The Heartbreak of Presbyopia

As I type these words, my personal chronometer is starting its annual rotation–“44 years”–and the words on my computer screen are crystal clear. No haloes, no fuzz, no fuss. Through the miracle of modern optics, I’ve fooled my brain into thinking that it’s 1984 again, when my limbs were limber and my eyes as sharp as an eagle’s. All is quiet on the Old Age Front. Quiet, that is, as long as I keep my head completely still and my eyes perfectly centered through the sweet spots of my birthday present–a brand spanking new pair of progressive addition, “no-line” bifocals.

For those of you who are still under the age of forty and therefore clueless, I’m referring to the malady that I’ve come to call, The Heartbreak of Presbyopia. Presbyopia comes from the Greek presbyter, meaning “old” or “elder” and the word for “eye,” optos. Put it all together and you get “old eyes” or “elder eyes,” if you prefer. Basically what happens is that the ciliary muscle which helps control the shape of the lens–which must grow more convex or “fatter” to see clearly at near–becomes, like all muscles, “stiff” with age. Add to that the fact that the lens itself becomes less flexible and what results is a perpetual browache, forehead furrows as deep as those produced by a John Deere tractor, the tendency to read books with arms outstretched and the constant lament, “Would someoneplease turn on the %#@*& lights?!”

You would think that a battle-hardened optometrist like myself would not be bothered much by these cold, hard facts of anatomy and physiology. But for me the Heartbreak of Presbyopia has been no less severe than the average John or Jane sitting behind the phoropter. Although I’ve been prescribing glasses for presbyopia for years, there is no way some know-it-all, wet-behind-the-ears optometrist in his late twenties can possibly relate to the emotional and physical anguish that is the Heartbreak of Presbyopia. I’ve often laughed at the lengths to which people will go to avoid reading glasses, including setting material on the ground when they run out of arm. But now I cringe when I think of how I’ve handled emotionally fragile emerging presbyopes in the past:

Patient: “Doc, (sniff, sniff), it’s terrible! I just can’t see the small print anymore, my arms are too short and if I get those horrible bifocals with the lines in them, everyone will know (gasp!) how old I am, waaaaaa!”
Me: “Ah, quit your belly-aching and grow up why don’t ya?! All God’s children got circumstances, so get up, get out and get over it! Next?!”

The fact is, I’ve also been in denial and resorting to extreme measures to avoid bifocals–even the dreaded pencil pushups. For the uninitiated, pencil pushups were first conceived in the torture chambers of medieval Europe. Many a coerced confession was extracted from some poor soul by forcing him to focus on the tip of a writing instrument while a hooded torturer would gradually bring the pen or pencil closer to the prisoner’s nasal bridge. With an inquisitor screaming, “Keep it clear, keep it clear!,” the victims’ eyes were forced to converge to the point of extreme discomfort and would sometimes even break loose from their muscle insertions. This would produce the “spinning globe” effect which often freaked out the torturers at least as much as the victims themselves.

With the advent of modern optometry, pencil pushups were found to have some value in training young people to use their eyes together more efficiently and to focus more accurately. For emerging geezers such as myself, however, such desperate measures are an exercise in futility. Unlike the heart muscle which responds to stress by growing stronger, the ciliary muscle only grows fatigued and upset, eventually responding with a whimper and a sigh, “Please, enough already!” So, a couple of weeks ago, I took the plunge, got behind the phoropter and refracted myself (yes, most of us do our own) and ordered my first pair of progressive addition, or “no-line” bifocals.

Now it’s true that if you get a lineless bifocal, your friends may not be able to guess that you’re somewhere on the far side of 40. Of course, there may be other telltale signs such as receding hairlines, graying temples or middle age paunch (aka “Beer Belly”) to give away your age. However, with various hair remedies available and the existence of beer belly now being seriously questioned by major news organizations, it seems like an opportune time to pony up the major bucks and carry out the Perfect Ruse.

Alas, there is no such thing as a free lunch. Along with the useful deception comes the fact that now you must become a walking bobble-head doll, constantly turning and nodding your head to keep the eyes centered in the “sweet spot” or channel of clear vision that runs through middle of the lens.

