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A clearer picture Hey, boomers -- having trouble reading the fine print? Here's a primer on the new methods that can bring better vision to aging eyes

You don't feel old, so why all of a sudden did reading small print get so difficult?

When did that number in the phone book become impossible to read? Are these words getting hard to decipher?

You're not alone.

By 2014, 90 million Americans will have developed an age-related condition called presbyopia, which occurs as the eye lens loses elasticity and its ability to adjust focus. Most people first notice symptoms in their 40s, when small print becomes a giant blur.

"That's because the lens is not changing shape any longer and is set in the distance prescription," explained Dr. Michael J. Endl of Fichte-Endl Eye Associates. Many people end up needing magnifying glasses called "readers," he said.

"Between ages 42 and 45, 95 percent of the population will need readers. If they are already wearing glasses for distance, they'll probably get bifocals."

Bifocals? Just the thought of wearing bifocals -- or even readers, for that matter -- is enough to make some image-conscious baby boomers cringe, despite the expanded selection of reading glasses that have popped up in stores.

"If you have never had an eye examination, the worst thing you can do is go to the drugstore and get a pair of readers. There are so many eye conditions that go undetected," said Dr. Amar Atwal. "Get the readers after you have had your eyes checked."

Today, thanks to continuing improvements in vision correction technology, more treatment options are available including monovision, lens replacement and conductive keratoplasty. All are aimed at restoring vision to aging eyes.


"Last time I was examined, I was told my eyes were getting old like me," said Michael Mutter, a 48-year-old welder who has worn eyeglasses since he was 5. "I've always had a problem with distance, but I was tired of glasses. They kept on falling down on my nose. They're a pain."

And while Mutter could see "adequately" up close, he admits it was getting increasingly difficult to read the blueprints and purchase orders he needed for his fabrication business in Depew.

Like many people, Mutter was skeptical of laser eye surgery, yet he wanted to shed his eyeglasses for good, especially since he was told his next pair should be bifocals.

"Some people love it; some people hate it," said Lynn Davies, supervisor for Refractive Surgery at Atwal Eye Care, about laser eye surgery. "Some people feel like they're losing depth perception. They feel a little off balance, so it's not for everybody. It's not a perfect scenario, but it does give people a broader range of vision."

In January, Mutter entered the world of monovision. With monovision, the dominant eye (the eye you would use to focus a camera) is focused for distance vision, and the non-dominant eye is focused for near to intermediate vision. The blend of near and distance vision may affect depth perception, experts warn, which could be a driving hazard.

In Mutter's case, one eye was corrected for distance vision while the other eye was left alone. Mutter considered two methods -- PRK (Photo-Refractive Keratectomy) or LASIK (Laser in-Situ Keratomileusis). Regardless of the method chosen, a laser will be used to correct the cornea. The difference between the methods is how the corneal surface is prepared for surgery, said Davies.

With LASIK, a flap is created on the corneal surface by a tiny incision. That flap will be lifted by the doctor, who uses the laser to correct the cornea, and replaces the flap. Vision returns quickly, with the patient seeing well in as little as five hours.

With PRK, the surgeon removes the epithelium, a thin layer of protective tissue that covers the cornea, with a hand-held instrument called a spud. This is less invasive, but it takes longer to heal because the top layer of cells must regenerate. Meanwhile, a protective contact lens is effective in minimizing the discomfort during the days following surgery. By two weeks, the patient usually shows improved vision.

>Happy with results

"You only get two eyes and I rely heavily on mine," Mutter said. "My business is not easy on the eyes. Welding under a helmet, the shop is dark. We're flame-cutting half the day. I was actually scared that this was not the right thing for me."

As for the $1,400 cost, Mutter compared it to buying his next two pairs of glasses, and the accompanying eye exams.

"I thought it was a wise choice. I have never been happier with anything in my life," he said. "The whole thing was done before I realized it. They told me I might have a perception problem with my driving, and that took some adjustment. I still wake up in the morning and reach for my glasses, and then I give it a second thought that I don't wear them anymore. It's a newfound freedom. It's nice."

>Lens replacement

Lens implants have traditionally been used to treat cataracts, a condition that occurs when the eye's natural lens becomes clouded. Lens replacement surgery originally received FDA approval for patients with cataracts, but some doctors have opted its use to treat presbyopia, thereby circumventing the need for cataract surgery in the future.

A bifocal lens implant, for example, will allow most patients to see images that are near (inside 16 inches), intermediate (between 16 and 36 inches) and distant (36 inches and beyond). At $3,500 per eye, this outpatient procedure takes 15 minutes for one eye, leaving a two-week window before surgery on the second eye.

At first, Beverly Demshuk, 56, considered laser surgery to correct her distance vision, but changed her mind when informed of the bifocal implant.

"If I only had laser surgery, I would still need glasses to read," Demshuk said. "When they said there was something to fix both, I opted for that. My eyeglasses were just not working. Now for the first time in decades, I'm not wearing them. It's kind of odd."

The lens extraction was accomplished through a stitch-free incision and made way for the millimeter-thick implant. Demshuk's first surgery was performed in February, the second in March. Risks -- similar to those in regular cataract surgery -- can include detached retina and infection.

"You're fully awake during the whole surgery," Demshuk said. "The worst part was waiting for 90 minutes to go in."

>Conductive Keratoplasty

Often called "CK," this least invasive, three-to-five-minute procedure uses radio-frequency or ultrasound waves to reshape the cornea and restore vision. In 2004, it was the first procedure approved by the Food and Drug Administration to treat vision loss caused by presbyopia.

"The ultrasound basically reshapes the front of the eye," said Endl. "It works wonderfully because you're only doing one eye, but the lens on that eye is still changing on the inside. It's turning back time, but not stopping time -- just like a face lift.

"That's why we can do it in our office with just a little anesthesia, and there's really no pain. You might have a little itchy burning for an hour or two, but that's it. Most folks can resume normal activity if not that night, the next day because there's no sutures, no penetration into the eye."

Costing about $1,250 per eye, there is one important element to note about CK. The procedure is not permanent. Even after CK, your eye lens will continue to lose flexibility, and in three years you likely will need to have it performed again.



>Options for your eyes

You can spend from $10 to $3,500 to improve your vision

Prescription glasses

Plus: Help with reading under the care of a doctor

Minus: Glasses can be bothersome, easily lost or broken and must be renewed often

Magnifying glass or Readers

Plus: Words are made easier to read. Relatively cheap solution, averaging from $10 to $50

Minus: Health problems with your eyes could be going undetected

Eye Surgery

Plus: Can shed your eyeglasses for good

Minus: It's surgery, and any surgery can be a health risk. It can be costly, averaging between $999 and $3,500, per eye

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