Are reading glasses inevitable?
September 10, 2017 5:23 AM   Subscribe

Virtually everyone, even with 20/20 vision, needs reading glasses at some point in their 40s. Or do they? Is there any way to stop or even stall the inevitable? I read about an app called "Glasses Off" that supposedly strengthens eye muscles but the reviews were very mixed. Wondering if anyone knows any strategies for avoiding the dreaded glasses. (Yes, I should ask my eye doctor, but I don't have one.)
posted by whitelily to Health & Fitness (31 answers total) 10 users marked this as a favorite
Yeah, it's pretty much inevitable. There are some exercises to strengthen vision, I'm not convinced they actually work. I recommend an eye exam; even an optometrist exam includes some basic eye health screening. They will probably give uou a prescription; you could buy from them, ignore it and just buy reading glasses, or buy online (you'll have to request a copy of the prescription). In my case, I needed bifocals and have different corrrection on each eye, so I bought online.
posted by coldhotel at 5:45 AM on September 10, 2017 [4 favorites]

Presbyopia happens because the lens (the part of your eye that changes shape in order to focus an image on your retina) becomes less elastic over time, just like the rest of your body becomes less elastic over time. This actually starts in childhood, but can be compensated, until it ... can't. Whoever comes up with a way to reverse aging will probably will a Nobel Prize.

Taking breaks from close work (e.g. reading, computers) is important to avoid the eyestrain and headaches that accompany prolonged accommodation. But eye exercises, like the type that have you look to one side and the other? Those use a totally different set of nerves and muscles than those controlling the shape of your lens, and are a scam.
posted by basalganglia at 5:47 AM on September 10, 2017 [4 favorites]

IANYOptician, but the short answer is yes, almost everyone will need corrective lenses as they get older, and no, there is not much you can do to stall or prevent that degradation, certainly not an app.

Longer answer is that some people get lucky with their eyes, and can function perfectly well without glasses at 60 and there are people who need serious bifocals at 30, there's a ton of variation in eyes. There's a chance you'll never need them, but I wouldn't bet on it.

There are exercises I'm aware of to strengthen eye muscles, but I don't know that I've heard of them being used to prevent aging of the eye, they're for lazy eyes, most of the reason people end up wearing glasses when they get older is in the lens of the eye.

The #1, absolute best thing you can do to keep your eyes healthy is to have an eye doctor, visit them yearly, and wear whatever correction they say you need. Eyes are an amazingly adaptable organ, it's very possible to 'need' glasses and not know it, and they can get so used to wrong input that corrections don't work as well.
posted by neonrev at 5:50 AM on September 10, 2017 [1 favorite]

neonrev: so say for sake of argument I need glasses now and don't know it - am I causing permanent damage to the health of my eyes?
posted by whitelily at 5:56 AM on September 10, 2017

I was really interested in this question as I enterered my 40s, never having had glasses (and coming from a family of glasses wearers) and did ask my eye doctor. He explained that, yeah, 40s is usually when you start needing readers and it can happen, relatively speaking, sort of fast because you've been compensating without noticing it (Saying "why is the type on medicine bottles so teeny nowadays?!") and then one day you notice that if you put reading glasses on, you can see again. That's exactly how it worked for me a few years ago. Here's more of an explanation from the American Optometric Association which also includes what warning signs to look out for.

Getting your eyes checked, if possible, is a good idea so you can establish a baseline and then you'll know more clearly if you are having a change from what is you-normal. There are even at-home eye tests where you can test your general vision. They're not a substitute for an eye exam, but they can give you some idea if what you're experiencing is normal.

If you need glasses now and it's normal age-related stuff, you can just get some drugstore glasses (seriously, this is what my eye doctor suggests) and then avoid things like eye strain which can cause headaches and other side effects of bad vision (difficulty driving, reading, etc).
posted by jessamyn at 6:01 AM on September 10, 2017 [3 favorites]

My husband prided himself on his 20/20 vision for years, as my eyes began their inexorable decline early, starting on my 20s and he felt very smug.

