Keep reading the fine print

WICHITA, Kan. – Sooner or later, you’ll find yourself holding the phone book at arm’s length when you look up a number.

The stock listings in the newspaper will be blurry.

You’ll wonder when the restaurant started using smaller type on its menu.

And then you’ll acknowledge an inevitability: Like death and taxes, presbyopia is something you can’t escape.

For most people, presbyopia — “old eyes” — starts showing up in the early to mid 40s, says Wichita ophthalmologist Mark Wellemeyer.

Tiny muscles in the eye, called the ciliary muscles, move the lens to change its focus. But the lens becomes increasingly rigid with aging, and the little muscles can’t move it as well. Eventually, they give up. The result: an inability to focus on nearby objects.

No, you can’t go to the eye gym to keep those little muscles in shape, despite infomercials’ claims. “There’s not a whole lot you can do with exercises that’s going to make that much difference,” Wellemeyer says.

Genetics play a big role in when presbyopia begins, he says. By the time most people are in their mid- to late 50s, their presbyopia is as bad as it’s going to get.

If you’re nearsighted, taking your glasses off for close-up work may get you by for a time. But sooner or later, your arm won’t stretch enough to get objects out where you can focus.

What are your choices when that day comes? You have several:

• Reading glasses – For people who have otherwise normal vision, these “Wal-Mart glasses,” as Wellemeyer calls them, work just fine.

Readers are available in a range of strengths, from 1.0 to 3.25 or so. You can buy them on your own, testing them in the store to see which suits your needs, or your eye doctor can prescribe them. They are inexpensive (unless you opt for the expensive ones). That means you can keep a pair in every room and get a new pair as your eyes get worse – or whenever you feel like spicing up your eyewear wardrobe.

Readers can be worn over contacts.

• Bifocals – People who wear glasses to correct vision usually move to these prescription lenses. Two options are available: traditional bifocals, in which a visible horizontal line separates the part of the lens for close-up vision from the part for distance vision, and progressive bifocals, in which the parts gradually blend into each other.

Wellemeyer estimates that more than half of people getting their first bifocals choose the “no-line” glasses. People who have worn traditional bifocals often have difficulty adjusting to the no-line version.

Trifocals, which include a middle distance area for computer work, for example, also are available in traditional and no-line versions.

• Contacts – There is a bifocal contact lens, Wellemeyer says, but only about 50 percent of those who try it can wear it successfully. More common is the “monovision” approach, in which the dominant eye wears a lens to correct distance vision, and the other eye wears a lens for close-up vision.

Getting used to monovision contacts takes two to three weeks, Wellemeyer says, and “some people never adapt.” Younger people usually do better at adapting.

• Vision-correcting surgery –

“There really are not a lot of surgical options for treating presbyopia,” Wellemeyer says, though it can be done with the same procedures, such as lasik surgery, used to correct other vision problems.

But because presbyopia can worsen and because a monovision approach has to be used, surgery isn’t a common approach.

If a person doesn’t get suitable results with monovision contact lenses, there’s no point in trying surgery. And surgery is a compromise: You don’t get the best of either distance or close-up vision.

• Lens replacement surgery – Traditional cataract surgery, in which an artificial lens replaces the natural one, doesn’t correct close-up vision.

Seven or eight years ago, the Array multifocal lens implant became available for people having cataract surgery. Concentric rings allowed good distance and near vision but created night-glare problems in many wearers. The Array lens still is available but not widely used, and it wouldn’t be used just for presbyopia.

About a year ago, the crystalens replacement lens became available. It has tiny hinges that allow the lens to move, as a natural lens does. And those tiny ciliary muscles seem to start doing their job again, gently moving the crystalens. But after implantation, the patient must do eye exercises to strengthen the muscles, a process that can take a year.

“You have to be pretty motivated,” Wellemeyer says. “And you have to do the exercises.”

Maureen Walter, who received crystalens implants in November during cataract surgery, is delighted with the results. She’s an artist and says, “My eyes are real important to me.”

She still uses her reading glasses to mix paint but takes them off to paint.

She’s still doing the eye exercises and says she now is able to read things that she couldn’t before surgery. And she no longer needs glasses to drive.

“It’s so freeing,” she says.

Another lens said to offer even better multifocal vision, called Restor, recently won Food and Drug Administration approval. It should be available beginning next month, Wellemeyer says.

The downside is that the crystalens and the Restor lens aren’t usually covered by insurance. So far, Medicare, which covers most cataract surgery, won’t even allow a patient to pay the difference for an “upgrade” to such a lens. That puts the cost of surgery at about $3,300 or more per eye.