The Eye Disorder That Comes for Those in Middle Age

I was surprised to learn that, were it not for my myopia, I might have noticed the presbyopia sooner. “A low amount of myopia is actually very, very convenient,” Xiaoying Zhu, a professor who specializes in myopia management, explained. “For myopic patients, if you don’t wear your distance correction, it’s like you have a pair of built-in reading glasses.”

Globally, people are living, and therefore aging, longer. There are more presbyopes than ever before—around 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’t extend beyond a phone held at arm’s length, and our lenses will barely need to flex at all.

There’s 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—“close-y”—and Vuity—“view-ity”) that temporarily relieve symptoms by simulating the light-reducing “pinhole effect,” the kind of sharpness you get from squinting. But the drops can come with unpleasant side effects, such as tachycardia and retinal detachment. Araj’s institute is funding research on how to make old lenses young. “There’s a grantee looking into hyaluronic acid,” he told me. “Can we add more of it and get less of the stiffness?” I recognized the name of this substance—which naturally occurs in the eyes, joints, and skin—as the active ingredient in anti-aging serums. Araj was pleased by the study’s early indications. Somewhere, I imagined, the lenses of middle-aged monkeys were getting more supple. “I would love to get more and more applications related to presbyopia,” Araj told me. “It’s difficult to think of another disease that has that prevalence.”

Araj’s own presbyopic moment arrived when he was fifty years old, browsing his favorite used bookshop in Montgomery County, Maryland. “I’d been there hundreds of times,” 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. “It was weird,” he said. “I’m not seeing the titles anymore. Of course, I know about presbyopia, but it’s different when it happens to you.”

As with many aspects of middle age—wrinkles, gray hair, crackly joints, fatigue—I 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 “genuinely panicked,” convinced that something has gone terribly wrong. Much of his job, he said, “is reassuring them that everything is going to be fine”—to the extent that approaching death is fine. The lens, like the rest of the body, simply becomes less flexible. “When you’re younger, you could sit crisscrossed on the floor,” he said. “Now your hips are screaming at you.” The mature lens can no longer do the splits.

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’d been wearing glasses to treat an astigmatism—a warping of the cornea or lens—but they were no help. “I got worried, because I am diabetic,” she recalled. (High glucose levels can damage the blood vessels in the retina, causing blindness.) “I waited a little bit. I tried to make the light more bright. I had to move my phone in different directions—closer, farther. I was trying to close my eyes a little. I finally read it, but it was really, really hard.” 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.