August 1, 2025 • 38 mins
I sat down with Dr. Jennifer Lyerly to explore why so many of us start struggling to read up close after 40—and what we can do about it. From the science behind lens stiffening to smart tips like tech hacks, glasses, and even pharmaceutical drops, this conversation will reshape how you think about aging eyes.
In this episode of The Eye-Q Podcast, I speak with Dr. Jennifer Lyerly about everything you need to know about presbyopia—the “midlife vision change.” We cover what causes it, why it’s not about weak eye muscles, and the latest in corrective lenses, contact options, and exciting pharmaceutical drops. Whether you’re 45 or 65, this conversation will help you see aging differently.
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Dr.Jennifer Lyerly
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LinkedIn: https://www.linkedin.com/in/jennifer-lyerly-76652882
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Your eye muscles are being tasked to do a lot of work when
that lens is getting stiffer. So we can try to make some
things easier on the muscle. I'm going to go ahead and put
this out there. I exercise.
You're not going to be able to make your eye muscle stronger.
Like we talked about, the muscles aren't the problem, it's
the thick lens. So doing eye exercises isn't
going to hurt you. You knock yourself out.
(00:21):
But if you could fix this problem with eye muscle
exercises we would all be doing on muscle therapy in our
practices to solve this instead of fucking pot glasses and
contact lenses. OK, so it's not something you
can train your muscles in to be able to cure, right?
Welcome to the IQ podcast. I'm Doctor Ronnie Bannock, here
to help you boost your IQ with powerful insights that connect
(00:44):
your eyes, your brain, and your whole body Wellness.
This episode was recorded duringthe Eye Health Summit, where the
world's leading experts shared breakthrough insights in vision
and holistic eye care. Welcome back everyone.
Today I'm so excited to welcome Doctor Jennifer Lyerly as our
expert guest on Presbyopia to talk about ways to manage this
(01:07):
issue that happens to almost everyone once you reach a
certain age. Welcome, Doctor Lyerly, we're so
excited to have you here. Thank you so much for having me.
I'm really excited to talk aboutthis because every single person
is going to have to deal with this in some extent in their
lifetime. Absolutely, it's inevitable for
the vast majority of people. But before we get to that topic
(01:29):
of presbyopia, Dr. Lyerly is an optometrist.
She practices in Raleigh, NC at Truevision Eye Care.
She's also the founder, Co founder of Defocused Media and
she has her own podcast educating many other people,
including lots of eye care providers about some of these
topics that we're going to be talking about today.
So we are again, so honored to have you join us.
(01:52):
So first of all, doctor, could you just give us a little bit of
background about what drew you to the field of optometry?
Like why was it that you wanted to be an eye doctor and and what
drew you to this particular areaof expertise, which is
presbyopia? So you can see I wear glasses.
I also wear contact lenses. Growing up, I one of four kids
and I was the oldest. So when we went to the eye
(02:13):
doctor, we were there for a verylong time, and my childhood
optometrist was such a nice guy.He let me help on the eye exams,
he let me play with the equipment, and they really
sparked some joy in me around this profession.
I wanted to grow up and do that too.
As far as specializing in presbyopia, I think I just do it
because that's part of what optometrists do.
We're helping people see, and ifyou're seeing anyone over the
(02:36):
age of 4045, this is something that you're going to have to
help and be really versed in talking about.
But maybe what makes me a littlebit different is I'm really
willing to try new things. I think outside the box.
So I've embraced presbyopia and all the different ways of
correcting it. Maybe that's one of my
colleagues, but I'm here to encourage that today.
Absolutely, and your story is not unlike many other eye care
(02:57):
providers. Many of us did have vision
issues as children or teens or young adults, and that's what
drew us into the field because we saw the tremendous benefit of
some of the treatments that we received to help us see better.
Now we want to pass along that information to our patients and
help others as well. So I love that doctor Lyerly.
So for our audience, let's just give us a 30,000 foot overview.
(03:20):
What is presbyopia? Why does it happen?
Who tends to develop this problem where I call it like my
arms just aren't long enough Syndrome, but the medical term
is presbyopia. Think of presbyopia as just a
normal birthday related change. It is really no different than
getting wrinkles on our face, our hair turning white is
(03:42):
happening sometime in those middle years of life.
