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Thread: Presbyopia

  1. #1
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    Presbyopia

    Around my 46th birthday, I discovered that I suddenly was having a problem reading the print in books. I scheduled an eye exam as I hadn't had an eye exam in at least six years. I have always had perfect eye sight, and had never even heard of presbyopia.

    After a discussion with the optometrist regarding my work habits, I got progressive lenses with a 1.50 add. My prescription said: For reading only. The glasses worked well, and I followed my doctor's instructions to use the glasses for reading only.

    During the next year, I found that I was having other problems: reading the time on my wrist watch, seeing the numbers on my cell phone, reading the dials on the dashboard of my car, and seeing the face of the person talking to me. I knew just about nothing about presbyopia, other than it caused problems when I was reading. When the time came for my next eye exam, I told the doctor about some of the problems that I was having. He told me that if I wanted to be able to see clearly most of the time, then I should be wearing my glasses most of the time (not just for reading). My prescription this time said: Full time wear, +1.75 add.

    This year, my prescription has gone to a +2 add. I have done research on the Internet, but have not been able to find articles on the progression of presbyopia. As I have always had perfect vision up to the age of 46, this has been more than a bump in the road for me! Could you please tell me what else I can expect to have problems with? None of my friends (of the same age) are having problems other than minor problems with reading, and they use reading glasses from time to time. I am the only one who is wearing glasses most of the time. Your help would really be appreciated (especially as I cannot find relevant articles on the Internet).

    Thanks!

  2. #2
    Optimentor Diane's Avatar
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    Eyeseeit,

    I'll attempt to phrase this in lay terms.

    Presbyopia is NOT a disease, but a condition that will change as you age. Good thing to age...

    Presbyopia occurs when the accommodative system (the crystalline lens, and muscles and zonules controling the crystalline lens, and the capsule that hold the crystalline lens, etc.) lacks suffice ability to focus at a near distance. I won't go into an indepth discussion here.

    There are several additional factors that accelerate presbyopia. Genetic factors fall in here, ocular (eye) disease or trauma, systemic diseases, diabetes, high blood pressure, multiple sclerosis, etc, and medications both prescribed and over the counter. Other things affecting accommodation can include alcohol, antidepressants, antihistamines, and diuretics can dehydrate the body and accellerate the hardening of the crystalline lens. Environmental conditions such as increased exposure to ultraviolet radiation, wind and dust and higher temperatures can accelerate the hardening of the lens, as well.


    Other factors can include work habits...near vision tasks...reading habits, including lighting, environment, etc. Even height and posture can contribute to the need for additonal power for accommodation.

    Not knowing what type of work you do, I can hazard a guess and think that you are at least on the computer a bit. Wearing lenses that have a UV (ultraviolet) filter, won't change much immediately, but long term can. It will also help with eye fatigue and irritation. Similar to UV protection to your skin when you are outdoors. Long term effects of UV on skin include discolorations and even skin cancers. Long term exposure to the eye include damage not only to the external surface of the eye, but increased discoloring of the crystalline lens, and additional hardening of the lens, as well as damage to the retina.

    OK, now, my next suggestion...Single vision lenses work well at near visual tasks, but the use of multifocal lenses, and I will suggest some type of progressive addition lens (no line bifocal/multifocal), will allow you to wear them without taking them off constantly, and give you less eye fatigue long term. Depending on all of your visual tasks, different types of lenses are best for different tasks. Even in progressive addition lenses, there are different designs suggested for different visual tasks. Get your optician to go over the different types with you and explain why one would be better for you over another type. Hopefully, he/she doesn't advocate one size fits all, because they don't. Progressive addition lenses give you distant correction, even if it is zero power (we call it plano), and then a progressive itermediate power in the progressive corridor (a little technical, here) and then the full add power at the bottom for full near visual tasks. Depending on whay you do most and where it is positioned, you need a different design...

    An Anti-Reflective coating will also help you with reflective glare from lights, overhead, in front of you and from behind. As we age, we are also more intolerant of reflective glare.

    OK, we've got some other great opticians and optometrists that can add a lot of great information here as well, and I'll drop off to let them add to this post. Go for it Shabbir and Pete.

    Diane
    Anything worth doing is worth doing well.

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    Presbyopia

    Diane, thank you for taking the time to give me such a detailed reply; I really appreciate it.

    There is one thing about which I am still not clear. With the progression of presbyopia, what else will be happening with my eyesight? I am currently having problems with my near vision, and intermediate vision up to about three feet. Will the presbyopia progress so that I will have problems up to four or five feet. How does presbyopia normally progress? How fast does it normally progress? Would an increase of +0.25 each year be considered normal? Is it also likely that my distance vision will be affected eventually?

    I have tried to find this out by reading dozens of articles on the Internet, but each one basically talks about problems with reading, and how reading glasses solve the problem. However, I have been finding out over the past two years that presbyopia doesn't only cause reading problems. I guess that I would just like to have an idea about what to expect in the future.

    Thanks!

