Insights from Dr. Erin Lally, MD, Ophthalmologist
I’m Dr. Erin Lally, a board-certified ophthalmologist who specializes in cataract surgery and retinal disease. One question I hear a lot from patients is, “Why can’t I see up close anymore, and what can I do about it?” Below I’ll go through the main options: glasses, contacts, LASIK, eyedrops, and cataract surgery. I’ll also spend a little more time on two lens implants, PanOptix and Vivity.
Why can I no longer see up close?
As we get older, the lens inside the eye slowly stiffens. This is called presbyopia. It usually starts in our early to mid-40s and gets worse over time. A stiffer lens can’t change shape as easily to focus on things up close, so small print gets harder to read. You might catch yourself holding your phone farther away, or notice eye strain and
headaches after close work.
What are my options to see up close again?
Glasses
Reading glasses are the simplest fix. If you also need help with distance, bifocals, trifocals, or progressives can cover both.
Contact Lenses
Bifocal and multifocal contact lenses correct near and distance vision in the same lens. Another approach, called monovision, sets one eye for distance and the other for near. Some people adapt to it easily. Others don’t.
LASIK Surgery
LASIK reshapes the cornea and can be a longer-term fix, but it isn’t right for everyone. People with certain eye conditions, thin corneas, or very high prescriptions may not be good candidates, and it’s not recommended if a cataract is already present. LASIK gives you clear vision at one set distance. It won’t bring back the full range you had before presbyopia, so you may still need glasses for some tasks.
Eyedrops
Several FDA-approved prescription eyedrops can temporarily improve near vision in adults with presbyopia. The effect wears off, so you have to keep using them. They aren’t risk-free. In susceptible patients, including those with existing retinal disease, these drops can cause a retinal detachment. Some people also have trouble with night driving or develop a focusing spasm (accommodative spasm).
Cataract Surgery
During cataract surgery, we can implant lenses designed to give you clear vision at more than one distance. Multifocal and extended depth of focus lenses fall into this group, and for a lot of patients they mean needing glasses much less, permanently.
If I am having cataract surgery, which lens will be right for me?
Lens implants (IOLs) have come a long way. It used to be that you picked one distance. Choose distance and you’d need readers. Choose near and you’d need glasses to drive. Multifocal and extended depth of focus lenses changed that by giving patients clear vision over more than one range.
That’s a real difference from LASIK, which usually sharpens just one distance. These lenses get closer to the range of focus we had before presbyopia. Two common options are PanOptix and Vivity.
PanOptix: a trifocal lens
PanOptix is a trifocal IOL. It has three focal points (near, intermediate, and far) and works by splitting incoming light between them. The goal is to let you read, use a computer, and drive with less need for glasses.
Compared with older multifocal designs, PanOptix tends to cause fewer problems with glare and halos. It doesn’t eliminate them, though. Some patients see rings around lights at night or notice some glare. It’s usually mild, and many people notice it less as their eyes adjust.
How is Vivity different?
Vivity is an extended depth of focus (EDOF) lens, and it doesn’t split light. Its design stretches and shifts light to create one continuous range of focus, strongest from distance through intermediate.
Because the light isn’t divided, glare and halos are less common than with multifocal lenses like PanOptix. That can make Vivity a better fit for people who are bothered by those effects or do a lot of night driving. The tradeoff: some patients still want readers for fine print.
Both are good lenses. They just work differently, and which one suits you depends on how you use your eyes day to day and how your eyes handle light.
What is coming next?
Researchers are working on a couple of approaches that could change how we treat presbyopia down the road:
- Smart contact lenses. Still in the research stage. The idea is a contact lens that adjusts its own focus during the day, possibly controlled through your phone.
- Regenerative medicine. The hope is to restore some flexibility to the eye’s natural lens. That would treat presbyopia at the source, but it’s a long way off.
How do I know what is right for me?
There isn’t one best option for everyone. It depends on how you use your eyes and on your overall eye health. That’s where I come in. I can help you weigh the choices and pick what makes sense for you.
Losing some near vision is a normal part of getting older, but you don’t have to just live with blurry vision.
Treatment for presbyopia keeps getting better, and more options are likely on the way. If you’re ready to figure out what would work for you, schedule an appointment with Dr. Lally.
Dr. Erin Lally, MD
Board Certified Ophthalmologist
Specialist in Anterior Segment and Retina
