Losing Focus

By staff July 1, 2003


Taking a new look at treating presbyopia. 

By Pat Haire 

As if turning 40 weren't traumatic enough, now we learn that it's often the magic number for the onset of an age-related vision impairment called presbyopia that progressively steals our ability to focus at will.

At this point, if you're 39 or younger, turn away. The rest of us can't bear to hear how you can still read type the size of a pin head at six inches or less. But before you youngsters start smirking, you should know that if you live long enough, you're going to have presbyopia, too. Says Dr. David Shoemaker, an ophthalmologist with Center for Sight, "It's inevitable."

By 40, he says, "The mechanisms that change the shape of the lens simply begin to fail." Your vision may blur if you glance at a newspaper after working on a computer for several hours, or you need more light to read fine print.

The problem is three-pronged, explains Dr. Harry Grabow of the Sarasota Cataract Institute. "First, age diminishes flexibility of the eye lens. As the inner core hardens, it loses its ability to change shape and focus at different distances." Age also causes the muscles that control the lens to weaken, he says. Finally, ligaments that connect the muscles to the lens become flaccid and can no longer transmit muscle activity to the lens.

"It actually starts the day you are born," says Sarasota optometrist Dr. Thomas Blom. And if age doesn't get you, diabetes or multiple sclerosis, excessive alcohol or anti-depressant use, and occupations (like computer work) that require you to stare at one point all day long can affect your reading vision.

The first defense against presbyopia is low-prescription "reading glasses" that you can buy at most drugstores. If you suffer from near- or farsightedness, you can move into bi- or tri-focal lenses or contacts.

The next option is monovision, where doctors create a slight nearsightedness in one eye so it performs for close-up vision. The other eye is then used primarily for distance. Monovision can be achieved through eyeglasses, contacts, or surgical procedures. Results vary among patients, but according to Shoemaker, "It's the best approach to dealing with presbyopia at this time."

Other surgical techniques, such as anterior ciliary sclerotomy and laser presbyopia reversal, use incisions inside the eye to tighten lax muscles. Doctors are also working with expansion bands that tighten the ligaments, which may give more muscle control and greater focus ability.

There are also a number of visual therapies available that may delay or diminish eyeglass use. The oldest of these is the Bates Method, named for Dr. William Bates, a New York ophthalmologist who practiced in the early 1900s.

Bates attributed many eye problems to stress, tension and laziness. "With one accord, ophthalmologists tell us that the visual organ of man was never intended for the uses to which it is now put," he wrote in his book, The Bates Method for Better Eyesight Without Glasses. He insisted that presbyopia was not a normal result of aging and could be prevented and even reversed through exercises that strengthened eye muscles and reduced stress on them.

Another visual therapy, the See Clearly Method by Vision Improvement Technologies, is built upon the basic principles of Bates but also advocates "progressive undercorrection," a process that uses steadily weaker prescriptions to blur vision and strengthen the accommodative (focusing) muscles in the eye.

Its claims to improve various vision problems, including presbyopia, are based on the experience of its founders, Dr. Merrill Allen, Dr. Francis Young and Dr. David Murris, who have all used these techniques with their own patients. They're also based on the company's clinical evaluation of people who used their program for five weeks. Of those people, 95 percent improved their visual clarity, 86 percent reduced or eliminated their use of glasses or contacts, and 67 percent reduced their prescription strength.

"I've seen significant results in a large percentage of well-motivated persons," says Dr. Henry Ettinger, a New York optometrist who's been using the See Clearly Method for two years. But Ettinger acknowledges that patients must devote at least 15 minutes a day to such exercises. "When they do, the success rate can be extremely high," he says. "Early presbyopes respond magnificently."

Not everyone is as enthusiastic about visual therapy. "I don't believe in it for presbyopia," says Blom. "It's an age-related problem, and you're not going to turn back the clock on time just by doing eye exercises."

Dr. Gary Bockhold, an optometrist with Center for Sight in Sarasota, agrees to some extent. "Gradually, the lens does get hard enough so that no amount of exercise will help," he says, but he urges his patients to stifle their eyeglass impulse. "If you give in to them too soon, it does weaken the muscles in your eyes. Once you start using them, it's only a matter of months before you need them for everything."

Bockhold encourages patients to exercise their eyes, and boasts one patient who made it to 51 before he needed glasses. His words for those of us who refuse to go quietly into that dark and fuzzy night: "Fight it as long as you can." 


If you've been trying to swat away amoeba-looking creatures dancing in and out of your sight, then you've discovered another vision problem afflicting middle-agers: floaters. These mostly clear, worm-like shapes occur when clumps of vitreous matter in the back of the eye break loose and "float" inside the eye. They're most noticeable against white backgrounds or clear blue skies.

Sarasota optometrist Dr. Thomas Blom says they're prevalent in older adults and more of a nuisance than anything else. But, says Blom, a sudden onset of floaters with flashes of light could indicate a retinal detachment, which, if not treated, can cause permanent vision loss.

"The main thing is to make sure it's not a break or tear," says Blom. "Once that's been ruled out, there's not much you can do about floaters." If they're impairing your vision, there are surgical techniques to remove them, but few doctors recommend them.

Instead, try looking side to side to move the floater out of your main line of sight. That, and keep an imaginary flyswatter handy to sweep them out of the way.

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