Author: Dr Val Phua MBBS, MMed (Ophth), FRCOphth, FAMS
Photo by: Mari Lezhava
It usually begins at about 40 years old. The distance at which you hold your favourite book or magazine gets progressively further and further away from you. All you life you’ve had perfect eyesight and you’ve always taken good care of your eyes but yet you seem to have some difficulty reading now. You repeatedly dismiss that it could be a sign of your aging eyes. Soon you even start feeling a significant strain and tension between your eyes from trying to focus too hard for too long. You finally check in with your friendly optometrist who then breaks the bad news. Yes you officially have presbyopia and need reading glasses. Welcome to the club.
Millions across the globe identify with this scenario. For many, reading glasses is a fact of life and they are readily accepted. However, there remains a significant number who get highly annoyed with this diagnosis and given prescription. Needing to reach out and slap them on each time you want to read your book or phone, looking for them high and low if you belong to the slightly absent minded group, and those unsightly nose marks after prolonged use. There has to be a better way and there is.
An option that is gaining in popularity is that of monovision. The concept is simple and the results are impressive. One eye is corrected for distance vision and the other for near work. This can be achieved with laser vision correction or cataract surgery by setting specific targets for refractive outcomes for each eye. It is common to undergo a contact lens trial to see if monovision is something one can adapt to. With monovision, there is a slight compromise in distance and near vision and even a decrease in appreciation of depth in exchange for convenience and the freedoms that come with being glasses free.
What if you have tried monovision and find it difficult to get used to even are uncomfortable with it? Don’t worry there are still ways around it. A whole new world of intraocular lens options are available that can address the blurring of vision due to cataracts, correct any short-sightedness, long-sightedness, astigmatism and yes even presbyopia. Welcome to the universe of multifocal lenses. The technology for these lenses have come a long way and many factors come into play when deciding on which lens to use. Some of the currently more popular choices include the Alcon PanOptix, the Zeiss AT Lisa Tri and the TECNIS Multifocal lenses. Each have their unique selling points with differing ways light is split to optimise vision for distance and near, allowing a majority of patients to be completely free from the need for reading glasses whilst still enjoying clear, sharp vision for distance objects. Those who like it really do swear by it but there remains also a not so silent minority who cannot stand the effects of glare, halo and the decreased contrast sensitivity that tend to come with these type of intraocular lenses. Some of these cases may end up requiring an exchange of the initial lens used before being satisfied with their vision.
Besides multifocal lenses, there are also other to deal with presbyopia after cataract surgery. This is in the form of extended depth of focus (EDOF) lenses. These lenses extend the range of vision by modifying the design of the lenses such that it allows an elongated area of focus rather than splitting light to allow focus for far, intermediate and near work. Whilst the multifocal lenses tend to compromise on intermediate range of vision, which may be unsatisfactory for some because this means looking at computer screens may not be so sharp, these EDOF lenses compensates for this by allowing improved vision for intermediate work with less risk of glare and halo but it does fall short of providing that additional clarity for near work. Some examples include the Tecnis Symphony lens and the Zeiss LARA lens. More recently, a “monofocal plus” lens has also emerged providing even greater options for patients to consider. These lenses aim to provide better near vision while eliminating the glare and halos associated with multifocal lenses.
There remains a group of patients who fall through the cracks despite the myriad of choices available for glasses freedom. These are patients who have tried but are unable to tolerate the monovision concept and also do not yet need cataract surgery. Options available to those undergoing cataract surgery are actually also available to this group of patients. In this case rather than mislabeling it cataract surgery, it would be appropriately called refractive lens exchange. In essence, the natural lens of the eye is removed, very much similar to the way a cataract is removed, albeit with negligible energy used and an intraocular lens is then inserted in its place. One does need to bear in mind that the risks involved in standard cataract surgery still applies in these cases.
The advances of ophthalmic surgery and technology have opened up a whole new realm of opportunities for people to lose their reading glasses. You may soon find reading glasses a rarity rather than the norm.