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A Close-up Look at Improving Reading Vision

Posted Aug 24 2008 1:49pm
PENNY ASBELL, MD: One of the jokes is that your arms are too short, because at first you can read here and have great vision, then you're going like this, like this, and eventually even holding it far away, you still can't see anything.

ANNOUNCER: That comes as a real shock to people who've never needed glasses before.

PENNY ASBELL, MD: There are people who their whole life they had great vision. They said, "I'm eagle eyes. I can see everything far away." Now they're into their 40s, and now they're having trouble reading, and it's really disturbing to them.

ANNOUNCER: What's going on is the gradual development of a condition called presbyopia.

PENNY ASBELL, MD: Inside the eye is a lens, and that lens actually changes shape. So when we're younger and we're looking from distance to near, it actually changes shape so the focus is good and we continue to have good vision.

What happens as we age is that lens gets a little stiffer, and it doesn't change shape as easily, and that's when you start reaching for reading glasses, because you need the extra power that the lens can't provide anymore.

Typically you first become symptomatic in your 40s, and you start with a low-plus lens, a +1. And then it moves up to about a +3 or thereabouts. So as we age we end up needing a little bit more, and it's changing over time.

ANNOUNCER: Glasses are probably the simplest way to easily read your newspaper.

PENNY ASBELL, MD: Everybody ends up needing reading glasses. This is universal. That's why they now sell reading glasses in the drugstore. Those work fine for many people.

ANNOUNCER: Getting used to glasses means keeping track of them. Some people choose to solve that problem by wearing glasses full time. Lenses can be divided to correct near, far and in-between. And for those who don't need help with distance, lenses can be clear on the top.

PENNY ASBELL, MD: There are glasses that have a different power on the top for distance, and the bottom power has reading power. Bifocals are usually the ones that you actually can see the line in them.

ANNOUNCER: "Progressives" are an update on the traditional bifocal.

PENNY ASBELL, MD: They look like normal glasses, but they actually have different powers to give you good distance vision and good reading vision all with one pair of glasses.

ANNOUNCER: Another option sounds a little lopsided, but actually works fairly well. In people who need help only with reading can wear just one contact lens. The brain miraculously makes the necessary adjustments to see everything else properly.

This system, called "monovision," works for people who also have problems with distance. Here two contact lenses are in order.

PENNY ASBELL, MD: Monovision is where you correct one eye for distance and the other eye for reading. Sometimes they call it blended vision, because you actually continue to use the two eyes together. It's just one's doing more of the distance vision, the other one's doing more of the reading vision.

ANNOUNCER: Monovision may need a bit of getting used to since it can create a sense of unbalance or change in depth perception.

PENNY ASBELL, MD: We may give them a pair of lenses, try it in the office, try it at home and decide if you're comfortable with that vision change. And most people are, by the way.

ANNOUNCER: In recent years two types of procedures have been offered to more permanently restore better eyesight. Lasik surgery was the first and has often been used to correct distance vision, although it is also used to help with reading.

PENNY ASBELL, MD: When we use a laser, we actually take off a small part of the cornea to change the shape. The cornea is the front window of the eye. If we change its shape, we can change the vision and get rid of contact lenses and glasses, and it can work extremely well. There's cutting involved. There's tissue removed. There's a permanent change to the eye.

ANNOUNCER: This type of surgery can change the life of someone who has worn glasses for much of their life. But problems can develop in certain people.

PENNY ASBELL, MD: If you already come into it with significant dry eyes, it may get worse after the laser procedure. If you're concerned about glare or halos, like with driving a car, sometimes that's a symptom that laser patients have after the procedure.

ANNOUNCER: Another procedure called CK uses a type of energy that comes from radio waves. CK is only used in people to correct difficulty reading.

PENNY ASBELL, MD: CK stands for conductive keratoplasty. CK is a little bit different. There's no tissue removed. There's no cutting. It's done all on the edge or the outer part of the cornea. And because of that, there's really a little less risk. We use a tiny probe that delivers energy to the part of the window called the stroma, and it shrinks that tissue ever so much, kind of like cinching a belt to tighten the cornea and make the central part steeper. So that small amount of energy is delivered. It shrinks the collagen tissue, the tissue in the cornea and cinches it so the cornea domes up or steepens up in the center.

ANNOUNCER: CK and Lasik: two different options for those who want to toss their glasses. But experts stress that neither is a sure-fire perfect solution.

PENNY ASBELL, MD: There's some variability in how the patient's going to respond, how they're going to heal and the final result that they're going to have. They may have good everyday vision for driving a car, reading a menu. But are they going to read War and Peace, you know, 1,000-page book, they may want to have reading glasses for their very best vision for reading in both eyes.

ANNOUNCER: And the hard truth is that no matter what you do, the aging process continues.

PENNY ASBELL, MD: People need to realize that they may need to come back and do a little bit more because their eyes have aged and they need more correction.

It would happen with laser or CK or contact lenses. Contact lenses, we'd be changing the power. In glasses, we'd be changing the glasses power.

ANNOUNCER: Still, at least now there are choices for the time when your arms get "too short."

PENNY ASBELL, MD: You could get corrected with glasses. You could get corrected with contact lenses. If those aren't for you, refractive surgery is another alternative. And fortunately, we have a lot of options for that, and many of them work very well.

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