Fast forward to when he turned 40 and figured he'd better have an eye exam since he really hadn't, like, ever. He went from "haha four-eyes" to "I wear bifocals now" as a result of that appointment. He'd been walking around with declining vision for years and hadn't noticed.
posted by soren_lorensen at 6:12 AM on September 10, 2017 [10 favorites]

It would depend on the prescription, but very possibly. It's not necessarily a physical thing, ime it's largely mental, the brain and eyes work together to process input and can compensate for a lot, especially over time. The reason I mention is because the hardest category of patient is the older person who has needed glasses for years, never wore them, and now the brain can't make it work anymore, and corrective lenses feel 'wrong' even if they are technically 'right'. It doesn't happen to everyone, but it can happen. It's basically just increasing eye strain over years as well. It's no good.

If you go and see a dentist every year to keep your teeth healthy, why not an eye doctor? You use them more, and can't even clean them.

(IANYOptician, which I will note is very different to an Optometrist. I'm speaking from patient experience, not actual medical knowledge.)
posted by neonrev at 6:16 AM on September 10, 2017 [1 favorite]

I was nearsighted, and got PRK (similar to LASIK) in my late 30s. My surgeon warned me that without surgery, I would probably be well into my 50s before I needed reading glasses, but with, it would be in my 40s. I decided that was an acceptable cost. Now in my mid-40s, I haven't gotten reading glasses yet, but it's becoming clear (heh) that I need them. I do that thing sometimes where you hold things farther away to read them, and I have a magnifying glass app on my phone which I occasionally use for small type.

So, um, I guess being nearsighted can delay the need for reading glasses, but then of course you need glasses or contacts for distance, plus that's not something you can do deliberately.
posted by DevilsAdvocate at 6:19 AM on September 10, 2017 [2 favorites]

Two bits of anecdata for you - by the time I got glasses, I had being accustomed to some fuzziness in the far field of view for... maybe a couple of years, maybe just one year. My vision was only 20-50 or so, so not severe. Even so, I noticed that it affected my depth perception for landscapes and such, because my brain had started to use how sharp the edges of things were as a guide for how close they were to me. Now I wear my glasses maybe 10% of the time but it seems to be enough to keep my brain from falling back into that habit. So I could see that being an issue, as neonrev said, with patients who've had uncorrected vision for a long time.

The second piece of anecdata is that after doing close work and using computers for a long time, your eyes do get tired in the sense of correcting the lenses as well. When I went from using computers constantly to using them more rarely for a few months, my prescription strength decreased, and my optometrist explained that as the reason. Taking breaks and looking farther away for a bit is supposed to help with this.
posted by Lady Li at 7:41 AM on September 10, 2017

The stiffening of the lens can't be compensated for by strengthening the associated muscles, because the human eye was designed by morons.

Not only is the retina laid in backwards so that the nerve cells wiring it to the brain run in front of the light sensors (octopuses get this right, but we mammals do not), the musculature around the lens that controls its focus is a stupid half-assed arrangement as well.

Focusing on nearby stuff requires that the lens gets thicker. Any sane engineer would simply have run a ring of sphincter straight around the outside of the lens, so that when you want your lens thicker you just contract that muscle and squeeze the lens at the edges; but that's not how our eyes are built.

Instead, the lenses are blobby gels that would assume their thickest shape if left completely to their own devices, suspended in a network of radial fibres that can apply various amounts of tension to stop them doing that. Those fibres, in turn, are surrounded by a sphincter that pulls them outward when it relaxes.

So in normal vision, the sphincter is relaxed, the fibres get pulled outward, and the lens gets tensioned and flattened. For close work, the sphincter contracts, the tension on the fibres is reduced and the lens then thickens because it can, not because it's being squeezed.

The lens never gets directly squeezed by the sphincter. Once you've got enough squeeze going to remove all the tension from the suspensory fibres, the thickening that the lens is then allowed to perform is all it's ever going to do.

There is simply no compression-capable connection between the muscle controlling the lens and the lens itself. You could have the toughest fittest strongest bestest most diligently exercised ciliary muscle in the whole world, and it still wouldn't compensate for a lens that had got too old and thin. And the lens itself isn't a muscle, so you can't make it stronger or more inclined to thicken itself just by working it. Once it's got old and thin and hardened, that's pretty much your lot.