But there's no magic world. We usually see around 40, some
of my patients start having trouble sitting up close, feel
like they have to hold their arms out further away in their
30s. And some of them it doesn't hit
them until their 50s, maybe even60s.
But sometime in that time in life, you're going to notice
like it's a little harder to adjust.
I think what's really important to understand about this is that
(04:05):
the eye focusing system has a few different parts.
So there's a lens inside of our eyes.
It's right behind the iris or the color part of the eye, and
its job is to focus in and out just like the lens on the
camera. So every time you move your
focus far away that close, that lens is adjusting in and out.
(04:25):
From the day we are born, the lens is one of the only body
parts in the human body that never stops growing.
Every year of your life it is laying down layers.
It's getting thicker. Things are like a little P trunk
and there is just laying down rings and rings and rings to
around 40. It's getting so thick.
Those muscles are trying to adjust it to focus in and out
(04:46):
and that thing is thick. It doesn't bug quite as easy as
it used to. And next year a thicker and next
year a thicker and next year a thicker.
We don't have any way to stop that thickening from happening.
That's what science is trying tobreakthrough, of course.
But every year that we're alive,that lens keeps thickening up
and it's actually the same process when you get to 6070
eighty and causes a cataract to develop.
(05:07):
So I think there's this misnomerthat it's, oh, my muscles are
weakening. Actually, the muscles are as
strong as they've ever been. They've lost nothing but what
they're having to do to adjust. This really stiff thick lens is
getting harder and harder until eventually it's impossible.
I Doctor Larry Lee. I love that analogy.
I've actually never heard that particular analogy before about
(05:28):
the lens being similar to a treethat's growing and every year
there's a new layer that's addedto it.
And like when you talk about theflexibility of the lens and how
it gets stiffer, it's like when you think of a young tree like a
sapling, it easily can bend in the wind, right?
But as the tree gets older, it gets thicker.
The trunk, it's more sturdy and it doesn't bend as much to the
wind, or at least the trunk of it doesn't bend.
(05:50):
So that's a wonderful analogy ofhow this change happens in our
eyes, and it is physiologic. It's part of aging.
You can't get away from it. I always tell my patients, if
you live long enough, three things are going to happen to
your eyes, right? You're going to develop
presbyopia, you're going to develop cataracts, and you're
going to develop these fine lines and wrinkles around your
eyes. It's going to happen.
(06:12):
So rather than try to fight it or struggle with it, I really
try to encourage my patients to embrace this aging change and
try to find ways to adapt. So let's talk about the best
ways to manage presbyopia. What are some simple things
before we talk about corrective lenses or anything like that?
(06:33):
What are some simple things people can do to manage it when
they're they're they just can't hold things close up to hold
things really far away to focus.Yeah, your eye muscles are being
tasked to do a lot of work when that lens is getting stiffer.
So we can try to make some things easier on the muscle.
I'm going to go ahead and put this out there.
I exercise, you're not going to be able to make your eye muscles
(06:56):
stronger. Like we talked about, the
muscles aren't the problem, it'sthe thick lens.
So doing eye exercises isn't going to hurt you.
You knock yourself out. But if you could fix this
problem with eye muscle exercises, we would all be doing
eye muscle therapy in our practices to solve this instead
of talking about glasses and contact lenses.
OK, so it's not something you can train your muscles in to be
(07:17):
able to cure, right? All right, so back to but how
can we help? Let's reduce how much the eye
muscles are having to do. And one of those things is
making sure you have good light.If you are a person that's going
through presbyopia or even the earliest parts of it, you're
going to have noticed that lightreally makes a difference.
If you're looking at small print, if you have good bright
lighting, it's going to be a loteasier to focus than it is in
(07:39):
dim lighting. And the reason why that is, is
our eye muscles that control thelens adjusted in and out.
The purpose they call the ciliary muscles, their other job
is to adjust the size of your people.
And so in bright light, they're constricting people with smaller
and that's cranking in your maximum eye muscle strength or
focusing up close. And then light people have to
(08:02):
relax. It's dilating.
You got to get more light in there so you can be able to see.
But those eye muscles then can engage the full amount of focus.
So it's harder to focus up closeto give yourself good light.
Make it easy to get on your eyesand then try not to hold things
so close. Like your computer for example.
