of the macular, which is the area of the retina that gives us sharp central vision which we use when driving, reading etc… Degeneration of the macular, therefore affects our central vision.

    There are 2 forms of macular degeneration. Dry (non-neovascular) or wet (neovascular). The term neovascular here means the growth of new abnormal blood vessels in an area. The dry form is more common than the wet form, but the wet form results in much more serious vision loss.

    Dry Macular Degeneration (non-neovascular)

    Dry ARMD is the early stage of the disease. It is due to the thinning and deterioration of the tissues surrounding the macular. We find yellowish deposits called, drusen, surrounding the macular. These drusen deposits are from the deteriorating macular tissue. Slowly, you start losing your central vision. Over a period of years it can cause severe vision loss.

    Studies have shown that vitamins A, C and E, can slow down the progression of dry macular degeneration. Therefore, the use of eye vitamins can reduce the risk of getting macular degeneration.

    Wet Macular Degeneration (neovasvular)

    Sometimes, dry ARMD will progress to the more advanced and damaging form of the disease, wet ARMD. With wet ARMD new abnormal blood vessels grow underneath the retina. These blood vessels are weak and start to leak blood onto the retinal cells which die off. This causes blind spots in your vision.

    The growth of new blood vessels is the body’s way of providing more oxygen and nutrients to the area. Unfortunately, because these blood vessels are abnormal, they leak and cause scarring, leading to severe vision loss.

    How do I know if I have Macular Degeneration?

    Macular degeneration usually results in a slow painless loss of vision. Symptoms you may notice of macular degeneration are:

    1. shadowy areas in your central vision
    2. unusual distorted, fuzzy vision.

    Your optometrist or ophthalmologist will be able to detect changes in the macular area before you notice any symptoms. This is done by:

    1. Retinal exam and,
    2. Amsler grid.

    An Amsler grid is a chart consisting of black lines in a grid pattern.

    If changes are detected, a fluorescein angiography will be done to examine the retinal blood vessels around the macular.

    Causes and Risk factors for developing Macular Degeneration

    • Age

    • Hereditary

    • Being caucasian (white) and female. ARMD occurs more often in the white population and because they have a lighter eye colour, they are at higher risk from UV damage.

    • Obesity and inactivity

    • Sun over-exposure

    • High blood-pressure

    • Smoking

    • Drug side-effects

    Treatment of Macular Degeneration

    There is currently no cure for macular degeneration, but some treatments are available which may slow down the progression of the disease.

    The only treatment for the dry form of macular degeneration is nutritional supplements which may prevent its progression to the wet form.

    Zinc, lutein, vitamins A, C and E have been shown to reduce the risk of developing macular degeneration and prevent its progression to the wet form.

    For wet macular degeneration, treatment is aimed at stopping the growth of the abnormal blood vessels. This is done by the use of drugs injected into the eye. Certain drugs have been shown to improve vision lost to macular degeneration.

    So, if you feel you may have symptoms of macular degeneration, or there is a history of the disease in your family, schedule an appointment with your optometrist or ophthalmologist as soon as you can.

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      Cataracts of the Eye

      A cataract occurs when the eye’s natural lens becomes cloudy. The lens is situated behind the iris (coloured part of the eye). The lens works just as a camera lens works. It focuses light coming through the eye onto the retina. It also changes shape, adjusting focus, allowing us to see clearly from near to far.

      As we get older small areas of the lens starts to become cloudy, preventing light from going through to the retina. With time larger areas of the lens become cloudy making it more difficult to see.

      Signs and Symptoms of Cataracts

      In the initial stages, cataracts may have little effect on your vision. As it grows, you may notice your vision become a little hazy, like looking through a misty window. Sunlight and indoor lighting looks a little brighter than normal. Night driving becomes difficult as oncoming headlights cause a lot of glare. Also, colours are not as bright as they were before.

      Some types of cataracts don’t cause any symptoms until it is quite mature. Other cataract types sometimes result in an improvement in your near vision, called “second sight”. This improvement is short lived as your vision deteriorates as the cataract grows.

      If you think you have a cataract, visit your optometrist or ophthalmologist for an exam to find out for sure.

      Causes of Cataracts

      • The most common cause of cataracts is ageing.
      • Exposure to ultraviolet light. Optometrists always recommend the use of sunglasses to minimize your eye’s exposure to the sun
      • Other types of radiation

      • Diabetics. Being diabetic increases your risk of developing cataracts.
      • Using steroids
      • Eating a lot of salt. Diets high in antioxidants, vitamins A, C and E may slow down cataract development.
      • Cigarette smoke and alcohol consumption.

      Treatment of Cataracts

      In the initial stages a change in your spectacle prescription may improve your vision. As the cataract grows, the only option is surgery. Surgery is normally recommended when the cataract has grown to a point where it significantly impairs your vision and affects your daily life.

      Cataract Surgery

      Cataract surgery is very successful in restoring your vision and it is relatively painless. During surgery, the surgeon removes the cloudy lens (cataract) and replaces it with an intra ocular lens (artificial lens). If you have cataracts in both eyes the surgery is done one eye at a time, usually a few weeks apart.

      After surgery, the eye is covered with a protective shield and within a few hours you will be ready to go home. You will need someone to drive you.

      Over the next few weeks you will need to administer eye drops daily and wear sunglasses to protect you from glare. You may have slightly blurry vision which will improve as the eye heals.

      During the first few weeks try to avoid any heavy lifting or strenuous activity like exercise. Also, try to avoid swimming pools and hot tubs as they can cause serious eye infections.

      Complications during or after cataract surgery is , but sometimes does happen. However, even serious complications can be resolved with appropriate follow up treatments.

      Many people consider poor vision an inevitable fact of ageing, but cataract surgery is a simple, relatively painless procedure to regain vision.

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