I’m 40 and I can’t see up close! What are my options?

You’re not alone!  This is a pretty common question that I get in the exam room.  Spoiler alert: a progressive lens is usually the best option.  Why?  Let’s take a look at what’s happening in the eye.

The medical term for losing the ability to see up close is presbyopia.  Our ability to view near objects is dependent on the focusing system in our eye. For most of our lives we take this for granted.  It works like the auto-focus of a camera and will bring things into focus for us at different distances instantaneously.  It all depends on the flexibility of the lens inside our eye, which lessens with age.

What is a progressive lens and why is it helpful?  Sometimes called a no-line bifocal, a progressive lens is one that has your distance prescription on top and gradually progresses to your reading prescription.  In other words, the strongest magnification is at the bottom of the lens.  Fun fact: The lens actually changes through many different prescriptions not just three!  In the picture above, take a look at the area marked by the dotted lines.  This shows to area of the lens that you’ll see most clearly through:

When using a progressive for the first time it’s a good idea for you and your optician to go over what to expect.  They can give you some helpful hints so that you get used to your lenses faster!

If you get a high-quality progressive, you’re much more likely to adapt quickly.  Essentially, the progressives utilizing the most recent technology give you the largest area to view the world with comfortably.  Older or low-cost progressives will, therefore, be much harder to get used to.  We see people all the time who hate their progressives, and it almost always turns out they opted for the cheap option.

Make sure you have a skilled optician take the measurements for your progressives!  Having the right measurements will make the difference between loving and hating your progressives.  Why?  Your prescription must be centered properly.  If it’s not, there’s a large chance that you’ll frequently be looking through a part of the lens that appears distorted.  This could even make you dizzy!

Additionally, there’s more than one type of progressive. There are progressives that have an optimal design for night driving, for far-sighted prescriptions, for people who have extremely different prescriptions between their two eyes. That’s why having a skilled optician is important.

There is also the quality assurance factor.  If a prescription is ordered online, we often find the prescription is not made correctly.  Ordering a progressive online is always a bad idea.  There are too many factors that go into the fit.

Why can’t I just do LASIK?   LASIK will not fix the inflexibility of the lens inside the eye.  If you need glasses before 40 it can correct for the distance, but up close will be difficult.  You would have to do something called monovision.  This is where you correct one eye for distance and one eye up close.  It will never end up being as clear as using your two eyes together.  Also, the help you’ll need in seeing things up close will increase as you age.  Doing permanent surgery to fix a moving target isn’t what I would recommend.

What about contacts?  Depending on your prescription, contacts may be a viable option.  I do fit patients in contacts all the time but they definitely have limitations.  They can get you through the day, but they are not – and will never be – perfect.  As long as you are okay with less precise vision when you wear them, you will do well.  Contacts will never be as clear as glasses.  If you want vision equal to that of your glasses you will NEVER be happy.  Glasses are the gold standard.  If you do choose to wear contacts, you should always have a pair of glasses on hand.  Eye infections are quite common, and everyone knows that Austin allergies are a major factor that can push you out of contacts.

Hopefully this sheds a little light on what some of your options are when your arms just don’t seem long enough anymore.

Dr. Susan Elizondo

Dr. Susan Elizondo

Dr. Susan Elizondo has been practicing optometry for 10 years, and proudly took ownership of Westlake Hills Vision Center in 2019. She has a passion for nutrition and practices a plant based approach to health and healing.

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