An arm length away is a great setup.
Try as the closer you are to think the more your eyes have to
(08:23):
work. And then taking breaks.
I know this is easier said than done but I highly recommend to
my patients set a little timer every 20 minutes, every 30
minutes, something like that. If you know you work on the
feeder 8 hours straight a day, take some breaks during the day.
Look across the room, close youreyes, blink a few times.
Let your eyes have a chance to refocus.
Otherwise, your eye muscles are going to be really tuckered out
(08:45):
and it's going to make it even harder for you to focus up
close. Now, those are some amazing
tips. Doctor Lyer Lee.
The other thing I oftentimes tell my patients is when they're
using a device, there are so many settings you can adjust to
help you read better, right? So we know technology can be our
friend in the scenario of presbyopia.
So what are some tips who give patients for their devices?
(09:07):
Good point. Don't feel defeated about
changing the size on things. I've had several patients in
their 60s tell me I don't have any trouble seeing that close.
You're going to be talking aboutI'm going to need reading
glasses, I never need anything. And then they have their phone
out and they've got 2 words on the screen per text message.
So if you make the size bigger, you'll find you might not need
(09:28):
reading glasses. It's a tip that a lot of my
patients are doing right now. Another really cool tip is the
flashlight on your phone. If you're having a hard time
seeing something, you can use the light on your phone for
extra visibility or even put it on the camera.
Hover over what you're looking at and make it bigger.
It's like a built in magnifying device just right there in your
hand. Also changing the contrast of
(09:51):
let's say you're reading on a tablet.
I love putting things into more of a night mode.
Black background, white text. It's a little easier to focus
added contrast, but it you can find softer ways of looking at
things that are less tiring on the eyes.
Yeah, I love all of those tips. I've tried them myself.
And actually, initially I used to feel a little embarrassed
about increasing the font size on my phone.
(10:13):
My daughter used to laugh at me like, oh, mom, you're so old you
can't see you have to increase the font size.
But you know what? If it helps you do it right,
that's you're the one who's has to, who has to suffer if you
can't read properly. So there is no shame, there is
no stigma in increasing the fontsize on your phone.
Trust me, I've been there. The other thing I wanted to just
(10:33):
ask you about Doctor Lyerly is you mentioned like using the
flashlight and the camera or taking a photo and then it
magnifying it. There are also some apps that do
that as well. Do you recommend just doing your
natural phone settings or using an app?
There are a couple of out there that I've tried, which is your
preference. I've just been having patients
use their built in camera, but yeah, it's fair about the axe
(10:55):
because I'm not familiar with them.
Yeah, I think there's one calledBig Magnify and it can, it can
do a lot of the things you just mentioned.
So it shines the flashlight, it can take a photo, it can really
blow it up and it can also invert the colors so you can see
white lettering on a black background.
So it does, there are a couple of them out there and I would
just say experiment and see whatworks best for you.
(11:17):
What are some of the most commonway is that you treat it in your
office as an optometrist? So, you know, the original, if
you will, the first thing you'reprobably going to get talked to
about if you're coming with these visual complaints is, all
right, how do we correct this with glasses?
And I think there's kind of two main categories of glasses
options. You've got what's called single
(11:39):
vision glasses, and this would be something like computer only
glasses, reading only glasses. When you put them on, they be
clear at that specific location.So like really clear here.
If they're reading glasses, if you look across the room now,
they'll be blurry. And that's when you have people
taking their glasses on and off or wearing them down here on
their nose. Really classic with reading
(12:01):
glasses to see this happening. So you can look over them far
away and look through them for reading.
Listen, you don't want to do that, OK?
You can wear progressives, whichas you can see, they are
invisible. There is nothing delineating the
distance from the reading. What's cool about, let's say for
example, a full progressive is at the center of your glasses,
(12:21):
the whole top portion, you're going to have all your far away
vision. And then when you look down,
you'll get gradually more and more help with the upflows.
So let's say you're a -, 3 prescription.
So in your progressive glasses you're going to have a -3, A
-275, A -250, A -225, A -2 all the way down to your reading
prescription. All of that's in there, but the
(12:42):
con is all of that's in there. So when you're looking at
different places, there's only going to be a small amount
dedicated to individual tasks. And that's why for some of my
patients, they'll find that a combination of progressives for
out and about and specific task classes like computer glasses or
reading glasses that make a widespace for that activity.
