Optic Options

Having trouble seeing the little things in life? Can’t read the newspaper or fine print on packaging any more? It could be a condition called presbyopia, and most people will develop it as they reach their 40s. The eye’s lens becomes less elastic and can no longer focus for reading or close-vision tasks. Presbyopia is not a disorder or disease, but rather a natural aging process of the eye.

For the last 30 years, I’ve worn either glasses or contact lenses every day to see distances. Following my 45th birthday, my up-close reading vision started to wane and, soon after, I chose to have laser surgery to cope with my presbyopia. Even if you undergo laser eye surgery as a young person and achieve perfect vision, you could still develop and need to treat presbyopia, according to Dr. Mark Cohen and Dr. Avi Wallerstein of Lasik MD, which has 22 facilities across Canada (none in P.E.I.) treating myopia, hyperopia and astigmatism. Looking at the big picture, there are over 11 million Canadians between the ages of 40 and 64 — roughly 35 per cent of the country’s population — many of whom may have presbyopia. This translates into a lot of people seeking optical options.

FOCAL POINTS. Laser eye surgery encompasses a number of procedures. To determine your best option, sophisticated imaging equipment creates both a map of the eye’s surface and a “fingerprint” of the eye’s visual aberrations. The required corneal change is calculated based on this information and the amount of correction you need in your glasses/contacts. The average corneal thickness is about 0.55 millimeters. “Some people have thicker corneas, and others thinner,” explains Dr. Sheldon Herzig, co-founder and medical director, Herzig Eye Institute. “It’s just another variable in the normal human body. It’s important in considering laser treatment to the cornea because you must not make the cornea too thin.” The treatment best suited for my eyes is Epi-Lasik PRK, designed for patients who can’t have a LASIK procedure because the creation of a LASIK corneal flap weakens the cornea. The cost? $5,600.

My presbyopia will be treated with the monovision technique, which adjusts one eye to see things close up and the other to see things farther away. The brain learns how to naturally focus in the distance and close up.

The pre-op consultation at Herzig Eye Institute in Toronto (www.herzig-eye.com) includes a full eye exam and tests my vision to determine my suitability for the PRK.

The day of my surgery begins with a lesson in post-operative care and medication: a kit containing large sunglasses, painkillers and four different eye drops — antibiotic, anti-inflammatory, lubricating and a mild steroid — used four times a day to aid the healing process and lessen the slight risk of infection.

Just before the surgery, my eyes are re-measured to confirm the degree of visual problem. The required corneal change is calculated based on this information and entered into the laser’s computer. Valium (an optional short-term sedative) and a shoulder massage help ease the jitters. I’m escorted into a cool, dark room and, as I climb into the reclining chair and take a final look around with my fuzzy eyesight, it feels a bit surreal.

My surgeon, Dr. Sheldon Herzig, puts anesthetic drops in my eyes so there’s no pain. Herzig is about to sculpt my eyes and, in doing so, change my life. He operates on one eye at a time, while the other is covered. My left eyelid is held open with a small speculum clip. He positions a suction ring over the same eye, and I feel some pressure as things go dark for about 20 seconds, during which the soft outer layer of the cornea is removed. The laser’s light starts flashing, and I hear the click-click-click of the machine for a few seconds as it corrects my vision. This less-than-a-minute process is then repeated on the right eye.

The whole operation takes less than 15 minutes, and my vision is blurry from a soft contact lens “bandage” that must be worn for three to five days until the outer layer of the cornea heals. Fifteen minutes later, as the anesthetic drops wear off, there is a gritty sensation, like falling asleep in your contacts. At home, my eyes feel dry and scratchy, and my vision has mild blurring. Soothing relief comes from the post-operative antibiotic and anti-inflammatory eye drops, and I use the lubricating artificial tears as often as desired.

The next morning, I have my first post-op appointment. Three days later, the contact bandages are removed. I can see, but the change is not so profound yet. PRK’s improvement is gradual and, over a few days, things start coming into sharper focus.

OUT OF SIGHT. By law, you are not allowed to drive, day or night, until your vision is tested and meets the requirement for driving standards. Monovision also takes a bit of getting used to as the brain learns to integrate the visual information from both eyes into a single, clear field of vision and adjusts depth perception. By the third week, I’m giddy with delight as I walk down the street in non-prescriptive sunglasses, reading signs and seeing faces clearly. Four weeks after having surgery, I’m approved to legally drive without vision correction. I take a final eye test at the end of three months. “Congratulations,” says Herzig. “Your right eye now has 20/20 distance vision, and your left eye is optimized for reading. If you need to see extra clearly at certain times, such as long sessions of reading or computer work, you might want reading glasses for those occasions, but you won’t need them for routine tasks. Keep using
lubricating drops if your eyes feel dry.”

– Multifocal Contact Lenses, which allow you to see close up, distances and in
between is another option for people with presbyopia. “The design has a near zone that blends out to a distance zone with an ‘intuitive’ pupil, and when custom fitted, a multifocal contact lens lets you see clearly at every distance without moving or even tilting your head,” explains Optometrist Dr. Upen Kawale, of Toronto Eye Care Optometric Clinic (www.torontoeyecare.com). So if you dread getting glasses for the first time, or you already wear contacts and find they work for you, this might be the way to go. I’m functioning well post monovision without wearing any vision correction but am still curious to try the contacts. “You’ve had very successful results with the laser surgery, but your eyes are not working together — one sees distance, one sees close up,” observes Kawale. “It’s like wearing one stiletto and one ballet flat. You can still walk, but not totally efficient.” He custom fits me with a pair of multi-focals from Bausch & Lomb Pure Vision Multi-Focal Contacts that allow a gradual shift in power across the lens, for a natural transition in your focus to see near, far and  in between. (www.goodbyereaders.ca). These silicone lenses are more breathable, less drying and comfortable to wear than traditional plastic lens, and are FDA approved for up to 30 days of continuous wear, sleeping included. “Now both eyes are working together, giving you enhanced distance vision and enhanced close up. That’s a big kick,” adds Kawale.
Price: $200 – $500 for a one-year supply

– Progressive lenses glasses are the most common correction for presbyopia. The
newest progressive lenses technology moves gradually from one prescription to the other, providing a smoother transition between the various prescriptive optical strengths. “Many people who have had laser monovision or wear multifocal contacts also buy prescription progressive lens,” adds Kawale. “Glasses provide a larger surface for the distance vision so you’ll see like a hawk. Once both eyes are in sync for reading, everything will be crystal clear with no compromises. With the proper progressive lenses correction you’ll be able to see better than 20/20; you’ll see 20/15. To give you a comparison, Tiger Woods has 20/10 vision. That’s seeing digital.” Progressive lens can be customized for any vision condition requiring more than a single correction lens, be it bifocals or trifocals, all with the same smoother transition between the various prescriptive optical strengths.

Price: $600 a pair (excluding frames)

I’ve dreamed for years of being able to wake up and see the alarm clock; now I can and it’s absolutely wonderful. Sure I still need my glasses if my eyes get tired from staring at the computer, and I’ll supplement with the contacts when I’m going out and want a little extra oomph reading print that’s very small, but I’m thrilled I can do everything else unencumbered by eyewear. It’s one of the best things I’ve done to improve my life.

— Charmaine Gooden