I find it difficult to express just how pissed off I was after my optometrist had explained this bit of anatomy to me. Suffice to say it was a lot.
posted by flabdablet at 7:58 AM on September 10, 2017 [41 favorites]

If you're interested in the science, read up on crystallin proteins. Most proteins in the body are replaced anywhere from every few minutes to every few days. Crystallin proteins, by contrast, are synthesized at the birth of the cell [and persist] throughout the life of the organism, which allows damage to slowly accumulate. If you want to go way out on the edge, there's at least one company which is doing pre-clinical research on an alpha-crystallin stabilizer. (I'm not suggesting that you do go way out on the edge, BTW.)
posted by clawsoon at 7:59 AM on September 10, 2017 [2 favorites]

If you started out 20/20, I guess glasses are inevitable but I've been nearsighted since my tween years and at 54, and still need glasses for distance but not for reading. My corneas feel pretty damn stiff though.
posted by bonobothegreat at 8:05 AM on September 10, 2017 [2 favorites]

Another summary of the science (in which "accommodation" basically means "flexibility"):
When young monkey lenses are subjected to mechanical stretching, the lens fiber cells are highly elastic, allowing the lens to undergo considerable changes in shape. A young monkey lens is soft and pliable, whereas a 46-year-old human lens essentially fails to undergo any change in shape with mechanical stretching (Figure 4). This is due to the progressive loss of accommodation, which, ultimately, by age 50, effectively results in complete loss of accommodation.

We have demonstrated this with isolated human lenses, mechanically stretching them to produce accommodative optical changes. Young lenses stretched in this way undergo 12.00 to 16.00 D of accommodative change, but the same amount of stretching applied to 60-year-old lenses fails to produce any accommodative optical change. That is because these lenses have become stiff and unable to accommodate. Mechanical compression of intact human lenses shows that they undergo an exponential increase in stiffness.
So even if we had a muscle to compress the lens, the lens would still get too stiff over time to be compressed.

You could spend more time in the cold, since heat contributes to the degradation of crystallin proteins:
Population surveys have shown that the age of onset of presbyopia is inversely related to temperature. In climates with warmer temperatures, people tend to develop presbyopia at an earlier age.
Ultimately, though, the problem is that we live too long: "The problem with both presbyopia and cataract is that humans are outliving the life expectancy of the lens."
posted by clawsoon at 8:12 AM on September 10, 2017 [1 favorite]

Also, for the benefit of other people hitting the age where this shit happens to you: when my eye tests first started showing me how much clearer text was with +1 dioptre of correction, I went and bought some cheap and shitty OTC non-prescription reading glasses. Little ones, so I could perch them on the end of my nose and look over the top of them. These worked pretty well for about two years.

Then things shifted to the point where I really needed +1.5 for reading, and the way optics works means that my feeble old lenses with +1.5 correction applied have a vastly reduced depth of field compared to bare eyes or eyes wearing +1s. Managing various strengths of reading glasses for assorted different kinds of work became a real nuisance, and I went back to the opto to ask about prescription multifocals.

These were enthusiastically recommended, so I bought a pair at vast expense (seriously, they were something like $600 compared to reading glasses at $15 a throw). And I hate them.

The idea was that these were something I'd be able to just throw on my face and never have to take off, and their multifocal nature meant I'd be able to retrain for accommodation by just tilting my head forward for far vision and backward for near vision instead of using my ciliary muscles. Which was fine as far as it goes, and actually does work; I got the hang of walking around in them after about a week, and it was quite nice to be able to access non-blurry-world without fiddling with my face.

But what I was really, really not expecting was the side effects of the quite narrow vertical field of focus in the reading magnification zone of multifocal lenses. I was simply unable to read a line of text without swinging my head left to right to left to right like some demented fucking elephant.

I read fast. Fixing my gaze straight ahead and moving my whole head to do it is just too slow. If I wear cheap shit-grade reading glasses instead of my Rolls Royce multifocals, I don't have to. So I've put them away, and just got better and managing multiple sets of reading glasses.

My optometrist assures me that most people do learn to drive their multifocals within a few weeks. I gave mine two months and noped out. I'm sticking with cheapo reading glasses for which destruction is not financially disastrous until they stop working for me altogether.