It's like a useful combo to havethose.
(13:05):
Yeah. And I also find that when
patients first get their progresses, let's say their very
first prescription, they have toadjust to it, right, Because if
they're not looking in exactly the right spot for that right
target distance, it's blurry. And also with the progressive
part, now correct me if I'm wrong, Doctor Larryly, but you
said the top parts for distance was pretty wide, but the bottom
(13:25):
part is it's going down, gettingto your reading prescription is
very narrow, right? It has this like hourglass
shape. So again, if you're looking just
a little bit off to the side, ifyou're outside of that zone of
the prescription, it can be a little blurry.
And all progressives have that same design where, and that's
how they're able to change, because they have to change the
power of the lens from distance to up close without a visible
(13:49):
line separating them. That'd be a bifocal, right?
But the only way they can make that change happen is to have
this peripheral defocus down. Now, depending on the design and
how old or new the design is, you can get wider and wider
peripheral defocus, wider and wider central zones, smaller
purple defocus zones. But even the very top design
(14:10):
progresses on the market. There's going to be an area out
here along the edge that's not got clear vision where the power
is changing in the glasses. Yeah, no, I've definitely
experienced that where I've gotten progresses and it's taken
me a while to get used to them. It also depends on where it sits
on your face and how large the frame is, etcetera.
I wanted to just ask you something earlier about what you
(14:31):
said about myopia. So let's say somebody has
myopia, which is near sightedness and they have a -3
prescription and they don't wantto work.
Progressives. Let's say they're not
comfortable with them. What else can they do?
Yeah, 1 great option that many of my maps will do is wear
distance glasses and take them off the seat close.
(14:52):
This is why people ask me all the time like why haven't I had
LASIK? I do.
My job is a lot of up close workand I seem fabulous up close.
So being a low Maya has a lot ofperks and the fact a lot of my
patients are struggling. Most are low myos because they
seem so perfectly up close without anything, and they only
have trouble when they're wearing their glasses and
(15:13):
contact lenses. When you have something focusing
your eyes for far away, your lens can't adjust its focus, so
that's when you create the problem of not being able to see
it up close. Got it.
And actually that's what I do iswhen I most of the time I wear
my contacts and will and I actually wear multifocal
contacts sometimes and we'll talk about that.
But when I'm wearing my glasses at night, I just take them off
(15:35):
to read and use the computer because my natural focal point
is here so I don't really need anything.
So why strain your eyes with wearing glasses and having to
accommodate if you don't need to?
Doctor Larry Lee, this has been such an intriguing conversation.
I'm sure that you've really created some eye opening
insights for many people about presbyopia.
What causes it? What are some base options for
(15:58):
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(17:02):
So thus far, Doctor Lyerly, we talked about some basic
approaches for presbyopia, whichwould be single vision, reading
glasses or work glasses and thenprogressive lenses.
Let's talk about contact lenses.What are some options with for
contact lens wearers and presbyopia so.
You've got 2 main categories of contact lens options.
(17:23):
Multifocal contact lenses where you're going to get a blend of
up close and far away vision or monovision contact lenses, which
is where one contact lens is going to be for far away and one
contact lens is going to be for up close.
Now as soon as I describe that, you see maybe 1 sounds like it
has a clear advantage over the other.
Multi focal contact lenses are the newer version.
(17:45):
They've been on the market for about 15 years now, but really
only really good for the last decade.
And we definitely see a mindset change because they have gotten
so good and prescribing doctors personal preference, a lot more
multi focal because it's preserving the binoculars, the
ability to move the two eyes together and both eyes get to do
both things. They're multifocal.
So you want to share your experience a little bit?
(18:07):
Yeah. So basically in my mid 40s, I
was really struggling with presbyopia and I started with a
multifocal that was a low ad. So they come in different
powers, low, mid and high. And what happened was it worked
really well for a couple years. Then I had to graduate to the
mid level and that worked well for a couple of years.
Then I had to graduate to the high level and after a few years
(18:28):
that that no longer worked for me, I was still having a lot of
trouble. And then I went to the second
option you described. So then I switched over to
monovision and I'd love it. It was a little bit of an
adjustment, but I'm so happy. Like I can see my phone clearly,
I can read clearly with monovision.
