In the 50-is-the-new-40 (or 30) era, many women manage to take the appearance of fine wrinkles or a few extra pounds in stride— after all, there’s always the next state-of-theart skin serum or a new exercise class around the corner. But one universal sign of the passing years can’t be forestalled with products, workouts, or even massive amounts of kale: that dreaded moment when you stand squinting helplessly at a price tag. The gradual blurring of near vision that most people start to notice in their 40s, called presbyopia, tends to rankle women in particular, with nearly 40 percent saying the simple act of putting on a pair of reading glasses makes them feel old.
“For many people, it’s one of the first signs of aging—and it’s a bummer,” says Julia A. Haller, ophthalmologist-in-chief at Philadelphia’s Wills Eye Hospital. Presbyopia is also the most obvious signal that you’ll need to pay more attention to your eyesight than you may have in your carefree youth. “Healthy people can usually get away with just one eye exam in their 20s and two in their 30s, even if they wear glasses,” says Haller. “But starting at about age 40, you should get a thorough exam and start having your eyes checked at least every couple of years.”
That’s because as you age there are simply more things that can go wrong with your eyes, from dryness to more serious conditions. And it’s critical for a doctor to know if you have a family history of eye issues such as glaucoma or macular degeneration, or any underlying conditions; diabetes, for instance, can lead to diabetic retinopathy, the leading cause of decreased vision in working-age Americans. Here’s what you can expect to see as your vision changes—and what to do to keep your eyes as healthy as possible.
Schedule a comprehensive eye exam when you turn 40, or sooner if you notice you have trouble reading or performing close-up tasks comfortably. There is no cure for presbyopia, but the basic treatment is simple and inexpensive: reading glasses. “You can get prescription lenses, but drugstore glasses are just fine, and we recommend them to patients all the time,” says Kendall Donaldson, an associate professor of clinical ophthalmology at the University of Miami Health System. Drugstore readers are cheap enough that you can (and should!) buy several pairs and stash them in multiple rooms, handbags, and pockets.
“Readers typically range in power from +1 to +3.5 diopter, so try the lowest power first,” Donaldson suggests. The test is basic—just try on several pairs at increasing powers until you can read clearly at a distance that’s natural for you (usually about 12 to 15 inches). Most people need to increase the power gradually every few years by half a diopter or so until about age 65.
If you already wear glasses for distance, there’s good news: You don’t have to sport your grandma’s funky bifocals. Progressive lenses have done away with the telltale line— and the jarring “image jump” it causes when you glance from near to far—by combining correction for distance, intermediate, and near vision into one seamless lens.
These days, even glasses can be optional for those willing to try an increasingly popular technique called monovision. Achieved through either contact lenses or LASIK surgery, monovision involves correcting one eye (usually the dominant one) for distance and the other for close-up work. The brain learns to suppress the out-of-focus eye to provide a clear picture. “It works for a lot of people, but it’s not perfect,” says Donaldson. In some, monovision can cause eyestrain, sensitivity to glare (especially at night), and reduced depth perception (golfers beware). “It’s important to try it first, which you can do with contact lenses, to see if monovision works for you,” she says.
No More Tears?
As you get older, your eyes also become more susceptible to dryness. While the stinging or grainy sensation you feel when your eyes don’t produce enough tears can be caused by factors like allergies, medications, or the parched air of a plane cabin, hormones play a part as well. And just as some women become intolerant of contact lenses during pregnancy, says Donaldson, the changes that occur during menopause—such as mucous membranes’ losing their moisture—can lead to dry eyes.
Mild or occasional symptoms respond well to over-the-counter artificial tears, which are available in a range of formulations; a doctor can prescribe stronger drops for more troublesome cases. Environmental and lifestyle factors can also make a big difference. Central heating and fans, for instance, tend to exacerbate dry eyes, as does the airflow in a car. “I tell my patients to point the air vents away from the face and wear sunglasses when possible to block the gusts,” Donaldson says.
Being prone to dry eyes in middle age means you’re also more likely to experience computer vision syndrome, which can arise from prolonged periods of close work on electronic screens. “When we stare at something for a long time, our blink rate decreases, and the surface of the eye becomes less lubricated,” says Donaldson. “It can affect anyone who spends 10 hours or more a day at the computer or reading a tablet or smartphone.” This type of eyestrain won’t cause permanent damage, but she advises keeping a bottle of artificial tears on hand, taking breaks from the screen every two hours or so, and consciously blinking more often.
For more stubborn cases of dry eyes, your ophthalmologist may suggest punctal plugs, which are tiny stoppers that partially or completely close the tear ducts in your lower eyelid to reduce tear loss. “It’s a minor procedure to place them, taking just a couple of minutes in the doctor’s office,” says Donaldson. The plugs can be made of silicone or, for patients who want to try them out temporarily, dissolvable collagen.
As you pass through middle age and beyond your late 50s, two more serious eye conditions can arise. The first and most common, a cataract, occurs when the eye’s lens gets cloudy, blurring vision. By age 80, more than half of all Americans either have a cataract or have had surgery for one. But they are eminently treatable—and you may even be able to postpone their onset. “The healthier you are, the more slowly cataracts develop,” says Donaldson. Refraining from smoking, eating a good diet rich in antioxidants, and limiting sun exposure have all been shown to help keep cataracts from forming.
If you do end up needing surgery, keep in mind that not only is it one of the most frequently performed, safe, and effective surgeries in the world, but there is a potential bonus. Because your cloudy lens is replaced with an artificial intraocular lens implant, the surgery sometimes corrects precataract vision problems like nearsightedness, farsightedness, and astigmatism.
Another less common but often more damaging condition is age-related macular degeneration (AMD), which doctors start evaluating for at age 55. AMD is a genetic disease that causes damage to the macula, the central part of the retina, which provides sharp central vision for tasks like reading, recognizing faces, and seeing street signs. There are two types of AMD, dry and wet, and about 90 percent of cases remain in the less severe dry form. When the disease is diagnosed early, high-dose vitamin and zinc supplements can slow its progression. For an unlucky 10 percent who develop AMD, however, the disease progresses to the more serious wet form, which can eventually lead to blindness. “Two signs of advanced AMD are having blurry areas in the central vision, and seeing a straight line, like that of a flagpole, as wavy,” says Haller. There is no cure for wet AMD, but injectable medications can now slow its progress and preserve or improve vision in most people.
As with cataracts, a healthy, nonsmoking lifestyle is thought to improve your resistance to AMD, along with sun protection— an excellent excuse for splurging on good sunglasses while you’re stocking up on those chic readers.