If you're considering dropping serious money on multifocals, do yourself a favour and try reading for a while through normal cheapo reading glasses with a bit of spray glue or something similar applied to them in such a way as to restrict your clear non-blurry view to a central wedge maybe 30° wide. If you can learn to cope with that without driving yourself round the twist, multifocals will probably be OK for you.
posted by flabdablet at 8:21 AM on September 10, 2017 [3 favorites]

It might be interesting to know that glass quality in multifocals is mainly noticeable in how wide or narrow that reading magnification zone is. (I happen to love mine but we're all different!)
posted by Too-Ticky at 8:33 AM on September 10, 2017

I'll add this note: Once you start wearing readers resist the urge to move to stronger and stronger correction; stick with the lowest + that you can for as long as you can. For me it seemed that if I succumbed to the siren song of "just a little sharper" it did allow my eyes to get lazier.

I guess I got lucky - years after correcting for severe myopia including astigmatism with lasik, presbyopia started claiming only one eye, resulting in natural monovision. One eye is good far and the other is good up close. I wear readers when I'm reading in low light; cheap ones from Sams are good enough.
posted by achrise at 8:53 AM on September 10, 2017

Oh yeah, there's maybe one more option: Accommodating IOLs (intra-ocular lenses). However:
Overall, the reported results with these lenses by independent authors have been modest in relation with the restoration of the accommodative power of the eye and these modest benefits are usually lost with time due to the long term changes in the capsular bag. This fact made these lenses to be almost abandoned in the last few years...
...which is maybe why I only see them mentioned in relation to cataract surgery and not presbyopia.

(Can you tell that an eye doctor told me a few months ago that my lenses were beginning their inevitable stiffening and I went into research mode?)
posted by clawsoon at 8:58 AM on September 10, 2017

I came here to say that wearing sunglasses when outside might help, but on doing a little research it looks like corneal hardening isn't really caused by UV but is just an age-related process. Still, ultraviolet radiation does cause cataracts and macular degeneration, so if you want your eyes to keep working as long as possible you should probably make wearing sunglasses with good UV protection a regular habit.
posted by Anticipation Of A New Lover's Arrival, The at 9:10 AM on September 10, 2017 [1 favorite]

I love my multifocals and yes everyone is different.

I've worn glasses almost all my life, with a short stint with contacts, and I'll just say that they are kind of nice in some ways - they keep rain and wind out of your eyes, if you get transitional lenses which do work better these days they darken in bright sunlight. It's not all bad!
posted by warriorqueen at 9:10 AM on September 10, 2017

There is research that people who spend time outdoors have better eyesight, presumably because they use the eye muscles for distance. But the age related vision loss appears inevitable. My eyesight is noticeably worse because I spend so much time using computers. Using my phone for any length of time has a distinct and unwanted effect on my vision. I realized I needed reading glasses when I had trouble reading the newspaper. The eye doctor said self-selected readers from the drug store are fine, but ask your eye doctor. Go to Walgreens, try on glasses, use the testing chart, if you want a simple test.
posted by theora55 at 10:40 AM on September 10, 2017

I had LASIK some years ago to correct my lifelong nearsightedness. During the intake meeting, I said that I knew that I'd need reading glasses at some point, and asked if there was a way to cheat that. The guy said I had two options:
  • "Mono" correction, meaning that they'd map one eye for distance vision and one for near vision. I've got a friend who's had this done and she's happy with it, but the guy at the eye clinic was clearly not a big fan, so I asked him what the other option is, to which he replied…
  • Corneal replacement. The offhanded way that he tossed this out damn near made me fall out of my chair. It's a lot more expensive (no surprise).
In the end, my LASIK correction wound up backsliding, so I wear glasses for distance vision sometimes. I'm 51 and don't quite need reading glasses yet, but I can see the day is coming.
posted by adamrice at 10:49 AM on September 10, 2017

But what I was really, really not expecting was the side effects of the quite narrow vertical field of focus in the reading magnification zone of multifocal lenses.

Another option is traditional bi-focal or tri-focal glasses. These have a much wider horizonal field of view so you don't have to swing your head to read a book.

