THE PRESBYOPIC POPULATION
Presbyopia is the loss of the ability to focus on close objects. A natural occurrence that starts around age ten and affects nearly everybody by the age of 40, presbyopia usually makes reading and close-up work more difficult. Presbyopia is an entirely natural and normal phenomenon, affecting almost 90 million people. Each year, an estimated four million more people become presbyopic, making this group the swiftest growing demographic segment requiring vision correction. While presbyopia is impossible to prevent and won't go away - our eyes will never learn to accommodate again - there are many simple and effective ways to deal with it.

ARE YOU A PRESBYOPE?
A visit to an eyecare professional is the only way to be absolutely sure of any necessary vision correction, but there are preliminary signs that may indicate that presbyopia has set in. Headaches and blurred close vision; and tearing, stinging or a gritty feel to the eyes, can be symptoms of presbyopia. Other symptoms include a need for more light to see clearly, and of course, the dreaded need for "longer arms" in order to hold reading materials further and further away so that the eyes can focus clearly.

HOW CAN PRESBYOPIA BE CORRECTED?
There are several options available to correct presbyopia, below:

Reading glasses and bifocal spectacles -- The vast majority of presbyopes wear some type of spectacles, usually bifocals, which combine both distance and near vision correction in each lens, or reading glasses, which simply correct near vision. Bifocal spectacles are often recognizable by the segmented appearance of the lenses--"granny glasses". Many individuals are reluctant to wear bifocal spectacles; they see these glasses as a symbol of growing old.

Some presbyopes have had success wearing single vision contact lenses with reading glasses only when necessary (without removing the contact lenses). While this does not solve the problem for people who want to be entirely free of glasses, it is a simple alternative that can save time and money. In addition, there is no real period of adaptation.

Segmented Contact Lenses providing "Alternating Vision"-- The design of segmented contact lenses is similar to that of bifocal spectacles, but segmented lenses actually work differently. The top portion of a segmented lens is for distance vision, the bottom for near, or reading, vision. Look straight ahead, and the distance portion of the lens will be in use; then look down to read, and the lens will bring the near vision segment into the line of sight. As a result, this type of lens provides alternating vision.

Certain design features help position the segmented lens on the eye. For one, the lens may have a flat bottom edge to allow the lower eyelid to assist in positioning; or it may be weighted on the bottom to prevent rotation. Because lens position is critical, the fitting of segmented lenses requires skill and patience. Several visits to a practitioner may be required in order to get this perfect.

Bifocal contact lenses are available as both soft and Rigid Gas Permeable lenses (RGP's).

Simultaneous Vision Contact Lenses -- Simultaneous vision contact lenses allow both distant and near objects to be in focus at the same time. The design places both near and distance vision correction in concentric rings --instead of top/bottom-- on the lens. A simultaneous vision lens resembles a bull's-eye with its concentric circles, with each of the circles providing different aspects of the vision correction. Some may have a single ring while others have numerous, depending on the individual prescription. When the brain receives the in-focus and out-of-focus images simultaneously, it is able to select the desired image

Related lens types include aspheric, in which the lens power changes gradually, from the center to the edge of the lens, and diffractive, which uses a series of grooves, cut into the back surface of the lens, to provide near vision correction.

Monovision Contact Lenses -- An alternative to bifocal lenses, monovision contacts correct one eye for distance vision and the other eye for near vision. Today, more than 30 years since its invention, monovision still has an extremely high success rate, yet only a small percentage of presbyopes use this method. monovision offers the advantages of simpler fitting and less expensive lenses, but some patients don't like the loss of binocular vision that it causes. (Binocular vision is the ability to use both eyes to see objects in three dimensions.)

Monovision usually requires a longer period of adaptation. Because depth perception is altered with monovision, additional correction may be needed for driving and operating heavy equipment. Under these circumstances, driving glasses to correct the reading eye for distance and improve binocular vision are recommended. Similarly, some wearers may require an additional near vision correction in the distance eye to allow prolonged or concentrated reading.

A variant of monovision, modified monovision, puts a bifocal contact lens in one eye and a single-vision contact lens in the other eye. This can give binocular vision for driving, while still permitting near vision for reading.

THE ADJUSTMENT PERIOD
The adjustment period can vary widely depending on the type of lens, the patient's motivation and visual needs, and the fitting schedule. Some simultaneous vision lenses require two weeks of continuous wearing before the patient adapts to the lens, while other types of lenses may be accommodated more quickly. The key to any adjustment period is ongoing consultation with your eyecare professional.

VISION CORRECTION OPTIONS AND THE EYECARE PROFESSIONAL
As the "baby boomer" generation matures and enters the presbyopic years, more and more eye doctors are correcting patients' vision with contact lenses. The flexibility and convenience that contacts provide are leading more and more people to contacts as science provides more options in contact lens wear, particularly for presbyopes. Because there are so many options, it is important to discuss the matter fully with an eyecare professional. In helping a patient reach a decision, an eyecare professional will consider the overall vision problems, the health of a patient's eyes, and his specific visual needs and motivations. An eyecare professional --either an optometrist or an ophthalmologist-- is best suited to help evaluate vision correction options.

GETTING MORE INFORMATION ON PRESBYOPIA

In addition to consulting with your eyecare professional, you can get information directly from the contact lens manufacturers as well as from the professional associations for vision specialists. The Contact Lens Council's website has links to these organizations' sites, as well as other useful sites.

GLAUCOMA CHECKS

Glaucoma is one of the leading causes of blindness in the U.S. It most often occurs in people over age 40. The Contact Lens Council, along with its advisory members, recommends annual eye examinations for people at risk for glaucoma. Depending on your specific history, your doctor may recommend more frequent exams. Glaucoma cannot be prevented, nor can vision lost to glaucoma be restored. If, however, an annual examination routine is followed, glaucoma can be controlled, as long as it is diagnosed early.

People at high risk for developing glaucoma include those with a family history of glaucoma, African Americans, the very nearsighted, and diabetics.

Glaucoma is an eye disease in which the internal pressure in your eyes becomes elevated due to clogged or blocked fluid channels. The nerve fibers in the optic nerve are damaged resulting in vision loss. Scientists are unsure as to why the passages become blocked.

Symptoms of glaucoma may include blurred vision or a gradual loss of peripheral vision. The most common type of glaucoma, however, is asymptomatic, painless and gradual, and must be detected by an eyecare professional.

A glaucoma check can be part of an optometric exam and will include a tonometry test to measure the pressure in your eyes; an optical examination that looks inside your eyes and at the optic nerves; and a visual test to check for changes in central and peripheral vision.

The treatment for glaucoma normally includes eye drops and medicines as prescribed by your doctor to lower the pressure in your eyes. In some cases, laser treatment or surgery may be required to reduce pressure.