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    Thumbs up EXCELLENT EXPLAINATION DIANE!

    Hello Eyeseeit,
    My colleague Diane has very well explained Presbyopia, all I have to add is it can begin as early as age of 35 or as late as age 50. Like Diane said, some conditions like diabetes can result in earlier onset of presbyopia as well unusual increase of it. Person with no corrective lenses will usually notice presbyopia in their mid 40s, hyperopes(far sighted) will notice presbyopia earlier, especially if they are not wearing their eyeglasses. Myopes (short sighted) will notice presbyopia later, especially if they are not wearing their full distance correction. It is also good advise to wear anti-reflective coated lenses to prevent glare, because as we age. We are more intolerant of reflective glare.
    I recommend you consult your optometrist for comprehensive eye examination and experienced licensed optician for selection of your eyeglasses.
    Regards,
    Optom

  5. #5
    Optimentor Diane's Avatar
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    Other ocular concerns

    Eyeseeit,

    OK, you're asking, so I'll attempt to answer. Fasten your seat belt, and don't be frightened.

    Presbyopia is a progressive thing, so in answer to your question about that, it will continue to advance until early 60's, when for all practical purposes all accommodation has been lost. See my last post for explaination of loss of accommodation....

    As the add power becomes stronger, the placement of near material is more critical, which is why either a trifocal or progressive addition lenses are recommended for intermediate viewing.

    Will you eventually require correction for distance??? Most people usually do, but not always. Other factors can impact that.

    Is an increase of the add power normally at about 0.25 diopters a year...could be more or could be less. At the age of 61, the average add power is 2.50 diopters and unless additional pathology is involved, rarely, does it go much higher, unless your visual task requires viewing micro sized images....

    As we age the visual system undergoes certain changes, and since vision actually takes place in the brain, that is impacted as well.

    Other factors that we see as we age include...slower visual processing...It takes longer for the brain to recognize images sent to it and interprete those images.

    The requirement for additional light is increased while sensitivity to light is also increased. Contrast sensitivity is decreased.
    Depth perception is decreased.

    The risk of glaucoma increases with age as does the probability of cataracts. Macular degeration and other conditions of the retina, including higher risks of retinal detachment. Floaters are increased as well. We see more dry eyes, and additional pathology because of that. With increased medications ingested, increased ocular conditions also increase.

    Things you may do to help stave off some of these things include good hygiene practices, including gentle eyelid washing, good dietary habits, avoiding smoking (nicotine reduces the size of the blood vessels allowing less oxygen and nutrients, etc. to get to the eye), DON't line your lid margins with eyeliner, eat fewer saturated fats to keep the lipids in the tear film adequate, drink plenty of clean water, and don't dehydrate yourself, to name a few.

    Make sure that you see your eyecare practitioner at least once a year, and if you have concerns, contact him/her prior to that.

    Wear good sunwear. Not all that SAY they are UV filtered are good. It's best to consult your eyecare professional.

    OK, you guys, ya'll finish this with your great ideas.. (How's that for northern AND southern talk?)

    Diane
    Anything worth doing is worth doing well.

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    Response to question about presbyopia

    Diane: thank you for your help. I really appreciate the time that you spent today giving me such great answers. You are great!

    Thank you!!

  7. #7
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    Diane has given you a great explanation in her Two posts. It is a normal progressive problem and you are 100% Normal. It does effect different people at different times and people who are more observant or dependent on there vision will naturally be more effected. Also people who have alwayshad excellent vision and now rquire correction that they never needed before do tend to be more frustrated with it or less accepting. I always tell my patints that the only way to avoid it is to die before you turn 40. Or, The bad news is if you live long enough this is what happens. the good news is you lived long enough. Stupid jokes, but the point is that you are normal.

    As far as your distance vision is concerned, you will probably stay the way you are or become a little farsighted (hyperopia) which may require some lens correction for your distance vision. We'll have to wait and see.

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    Answer regarding presbyopia

    For Stopper (Rising Star): thank you very much for your response to my questions on presbyopia. I am extremely grateful for the help that I have received from you and the other members.

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    The story on presbyopia...................

    The Presbyopia Story

    From the Oxford English Dictionary: [from Greek: presbyz - an old man - eye]:

    “An affection of the eyes incident to old or advancing age, in which the power of accommodation to near objects is lost or impaired, and only distant objects are seen distinctly; a form of long-sightedness.”


    When we are young, we are able to focus easily on objects either at close range or far away. This ability is called“accommodation”. We lose the ability to accommodate gradually with age, so that by age 50 to 55, accommodation is completely gone. This loss of the ability to accommodate is called presbyopia and is the reason why, beginning in our 40s, we need to wear reading glasses or bifocals. When people develop presbyopia, they find they need to hold books, magazines, newspapers and other reading materials at arm's length in order to focus properly. This eventually happens to everyone, and although not a blinding condition and correctable by various optical means, presbyopia is annoying and can be costly in terms of purchasing new eyewear.