If you get bi-focal or tri-focal lenses, insist that they are made of glass, not plastic. Yes, they will balk because they often have to go out of house to order them, but glass bi-focals are much superior to plastic because the line between the lens zones is almost invisible to the wearer. Plastic bi-focals have a very annoying blurry transition line between the upper and lower lenses.
posted by JackFlash at 10:58 AM on September 10, 2017 [1 favorite]

My vision has always been amazing, but between forty and forty-one my arms got a little short. I went off and got checked and they offer d me varifocal readers so good for tv and computer but also not having to take them off when talking to people. I gave them a good college try, but they made me puke, I couldnt deal so I went back and am on my first try of using my new regular screen glasses. I have a really hard time knowing if it's working or not, I can feel my eyes working when I put them on and take them off.
posted by Iteki at 12:55 PM on September 10, 2017

Not to go too deep into the multifocal tangent, but I hated my multifocals for about 13 years. Then I got some high-end digitally rear-surfaced ones and I almost love them. I still wear separate glasses for reading, but my multifocals are optimized for distance, and almost as good for distance as before I got presbyopia. An optician who knows what he or she is talking is invaluable.
posted by still_wears_a_hat at 3:00 PM on September 10, 2017

This NYT article says the Glasses Off app actually works. Although the physical changes are inevitable, apparently you can adjust mentally to offset them. It requires a real investment in time, though.
posted by Mr.Know-it-some at 4:31 PM on September 10, 2017 [1 favorite]

Drug store/grocery store reading glasses are wicked expensive. ~$20/pair. Once I learned my "number" based on trying out drugstore glasses I was able to get four pairs for $20 on Amazon.

To avoid them you can always deny them. I never wear my reading glasses in public, I just hold the thing I'm reading farther away.

Best of luck!
posted by bendy at 8:54 PM on September 10, 2017

high-end digitally rear-surfaced ones

are allegedly what I was supplied with as well, so YMMV as always.
posted by flabdablet at 9:46 PM on September 10, 2017

High quality reading glasses for a buck a pair at Dollar Tree dollar stores. I tend to go into the store and buy twenty or thirty pair, varying strengths, litter them all around my condo, my bicycle bag, my pickup.

I laughed at my sister when she began to wear glasses in her late 30s, I was all "Hardy-har, you are a weakwilled ninny, whereas I am not, and have perfect vision." Then at 43 the bottom fell out, and I began to need readers.

The glasses at Dollar Tree, sometimes they have all kinds of designs and bright colors, sometimes just pretty much Plain-Jane frames. But they're tough as nails, and if (when) they *do* break, when I fall asleep with them on, or sit on them, or what-have-you, I chunk them in the trash and get a different pair, one of the many pairs littered here and there.

PRO-TIP: Supposing you're wanting to read something *real* small and in a darkened room or whatever, and you can't read what you're trying to read, well, hey, just slap another pair on top of the first pair and you *will* be able to see, pretty much see everything.
posted by dancestoblue at 4:30 AM on September 11, 2017 [3 favorites]

I am one of the rare people who is nearly 60 and have yet to need reading glasses. My siblings both younger and older have used readers for years but I haven't. It could be the luck of the draw or that I have spent much of my professional life constantly switching between close-up computer screens, mid-distance video monitors, and far distance photography and even further distance driving (I am an automotive media content creator). At my last optometrist visit a year ago the doc suggested that I might want a mild correction for distance that I "might use for driving at night in an unfamiliar city," but cautioned that eyes quickly adapt to correction and lose their ability to focus without correction.
posted by bz at 9:59 AM on September 11, 2017 [1 favorite]

but cautioned that eyes quickly adapt to correction and lose their ability to focus without correction.
posted by bz at 11:59 AM on September 11

I was told the exact same thing by an optometrist, that yes, I could use glasses but the minute I put glasses on I would be married to them for good. Though my eyes do go in and out of focus, esp when tired, they can still focus, and I don't want to lose that.
posted by dancestoblue at 5:49 PM on September 11, 2017

yes, I could use glasses but the minute I put glasses on I would be married to them for good

This has certainly been my experience, but I think it was driven less by eyes altering in response to correction than by the realization that I'd already spent at least a year living in a much blurrier world than necessary.

Being actually able to see things at close range again is quite addictive.
posted by flabdablet at 7:23 PM on September 13, 2017 [1 favorite]

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