Clearing things up

Health: For the estimated 90 million American adults who suffer from presbyopia, advances in contact lenses, eyeglasses and surgical techniques offer hope for improved vision.

September 02, 2001|By Lisa Liddane | Lisa Liddane,ORANGE COUNTY REGISTER

In the winter, Denise Hess sat on her living room sofa to work on her needlepoint. Eyeglasses perched on her nose, she held out the fabric at arm's length, struggling to count the tiny squares.

And the dance began.

She adjusted her glasses. Forward. Backward. Up. Down. And so on, until she found that sweet spot in which the fabric didn't appear blurry.

Hess, 49, a library technician from Yorba Linda, Calif., has presbyopia -- a condition in which eyes are unable to see nearby objects clearly. This usually occurs after age 40, when the eyes' lenses become less flexible.

Symptoms of presbyopia, which affects an estimated 90 million adults in the United States, include having to hold reading material farther away, headaches and difficulty seeing in poor lighting.

Hess' tango with her eyeglasses ended months later when she bought disposable bifocal contact lenses that enable her to see near and far. They are among the technical improvements that have increased options for presbyopes who want eyewear tailored to their lifestyles.

Sure, drugstore-variety reading glasses work for some. But many baby boomers, optometrists say, want nothing to do with old-fashioned reading glasses, known as "cheaters."

Beyond cosmetic appeal, contact lenses and progressive addition lenses offer some distinct advantages. They can accommodate -- in ways that drugstore-variety reading glasses sometimes can't -- other vision-related aspects of a person's lifestyle, such as using a computer, exercising or playing a sport, or other eye conditions, such as astigmatism.

Here's a look at some of the options for aging eyes:

Contact lenses

In recent years, disposable or frequent-replacement contact lenses for correcting presbyopia have become available. Disposables are replaced about every two weeks; frequent replacement, typically every month. Disposables are popular because they are relatively easy to replace if lost or damaged, and because they might be less likely to cause eye infections than lenses worn for longer periods.

Disposables have many advantages, said Timothy B. Edrington, chief of the cornea and contact lens service at the Southern California College of Optometry in Fullerton.

"For many people, there's immediate adaptation to the comfort of disposables," he said. "Patients can try them on at a limited expense. Because rigid bifocals are made to a specific prescription for a patient, it's not as easy for patients to try several versions."

Rigid gas-permeable lenses, available for more than a decade, remain a valuable option, especially for people who need more complicated prescriptions that can't be made in disposable lenses.

Contact lenses can correct presbyopia in several ways:

* Bifocals: Like bifocal eyeglasses, each lens has two powers -- one for seeing near, the other for seeing at a distance.

* Multifocals: Like progressive lenses of eyeglasses, these enable a wearer to see near, far and in-between. The lenses have several zones of power to assist the eye gradually, depending on where it's focused. Like bifocals, these lenses sometimes might not provide crisp clarity.

* Monovision: A lens for reading and seeing near objects is placed in one eye and a lens for seeing distant objects in the other. In some cases, an optometrist might put a bifocal lens in one eye and a lens for distance in the other. Many people adapt well to monovision, Edrington said. Others have difficulty with some blurriness. Monovision can result in some loss of depth perception, but most patients seem to cope.


Progressive-addition lenses have improved eyeglasses for presbyopes, said Robert J. Lee, assistant professor of optometry at the Southern California College of Optometry. These lenses look like single-vision lens.

The top part of the lens typically is for distance viewing, the middle for intermediate, the bottom for reading, Lee said.

But a lens might have hundreds of computer-generated zones with seamless transitions to accommodate other daily activities such as sports, exercise and hobbies.

Thanks to sophisticated optical plastics, Lee added, lenses are thinner and lighter, which help make eyeglasses more comfortable and attractive.

Even longtime users of traditional bifocals and trifocals have become converts to progressives.

Charlotte Wilkins wore bifocals and trifocals for 10 years for her morning coffee-sipping and newspaper-reading.

In January, her optometrist told her about other options. Wilkins, 56, declined contact lenses because she found them inconvenient. The retired nurse from Fullerton bought her first pair of progressive-addition eyeglasses with titanium frames. She isn't looking back.

"I don't have to look right through the lines or down or up," she said. "I focus very quickly. I can read the newspaper without having to stand on my head."

Surgical techniques

Implanted bands, permanent lenses and lasers are some of the surgical devices and techniques that researchers are exploring to help people deal with presbyopia.

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