    Presbyopia is caused by an age-related process, generally thought to be a slow loss of flexibility of the lens inside your eye. However, the development of presbyopia is actually poorly understood, and several theories have been proposed. In the laboratory of Paul Kaufman, MD, steps are being taken to understand presbyopia and to find a way to preserve – or replace – the accommodative function of the eye.


    How do we accommodate to view objects up close? During accommodation, the ciliary muscle (which encircles the inside of the front part of the eye) moves forward and inward in the eye, releasing tension on the threadlike structures (zonules) holding the lens and thereby releasing tension on the lens. The lens then thickens and moves forward, increasing the optical power of the eye and allowing us to see objects clearly at close range. Just as a thicker magnifying glass makes objects look larger and closer, the thickened lens of the eye during accommodation performs this same function.


    To reverse this process, the muscle relaxes back into resting position, tension is returned to the lens, and it is flattened in to the unaccommodated (thinner) state, leaving the eye focused at distance. Changes with age in the ciliary muscle, lens and its capsule have been the focus of the search to explain presbyopia.


    Lens: Traditional teaching attributes presbyopia to a hardening of the lens of the eye, so that even when tension on the lens is relaxed by ciliary muscle contraction, the lens does not thicken. According to Kaufman, “Physical measurements do show a substantial increase in lens hardness with age. However, it is unknown whether the hardening of the lens is the direct cause of presbyopia or whether the lens hardens because other factors, such as loss of function of the ciliary muscle, cause the lens to‘atrophy’ or harden from disuse.”


    Lens capsule: The lens is surrounded by a thin transparent membrane, known as a capsule. Since the capsule is thought to mold the lens substance, aging changes in the elasticity of the capsule may also play a role in presbyopia. The capsule becomes less elastic and more brittle with age. In Kaufman’s lab, data show that the capsule aids the movement of lens and ciliary muscle during accommodation and relaxation; therefore, its alteration with age might play a role in the development of presbyopia.


    Ciliary muscle: Some researchers suppose that the muscle loses its ability to contract. But based on tissue examination, the ciliary muscle appears healthy even in presbyopic eyes. It is known that it is not the force of muscle contraction, but rather the forward and inward movement of the muscle that releases the tension on the lens and allows the lens to thicken (accommodate). Microscopic and videographic studies in Kaufman’s laboratory clearly raise the possibility that a loss of ciliary muscle movement is involved in the development of presbyopia.



    How can we fix presbyopia?
    “That’s the million dollar question,” says Kaufman, Chief of the Glaucoma Service and recent recipient of a Research to Prevent Blindness Physician-Scientist Award. &#x201CThe most likely therapy under development would be to replace the aging natural lens in the eye with a moldable, flexible plastic lens at the time of cataract surgery.” Kaufman explains that during normal cataract surgery, the hazy lens is removed and a firm plastic intraocular lens is placed inside the lens capsule. Instead of a firm lens, new lens materials now under development might offer the ability to regain accommodation – if the problem were indeed that the old lens simply had become too inflexible,” Kaufman says. &#x201CHowever, if the problem originated in the lens capsule or in the zonules, this fix might not be effective,” he continues.&#x201CArtificial capsules might be developed in the future to solve these problems.”


    While some of these approaches may seem like “Star Wars” concepts now, all are being actively investigated. Kaufman’s work contributes the relevant fundamental knowledge to help advance these approaches and provides a system in which to test them. In the longer term, it may be possible to restore elasticity to the lens, capsule or ciliary muscle through drug therapy or genetic approaches. This clearly is far down the road, but it may become possible as our basic knowledge about connective tissue biology, connective tissue aging and ways to modify them advances.

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    Thank you to Chris Ryser

    Pour Chris Ryser: merci pour votre reponse. (Moi, je suis canadienne-de Toronto, et je parle un peu de francais.)

    For Chris Ryser: thank you for your reply. (I am a Canadian-from Toronto, who speaks a little French.)

    Unfortunately, my American keyboard does not have the appropriate French accents; it's not that I don't know when to use them!

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    Objection! OptiBoard Gold Supporter shanbaum's Avatar
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    Thumbs up Re: Thank you to Chris Ryser

    Eyeseeit said:
    Pour Chris Ryser: merci pour votre reponse. (Moi, je suis canadienne-de Toronto, et je parle un peu de francais.)

    For Chris Ryser: thank you for your reply. (I am a Canadian-from Toronto, who speaks a little French.)

    Unfortunately, my American keyboard does not have the appropriate French accents; it's not that I don't know when to use them!
    é - ALT-130
    è - ALT-138
    ê - ALT-136
    ç - ALT-135
    à - ALT-133
    â - ALT-131

    Hold down the ALT key and type the numbers (on the keypad, the ones above the alpha keys won't work) et, voilà!

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    Thank you to Shanbaum

    Thank you to Shanbaum for the info. on how to create the French accents on an American keyboard.

    All of you guys here at OptiBoard are incredible!

    Thanks again!!

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