About a year ago, I found it increasingly difficult to see things that were right in front of me. I\u2019d been wearing contact lenses for myopia, or nearsightedness, for more than a decade, but never had trouble with closeups: reading food labels, clipping my nails. Suddenly, I did. The words in this and other magazines looked like vibrating ants. I thought that I might just be tired, or that the atmosphere around me was warped by an inexplicable haze. One day, while washing a wooden cutting board, a splinter lodged in my left index finger. I drew the finger to my face, then away, then close again, trying to get enough visibility to tweeze. I had contradictory thoughts: Middle age is upon me, followed by This is how a newborn must see.<\/p>\n
I complained to a future me: a writer friend who\u2019s a bit older and has a penchant for big, dramatic glasses. We were standing at her kitchen island, where she likes to consult recipes and tap out e-mails. \u201cI\u2019m surprised you don\u2019t already have bifocals,\u201d she told me, rubbing the flesh under her nose pads. She meant no harm, but the comment stung like a poke in the eye.<\/p>\n
Last summer, I made an appointment with my sometime optometrist, at a Costco in Washington State. Her practice was independent, but the glasses and contacts displayed outside the office were sold at Costco prices, to Costco members. Next door was the food court, where the chicken bake ($3.99) and hot dog plus soda ($1.50) were advertised in fonts so Costco-big, under such harsh overhead lighting, that they could not be missed, even by the most severe myopes. In this warehouse of giant things, my declining vision didn\u2019t seem to be as much of an issue.<\/p>\n
The doctor was efficient and aloof. She wore glasses and a mix of denim and florals that reminded me of a nineties mom. (In the nineties, my mom was the age that I am now.) I told her that I\u2019d come in for a regular checkup, but that I was also having difficulty with fine print. This was my way of inviting sympathy and reassurance, though I hoped to be diagnosed with something other than time-induced bodily deterioration. \u201cYup, you\u2019re at that age,\u201d the optometrist said, not making eye contact. \u201cIt happens.\u201d<\/p>\n
Her small exam room was dim\u2014an unfair handicap, I thought. She seated me in front of the eye-testing machine, a giant beige View-Master with a seemingly infinite store of retracting lenses. I looked through a pair, toward a digital version of the classic Snellen eye chart\u2014E F P T O Z\u2014projected on the opposite wall. \u201cHow\u2019s this?\u201d Clack. \u201cCan you read the third line up?\u201d Clack. The lenses made a satisfying noise as they dropped into place. \u201cWhich is better\u2014A?\u201d Clack. \u201cOr B?\u201d Clack. I\u2019d always found this aspect of the exam suspiciously unscientific, too trusting of the patient. Who was I to tell the difference between A and B?<\/p>\n
She confirmed that I had graduated into a double prescription: myopia and \u201cYup, you\u2019re at that age.\u201d She didn\u2019t name or explain the second condition before reviewing the most popular treatments. I could switch to full-time glasses, like the wiry metallic ones she was wearing\u2014either bifocals, with that unsightly horizontal line, or progressives, which had blended bands of correction for distance, intermediate, and near vision. I could wear magnifying reading glasses on top of my myopia contacts. Or, mercifully, I could continue to wear contacts alone\u2014multifocal ones, a newish technology that combined distance-treating bits with middle-aged-eye-treating bits. The two prescriptions would be arranged in concentric rings, alternating outward as though from a bull\u2019s-eye.<\/p>\n
Multifocal contacts would let me stay free of spectacles and the angry nose-pad marks that came with them, but there was a catch. The light entering my eyes would bend at two different angles, confusing my brain and making my vision a little blurry. \u201cWhat do you mean?\u201d I asked. Blurry at all distances? All the time? \u201cIt\u2019s hard to explain,\u201d the optometrist said. \u201cYou\u2019ll see.\u201d<\/p>\n
The diagnosis she dared not speak was presbyopia\u2014Greek, but not poetic, for \u201cold eyes.\u201d (Presbys: old man, elder, ambassador.) Presbyopia is technically an eye disorder, but one that everyone past the age of forty-five contracts. \u201cWe\u2019ll all, if we\u2019re lucky enough, experience it,\u201d Houmam Araj, who directs lens research at the National Eye Institute, a part of the National Institutes of Health, told me. Before middle age, the two main vision disorders are myopia and hyperopia, or nearsightedness and farsightedness. Myopia is caused by an overlong eye; light carrying the image of an object comes through the cornea, and then the lens, but lands short of the retina\u2014an exquisite layered tissue, composed of more than sixty types of neurons, which transform the light into electrical signals that are interpreted by the brain. Hyperopia, conversely, is a condition of smooshedness, of light going past the retina. About thirty per cent of all adults are myopes; the rate is similar for hyperopes.<\/p>\n