If you make the mistake of turning your eyes like God intended you to, then life suddenly becomes a little more precarious. The distortion that you get through the edge of your average no-line bifocal lens causes blurry peripheral vision. I discovered this immediately as I backed up in the parking lot after putting my new glasses on for the first time. As I looked over my shoulder and cut my eyes to the left, the cars parked behind me began to dance merrily around in a mirage-like shimmer, laughing and taunting me as I gingerly released my clutch into a nervous reverse.

It’s also good to remember that normal peripheral vision has important survival value, such as the ability to detect and avoid the large, Mack truck which may be hurtling toward you at the local crosswalk. Wearing a no-line bifocal may lead to the following scenario:

Cop # 1: “Say, how old do you think that stiff is over there who just got pancaked by that semi?
Cop # 2: “I’m not sure, but he can’t be over 40 because there’s no bifocal line in his glasses.”

Actually, I’m relieved to see that the same old line that I feed all my patients about “glasses are like new shoes–they feel weird at first but after a week or so you break them in,” is for the most part true. The distortion isn’t nearly as noticeable now and I no longer have to throw back a handful of ibuprofen in order to get rid of that pesky browache. Ah, sweet surrender!

But from now on, I think I’ll be a little more sympathetic when my patients come in for their first bifocal. Having “felt their pain” and experienced the Heartbreak of Presbyopia firsthand, “the chickens have come home to roost,” and I think I’ll lend a more empathetic ear. Here sits one bespectacled, Foghorn Leghorn who’s having to eat a little crow.

  1. Ed Fowler

    Happy Birthday! Some of us are over 40 and clueless too. Hey, could you make the fonts in your blog bigger and brighter?

  2. Anonymous

    I always knew you’d succumb to the effects of aging… even if you postponed it longer than most !!!
    Happy Birhtday, my Friend!
    And why didn’t you come to see ME for those wonderful no-line bifocals ????
    Ernie Bowling, fellow suffering ^ aged optometrist

  3. mike

    Professor Bowling–

    I know that post must have brought back a lot of misty memories! 😉

    Yes, I was a holdout, but now that I’m getting used to my new specs, I’m starting to think one of those new automatic wheelchairs might not be such a bad deal–might come in handy when shopping at Sam’s Club.

    At first I didn’t want to admit that I had a problem, hence my hesitation in calling on your services. You’re a great optometrist and all, but the commute across Lookout Mountain is a killer!

    Thanks for stopping by…don’t be a stranger.

  4. mike


    Go to “View” then, “Text Size,” then hit “LARGEST!”

    Or,go see your friendly neighborhood optometrist!

  5. DJG

    I thought I had won the aging battle. I had Lasik surgery almost 3 years ago to correct severe near-sightedness and astigmatism. My left eye has weakened to about 20/30, thus I can see to read. However, it is getting worse. I found out my Dr will still enhance my left eye for free. Hey, if I am going to have to have readers anyway……

  6. Hoots Musings

    I must be aging too fast as my first set of bifocals, lineless, arrived when I was 40.

    Tried the mono-vision contacts and I looked like POPeye’s wife. Got me some of them thar bifocal contacts and I cannot read anything within 24 inches of my face.

    Wondering if lasik would work for me? What are your thoughts Dr. Mike?

  7. mike

    Good luck with the enhancement; glad your “warranty” is still in effect!

    Don’t know without knowing your prescription and more about your eyes, but it’s safe to say that most presbyopes will still require reading glasses after LASIK unless you try some sort of monovision.

    Here’s a good site to learn more about the various options.

  8. contratimes

    At 44 years of age, I am on the threshold of pencil push-ups, though I can neither see the pencil nor see what I am writing with the darned thing. I am afraid what it all might mean when it comes to writing out checks. Oops!

    I had an editor who used two sets of glasses, which he could pull out and switch faster than a gunslinger on speed. Zooowip! In an instant he went from one pair to the next at blazing speed: Near, far, near, far. Of course, had I tried it, I would have poked an eye out (not that he ever asked me to do it for him, mind you). I mean, if I tried it on myself I’d poke my eye out.



