Presbyopia develops as we age and makes it difficult to focus on close objects
Broadcast Retirement Network’s Jeffrey Snyder discusses treatments for presbyopia with the American Academy of Ophthalmology’s Sidney Gicheru, MD. Current treatments include reading glasses, glasses with bifocal or multifocal lenses, bifocal contact lenses, surgery, such as LASIK and now, eye drops.
Jeffrey Snyder. Broadcast Retirement Network
This morning, vision loss due to aging may be remedied by new eye drops. Joining me now is Dr. Sid Gichuru of the American Academy of Ophthalmology. Dr. Gichuru, it’s so great to see you. Thanks for joining us this morning.
Sidney Gicheru, MD, American Academy of Ophthalmology
Well, thank you so much for having me on. I’m a refractive surgeon here in Dallas, so we specialize in procedures to get patients out of glasses. I’m honored to be here, and thanks for the invite.
Jeffrey Snyder. Broadcast Retirement Network
Yeah, absolutely. We’re going to talk about, I actually brought my reading glasses because this is something I think near and dear to my heart and probably to your heart because you do a lot of this work. We tend to lose portions of our vision, doctor, as we age.
I think it’s called presbyopia.
Sidney Gicheru, MD, American Academy of Ophthalmology
Presbyopia. It’s a problem that most people, if you live long enough, will eventually endure. It has to do with the fact that every part of our body ages.
Presbyopia is caused by aging changes that happen in the lens of your eye. When we’re born, that natural lens is clear and soft, and it’s able to change shape to allow us to see far and near. At some point, typically in the early to mid-40s, that lens will start to harden, and we find ourselves kind of holding things further away to see them.
It eventually gets to the point where the arm isn’t quite long enough, and a lot of us will start using reading glasses, bifocals, and trifocals.
Jeffrey Snyder. Broadcast Retirement Network
According to the research, there’s about 1.8 billion people around the world that live this. It’s not just an American phenomena. It’s a human phenomena.
Exactly, right. That’s significant. Now, typically, you’re a specialist in this area of ophthalmology.
How would you typically treat somebody who has presbyopia?
Sidney Gicheru, MD, American Academy of Ophthalmology
The easiest thing is glasses. That is usually reading glasses, bifocals, trifocals, depending on where in the presbyopia progression you are, because presbyopia does worsen as we get older. In some patients on the younger end of presbyopia, we will sometimes do something called monovision, where we fit contact lenses one eye distance, one eye near.
In some other patients, we can fit multifocal contact lenses. Surgically, with LASIK, we can do monovision LASIK, which is, again, one eye near, one eye distance. The biggest exciting thing that we’re doing now is a procedure called a refractive lens exchange, where we can remove the natural lens of the eye in a procedure very similar to cataract surgery.
Then we’ll put in something called a presbyopia correcting lens that corrects vision to give you good vision far near in an immediate distance. There are many ways to treat it.
Jeffrey Snyder. Broadcast Retirement Network
Yeah, it’s certainly treatable from the less invasive up to the invasive. You were talking about the refractive surgery and LASIK. Let’s step back, though.
How do I, other than, you know, I’m holding a script here, and obviously, it’s hard for me to read. Would my doctor, my ophthalmologist, be able to test me for this to be able to determine, hey, you know, Jeff, you’ve hit your 40s. I’m not really 40, I’m 53, but I’d hit my 40s, and you really should start thinking about X, Y, and Z.
How do you find that out?
Sidney Gicheru, MD, American Academy of Ophthalmology
That can be treated either by your ophthalmologist or your optometrist, right? And it’s a common problem that all of us see on a daily basis, right?
Jeffrey Snyder. Broadcast Retirement Network
And so this would be, like, you’d go for your typical annual eye exam. So they’re looking for pressure, the glaucoma pressure test, or they’re dilating, and they do the, I think it’s called the Jagger eye test, right? And they hold it close, and they just say, you know, you suck.
