Presbyopia and How to Fix It - Patient Money

There’s no escaping it. Diet and exercise, the baby boomers’ weapons of choice for warding off age-related health problems, have no effect.Presbyopiagenerally starts in the mid-40s, when people begin to notice that they have difficulty punching out a number on their mobile phone or reading a book. Over the next 20 years or so, the eyes continue to lose their ability to zoom in on things; by about age 65, it’s often impossible.

“It’s like having a camera with no multifocal option,” said Dr. Rachel J. Bishop, chief of the consult services section of the National Eye Institute.

About four years ago, Freda Dallas noticed that she was having trouble reading and helping her son with his homework. Ms. Dallas, 51, works as a vision therapist with children to correctcrossed eyesand other problems at theOhio State University College of Optometryin Columbus, Ohio.

She knew right away what her problem was.“I was in denial,” she said.

Until then, Ms. Dallas generally wore regularcontact lensesto correct her severemyopia, or nearsightedness. She knew that she did not want to switch to glasses with bifocal lenses. Once, during a Jazzercise class, her glasses had flown off and she could not find them without her classmates’ help. She needed an option that would stay put.

Her optometrist suggested multifocal contact lenses, which correct for both distance and nearvision problems. Ms. Dallas tried them, and loved them. They’re more expensive than regular contacts or bifocal glasses because she has to replace them every two weeks at an out-of-pocket cost of about $200 annually, including cleaning solution. (Her visioninsurancecovers another $250 of the cost.)

But it’s worth it.“They’re really comfortable, and I’m sold on them,” she said.

Like many people, when Ms. Dallas first noticed she was having trouble reading she tried to compensate by shining a brighter light on the page. Others try holding reading material at arm’s length. But at some point, even the longest-armed person can no longer read the fine print on a menu.

That’s when it is time to find some help. Both optometrists and ophthalmologists can perform eye exams and prescribeeyeglassesand contact lenses. Ophthalmologists are medical doctors who can also perform eye surgery, likeLasik, to correct refractive errors.

Here’s some advice on what to ask them about, and how to pay for it.

A VISION PLANMany employers offer or provide vision insurance for their employees, but it can also be purchased as a stand-alone product. AtVision Service Plan, a large vision insurer, individual coverage costs between $149 and $181 annually, depending on the state, said Gary Brooks, V.S.P.’s president for vision care.

A typical plan covers a comprehensive annualeye examand provides a certain amount, often a few hundred dollars, toward the purchase of contact lenses or glasses. Likehealth insurance, prices may be cheaper if members use a practitioner in the insurer’s network.

For many types of corrective lenses, however, vision insurance coverage is inadequate, experts agree. The biggest advantage may be that the coverage encourages baby boomers to get annual eye exams, which can catch vision problems at an early stage.

Glaucoma, for example, damages the optic nerve and is the leading cause of irreversibleblindness, yet half of people with glaucoma don’t know it, said Dr. J. Alberto Martinez, an ophthalmologist in private practice in Bethesda, Md.

GLASSESThe easiest and cheapest solution for presbyopia is to go to your local drug or discount store and buy a pair of $10 reading glasses. For those whose only vision problem is presbyopia, cheap reading glasses may do the trick.

But for many patients, one-size-fits-all reading glasses cause eye fatigue, said Dr. Martinez. If that is the case, prescription glasses or contacts may be best.

The least expensive prescription option is bifocal or trifocal glasses with a visible line separating the top portion of the lens, which corrects for distance if necessary, from the bottom portion, which corrects for presbyopia. On trifocals, there is a middle section that corrects for intermediate distances. These lenses can be bought for under $200; frames are priced separately and can run from under $100 to more than $1,000 for those by high-end designers.

Progressive eyeglass lenses— in which the lens power gradually increases from the top of the lens to the bottom— eliminate the unsightly focal lines and avoid the image jump that can occur with traditional lenses. The downside is that progressive lenses often are significantly more expensive than bifocals or trifocals, sometimes $400 or more, and can cause visual distortions that some people have difficulty adjusting to.

CONTACT LENSESBifocal and multifocal contact lenses have two or moreprescriptionsin the same lens, similar to eyeglasses. They come in a range of hard and soft materials with various disposable options.

In the past, some doctors told patients with presbyopia that they were not good candidates for multifocal lenses. Although fitting presbyopic patients with multifocal contacts is more complicated than fitting people without it, it’s a good option for many patients, said Kathryn Richdale, a senior research associate also at theOhio StateCollege of Optometry.“The lenses have come a long way in the past few years,” she said.

Expect to pay a fitting fee of up to $200, and up to $500 a year for lenses.

Some patients do well with a different therapeutic approach called monovision. Rather than correcting both eyes for both distance and near vision problems, monovision corrects one eye for distance vision and one eye for near vision.“Your brain learns to ignore the image that’s not in focus,” said Dr. James Salz, a clinical professor of ophthalmology at theUniversity of Southern California.

This can be accomplished with contact lenses or through Lasik surgery, which reshapes the cornea. If someone is considering an irreversible process like Lasik, however, it’s important to test monovision first with contact lenses, say experts. And insurance generally does not cover Lasik surgery, which typically costs up to $2,500 per eye.

Research shows that about 70 percent of patients tolerate monovision, said Barry Weissman, a professor of ophthalmology at theUniversity of California, Los Angeles. As people age and their presbyopia worsens, however, the growing difference between the two corrections often causes discomfort, he added.

LENS REPLACEMENTAs the eye ages, the lens may developcataracts, or cloudiness. Eye surgeons correct the problem by replacing the lens. Now some of these intraocular lenses can also correct for presbyopia.

But be warned: health insurance will generally covercataract surgery, but if you opt for one of the new lenses that correct presbyopia rather the standard single-focus lens, you’ll have to pay the difference— up to $2,500 per eye.

Some ophthalmologists are now replacing people’s healthy lenses with presbyopia-correcting lenses. Because it is not medically necessary, insurance won’t cover the $3,000 to $7,000 cost per eye.

And some doctors are wary of the practice.“To correct just for presbyopia, I myself wouldn’t do that,” said Dr. Bishop.“I don’t believe the risks are outweighed by the benefits.”

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