  9. PatrickMead

    I would be offended by your article if I could read it. There is nothing wrong with my eyes. It’s just that my wife isn’t here to hold the monitor over in the living room so I can focus on the obviously defective typeface you have chosen. That’s it, yep. It isn’t me. It has to be you. Doesn’t it? Why are my letters all fuzzy on this comment page. What kind of comment page is this?

    From a rapidly — not gracefully — again friend.

  10. mike


    I think I know your editor (or at least thousands like him). I have treated many a “near-far-near-far-oops!” corneal abrasions in my career. Rapidly alternating pairs of glasses is right up there with “never pluck your own eyelashes with a sharp pair of tweezers” on my list of things that you should absolutely never try yourself.


    You are hanging on tight, my rapidly-but-not-so-gracefully aging friend. I can feel your ciliary muscle tension all the way down here in the Deep South.

    Repeat after me: “Though outwardly I am wasting away, inwardly I am being renewed day by day. Though outwardly I am wasting away…”

  11. extremist

    This is one aging experience I will not have to look forward to — having no natural lenses; there is nothing for my ciliary muscles to shape. I haven’t had any lenses since cataract surgery at the age of three.

    I’ve always wondered whether these muscles serve some other purpose as well or whether my brain even bothers to send the signal to them to try to focus on something near or far. For me, everything has always been at one set focus — no adjustments. It’s hard to even imagine what it would be like not to need bifocals. I got them in kindergarden.

  12. mike


    Congenital cataracts are a raw deal, sorry you’ve had to deal with that one. On the upside, though, all this presbyopia angst is a moot issue since for you bifocals are old hat.

    If I remember my first year physiology correctly, the brain continues to send it’s signal to focus, even in the absence of the natural lens. So, yes, your ciliary muscle is still getting a little workout. Also, the muscle is part of the larger ciliary body complex which produces a watery fluid (aqueous humor) which gives shape and form to the front of the eye and provides nutrition to the cornea and the lens (if you have one).

    Ok, curious minds want to know: are you a “conservative” who sticks with the tried and true straight top bifocal with the line, a “progressive” who prefers the freedom of a lineless lens, or are you a “libertarian” who opts for contact lenses and the use of “readers” only for near?

  13. bGods4ever

    For you I will come out of the closet and admit in front of your rapidly growing blog commune, I wear progressive lenses too. Oh, and I have the hair and belly action, if you hadn’t noticed. (Wait, my comment doesn’t even list my name, so no big deal:) But in an effort to leverage maximum vanity, I am currently attempting mono vision contacts to return to the, “Wow, he doesn’t even need glasses” crowd. (Still working with my-opt to get this dialed in.) At the risk of encouraging your efforts (my secret motivation), nice blogs! Happy belated b-day as well. Count your blessings!

  14. mike


    Thanks for the kind words and the birthday wishes!

    As you might recall, I went on record as saying that your last pair of glasses were very cool, giving you a Gen-X, Emerging church pastor kind of look. I tried monovision contacts and felt that it got in the way at work–I need good stereoscopic vision and depth perception for examining eyes. But a lot of people try it and love it.

    Best wishes to you as you try to hold the line against Father Time!

  15. Jason Bybee

    Dude, it’s been a couple days since I’ve checked in and you’re up to Cope-esque levels on your comments. Sweet. Keep writing the good stuff and in the words of Terrence Mann, “They will come.”

  16. extremist


    Conservative, of course. Straight bifocal with a line. At least on weekdays.

    Now that I have my artificial lens implants (which I only got 2 years ago) I can go without contact lenses and don’t need coke bottle cataract glasses either. So, I wear contacts on the weekends when I read less frequently. On those days it is the libertarian option — contacts with “readers” only when necessary.

  17. mike


    Aha! I knew it! 😉

    I’m glad to hear that you got the secondary intraocular lens implants. Those “coke bottle” aphakic lenses can mess up your peripheral vision even more than the no-line bifocals!

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