You made a J into a G. You need some help.
Sidney Gicheru, MD, American Academy of Ophthalmology
Right, exactly. And usually, the patients will come in complaining of a change in their near vision. A lot of them will borrow their partner’s reading glasses.
That can be another way to kind of discover it.
Jeffrey Snyder. Broadcast Retirement Network
Yeah, and there have been, you know, you mentioned refractive. Let’s talk about the development of new technologies. This is an exciting time.
You’ve been in this field for a long time. This is probably a very exciting time in terms of research and development and technology in the field of ophthalmology, and in particular, presbyopia. Right, that is correct.
And what types of investments? I know one thing that I’ve read about are eye drops. Do those actually work?
And how would that work relative to your glasses? Do they replace the glasses? Do they replace the lenses?
Sidney Gicheru, MD, American Academy of Ophthalmology
Right. So, in 2021, there was a medication called Vuity that was FDA approved. And it’s an eye drop that is a dilute version of an eye drop that we’ve used for many, many years for glaucoma called pilocarpine.
And this drop will constrict your pupil and also affects the ciliary muscle, which is the muscle we use for focusing. And the thought was that it would help patients with their issues with presbyopia. Now, I am also in my 50s.
And I actually used the drop in my eyes before we started the interview in the interest of science and journalism. I’ve used it before. With my prescription in my age, it just gives a slight improvement in near vision.
It’s not like a profound change. And when I’ve used it before, it’s also kind of a temporary change. The nice thing about it for most patients is it will work relatively quickly, typically within about 15 minutes.
You’ll usually get anywhere from 6 to 9 or 10 hours of effect. But again, is that going to cure presbyopia? Absolutely not.
But it will aid some patients in terms of improving the symptoms.
Jeffrey Snyder. Broadcast Retirement Network
So it sounds like I was going to ask, just I’ll let you finish. But in terms of it sounds to me like almost like a bridge step to some of the others, like the refractive surgery and some other things like, hey, you know, Dr. Gichuru, I may not want to invest completely in the refractive. Let’s try this.
Sorry.
Sidney Gicheru, MD, American Academy of Ophthalmology
Yeah, I think that’s where it would work best. I also feel it would work best maybe on patients on the younger side of presbyopia, maybe patients in their early to mid 40s probably would work a little bit better in patients who are a little bit nearsighted like myself. But again, I think it’s more of like a bridge step before we try something else.
Because again, to me that the effect was relatively small. But again, I’m on the older side of presbyopia.
Jeffrey Snyder. Broadcast Retirement Network
And look, I’m a wimp. I don’t like any type of pain. Does it hurt to put the drop in?
And look, I’ve accidentally put I wear contact lenses. I think I told you the audience may not know. I’ve accidentally dropped the cleaning solution in my eyes accidentally.
That was extremely, extremely painful. Is this a painful drop to put in?
Sidney Gicheru, MD, American Academy of Ophthalmology
So when I put it in, it did burn for a few seconds. Obviously, that will vary from patient to patient. Yeah, so it does do that.
Now one of the one of the issues is also there can be the potential for side effects. Pylocarpine, when we were using it more regularly as a glaucoma medication, one of the things we would warn patients about is the risk of developing a headache. It’s usually a brow ache.
And it tends to be temporary. But then there can also and also you’ll tend to see some issues with redness, which for most patients is temporary. But like any medication, there can be side effects.
And so that’s something to consider. Obviously, before you start using it, I definitely would seek the help of a professional eye care provider, either an ophthalmologist or optometrist. In either case, it really has to be prescribed by either by a medical doctor or optometrist.
So either way, you have to see a medical professional to get it.
Jeffrey Snyder. Broadcast Retirement Network
And does it need to be a specialist within the field of ophthalmology or optometry?