Presbyopia isn\u2019t a problem of eyeball shape but of the lens: a convex disk, the size of a mini M&M, that sits behind the cornea and helps the eye adjust its focus. In the young eye, the lens is flexible. Stringy ciliary muscles, like the springs of a trampoline, surround the lens and pull on its edges, making it rounder or flatter as needed. A youthful viewer can thus flit between near (a Lego piece) and far (the playground down the street) without any noticeable transition. The lens of a camera mimics this automatic activity. But, in what doctors refer to as the \u201cmature eye,\u201d the lens becomes rigid, and the ciliary muscles malfunction. Feeling both nearsighted and farsighted at once is the result of a \u201clack of accommodation,\u201d the failure to toggle between focal lengths. By middle age, everyone loses around a third of their amplitude of accommodation.<\/p>\n
I was surprised to learn that, were it not for my myopia, I might have noticed the presbyopia sooner. \u201cA low amount of myopia is actually very, very convenient,\u201d Xiaoying Zhu, a professor who specializes in myopia management, explained. \u201cFor myopic patients, if you don\u2019t wear your distance correction, it\u2019s like you have a pair of built-in reading glasses.\u201d<\/p>\n
Globally, people are living, and therefore aging, longer. There are more presbyopes than ever before\u2014around 1.8 billion of us. A disproportionate number are concentrated in East and South Asia, where the population is very big, and very old. By 2030, some 2.1 billion people will be afflicted by middle-aged eyeballs. Then, by 2050, this figure is predicted to drop, owing to an uptick in myopia. Many researchers believe that smartphone use and a lack of outdoor activity (see: iPad kid) are making more of us nearsighted at an earlier age. Perhaps, in a thousand years, the average visual field won\u2019t extend beyond a phone held at arm\u2019s length, and our lenses will barely need to flex at all.<\/p>\n
There\u2019s no cure for presbyopia, just a lot of treatments. Besides glasses and ready-made soft contacts, there are customizable hard contacts, Lasik-type surgeries, and prescription eye drops (with punny brand names such as Qlosi\u2014\u201cclose-y\u201d\u2014and Vuity\u2014\u201cview-ity\u201d) that temporarily relieve symptoms by simulating the light-reducing \u201cpinhole effect,\u201d the kind of sharpness you get from squinting. But the drops can come with unpleasant side effects, such as tachycardia and retinal detachment. Araj\u2019s institute is funding research on how to make old lenses young. \u201cThere\u2019s a grantee looking into hyaluronic acid,\u201d he told me. \u201cCan we add more of it and get less of the stiffness?\u201d I recognized the name of this substance\u2014which naturally occurs in the eyes, joints, and skin\u2014as the active ingredient in anti-aging serums. Araj was pleased by the study\u2019s early indications. Somewhere, I imagined, the lenses of middle-aged monkeys were getting more supple. \u201cI would love to get more and more applications related to presbyopia,\u201d Araj told me. \u201cIt\u2019s difficult to think of another disease that has that prevalence.\u201d<\/p>\n
Araj\u2019s own presbyopic moment arrived when he was fifty years old, browsing his favorite used bookshop in Montgomery County, Maryland. \u201cI\u2019d been there hundreds of times,\u201d he told me. He was scanning a shelf to his right, on histories of the Second World War, then looked left and encountered a blur. \u201cIt was weird,\u201d he said. \u201cI\u2019m not seeing the titles anymore. Of course, I know about presbyopia, but it\u2019s different when it happens to you.\u201d<\/p>\n
As with many aspects of middle age\u2014wrinkles, gray hair, crackly joints, fatigue\u2014I was aware of presbyopia, but unprepared to actually experience it. A repertoire of cultural sacraments marks our passage into biological adulthood, but the yawning decades beyond it unspool without ceremony. Dennis Cheng, an optometrist in my Brooklyn neighborhood, told me that many of his newly presbyopic patients come in \u201cgenuinely panicked,\u201d convinced that something has gone terribly wrong. Much of his job, he said, \u201cis reassuring them that everything is going to be fine\u201d\u2014to the extent that approaching death is fine. The lens, like the rest of the body, simply becomes less flexible. \u201cWhen you\u2019re younger, you could sit crisscrossed on the floor,\u201d he said. \u201cNow your hips are screaming at you.\u201d The mature lens can no longer do the splits.<\/p>\n
A temple to eye science sits, unassumingly, in midtown Manhattan, next to a Joe & the Juice and across from Bryant Park. The SUNY College of Optometry, where Zhu leads a myopia program, is a combination eye clinic and research lab. On a recent Thursday afternoon, an optometrist named Marina Su was peering into the eyes of Martha Infante, a forty-one-year-old mother and kitchen designer. Early last year, Infante had woken up, grabbed her phone, and found that she was unable to read a text message from a friend. She\u2019d been wearing glasses to treat an astigmatism\u2014a warping of the cornea or lens\u2014but they were no help. \u201cI got worried, because I am diabetic,\u201d she recalled. (High glucose levels can damage the blood vessels in the retina, causing blindness.) \u201cI waited a little bit. I tried to make the light more bright. I had to move my phone in different directions\u2014closer, farther. I was trying to close my eyes a little. I finally read it, but it was really, really hard.\u201d An optometrist eventually diagnosed her with presbyopia and added magnification to her prescription. That helped for reading up close, but Infante felt dizzy when she walked, and if she tried to walk or drive without glasses she could barely see.<\/p>\n