Sidney Gicheru, MD, American Academy of Ophthalmology
Ideally, yes. Somebody who knows your eye, someone who already has assessed you for your risk of glaucoma, etc.
Jeffrey Snyder. Broadcast Retirement Network
I want to kind of say, I mean, that’s an important development. I want to go back to the refractive surgery a little bit more if we could talk about that. I’m sorry, refractive lens exchange.
Let’s talk about that because it sounds like that could be a permanent solution because what we talked about with the drops is more of a bridge solution. That’s a permanent solution. Is it not doctor?
Sidney Gicheru, MD, American Academy of Ophthalmology
Yeah, that could be definitely looked at as a more permanent correction of presbyopia. And in fact, the lenses we use are called presbyopia correcting lenses.
Jeffrey Snyder. Broadcast Retirement Network
And again, I’m a wimp. I’ve heard that LASIK is painless. Is this a painless surgery?
Are you knocked out? How do you go about?
Sidney Gicheru, MD, American Academy of Ophthalmology
The way we do it in our practice, you’re very relaxed. We’ll give you a medication like Valium. So you’re very, very relaxed.
We’ll use some eye drops to numb your eyes. So you’re not able to typically feel pain. You’ll just feel typically pressure like so.
And a lot of patients worry, how am I going to keep my eyes open? And we use a little device called a lid speculum to hold your open. Most patients tend to be very comfortable.
Pain is not something that we typically hear of, but obviously anything can happen with a procedure. But typically on a routine case, we don’t hear complaints of pain.
Jeffrey Snyder. Broadcast Retirement Network
And who would be a candidate? So you mentioned the presbyopia drops. I’m going to call them typically for people kind of at the early stages of presbyopia.
What about someone who in their sixties, seventies, eighties, nineties, maybe they hit triple digits. Would this be an option for them?
Sidney Gicheru, MD, American Academy of Ophthalmology
They could try it. But again, I don’t think you’re going to be able to get as much of an effect with patients who are in the more advanced stages of presbyopia. And it has to do with the as we age, we talked about the lens hardening and not being able to change shape quite as well.
The older we get, we get the firmer the lens gets. And in fact, a cataract basically means that your lens has become very firm, very cloudy to the point where it affects useful vision. Yeah.
Jeffrey Snyder. Broadcast Retirement Network
Last question for you, doctor. I just want to kind of pull back a little bit for our younger viewers out there, you know, that people talk a lot about screen time. Are there things we can do to prevent or protect our eyes?
A lot of us are using, look, you and I are on a zoom call right now. We all use our phones or the things that we should be aware of as, you know, potential patients to, to protect our eyes both outdoors and indoors when using the computer.
Sidney Gicheru, MD, American Academy of Ophthalmology
So I think protecting your eyes from UV light, I think is, is helpful with computers. You know, there is such a thing as computer vision syndrome. And it really had that part really has to do with the fact that when we focus on something like a computer for hours and hours and hours, it’s been shown that our blank reflex actually decreases.
And so those patients tend to be more prone to dry eyes. So for those patients, we usually will recommend using something like an over-the-counter artificial tear. I tell my patients, whenever you use a computer for a long period of time, just train yourself to maybe every 10 to 15 minutes, look out in the distance, blink a few times, and then go back to your work.
And that seems to help.
Jeffrey Snyder. Broadcast Retirement Network
Yeah. Got to protect them. You only get technically only get one set, right?
I mean, I know you can set up two eyes, so, you know, you got to take care of them. Dr. Gichuru, we’re going to have to leave it there. Thank you so much for joining us, sir.
And we look forward to having you back again very soon.
Sidney Gicheru, MD, American Academy of Ophthalmology
Thank you so much. I appreciate it. Thank you.
Jeffrey Snyder. Broadcast Retirement Network
And that wraps up this morning’s episode. We’re back again tomorrow though. Until then, I’m Jeff Snider.
Stay safe, keep on saving and don’t forget, roll with the changes.
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