So try out different things. That's my recommendation from my
personal experience is what may work for you also at one stage
(18:52):
of your life may not work for you at a different stage of your
life. So true.
I'd love to dig in a little bit about what's different about
these in case someone's considering it but wants to know
more. So multifocal contact lenses, I
think sometimes there's this misconception that it's always
progressives, like it's like your glasses, but they function
in two totally different ways. When we're talking about
(19:13):
glasses, we talked about and progressives the distances on
the top. Then you get into the computer,
then you get into the ringing and you move your eyes up and
down to get to different places.You think about a contact lens,
you move your eye up and down. The contact lens just stays in
the center. You're always looking through
the center of a contact lens, soyou couldn't possibly design it
in that same way. So the way that it gets around
(19:33):
that is in a multi physical contact lens, you actually have
layered rings stacked into the center of the contact lens.
So at any one moment your brain is seeing both a distance and
then up close vision stacked on top of each other.
I like to describe it to my patients is like looking through
a screen door. You can look through the screen
and see outside. You can focus on the screen and
(19:54):
then you'll notice outsides blurry behind it.
But it when you're looking through a screen door, you can
always see those things, right? It's not just like a perfect
crisp outside. So I tell people like there's
always something you're looking through.
So it's not your Crispus clearest 2020 vision of your
life. It's a blend of focus.
And that's why I think they purposely say they don't call
them progressive contact lenses for a reason.
(20:17):
And like you said, many people will notice on the lower eye
powers when their eyes don't need as much help, maybe a
little easier to use as your eyes mean more and more help.
It's really hard to get enough reading blend, have great up
close without it hurting your distance blend.
So there's these compromises. That's a word I hate to use, but
I always tell people it's like aseesaw.
(20:37):
The more distance I put in there, the less reading, the
more reading I put in there, theless distance.
So we're just trying to find theright blend for you.
And I like phrasing it that way instead of what are we
compromising homeless focus positive here We have a pretty
high success rate. It's like an 80% success rate
now Monovision, pretty similar success rate.
It's about 75%. When you look at the study data
(20:59):
and patients like yourself and honestly have a similar
prescription probably we really can take to monovision.
If you see great up close without glasses or contact
lenses, any contact lens I put on your eye to help you see far
away is going to take away some of that ability to see up close.
So if you're naked eye is perfect for up close, just
wearing one contact lens for faraway would preserve that great
(21:20):
thing that's happening over here.
It like you said, takes me getting used to.
I always hope people give it a good two weeks.
You're going to hate it the first couple of days.
Hang in there. Nobody says, oh, it feels great
natural to look out of one eye. The other con with monovision
that you might have been this isif you do a lot of computer
work, we do not have 3 eyeballs,we only have two.
(21:41):
So I have to pick one eyes, probably going to pick driving
because that's important. So then the other eye has to
pick is it going to be good for reading or is it going to be
good for computer? And for some people, they can do
either one, but some people's eyes are very specific on what
they need for each distance. And one of those two things is
going to be out of focus. So here's the great news.
You can always supplement with glasses over the top.
(22:03):
So let's see, it's really good at this one thing, but you'd
love to use two eyes to look at your computer for 8 hours a day
with another computer. Hey, let's do some computer
glasses over top of your contactlenses.
I think just going into it with an open mindset of there's not
one-size-fits-all. These are not time machines.
The glasses aren't time machines.
The contact lenses aren't time machines.
None of these is going to give me my normal 25 year old vision.
(22:24):
This is my 40 year old vision, but if I'm open minded to
solutions there's a lot of creative thinking we can do.
Absolutely. And I think the other thing I
heard you say as you were explaining this is you really
need to 1st determine what your own needs are, right.
So are you spending most of yourday at computer arm's length
distance? Or is most of your day up close
(22:45):
on your phone? Or are you outside?
Do you work outdoors? Are you not really up close?
And then relay that information to your eye doctor because
that's really important for youreye doctor to know what your
daily needs are. And maybe they change.
Maybe you have different needs during the week than on
weekends, and that's totally fine.
Maybe you have a couple of different pairs of glasses or
different types of contact lenses for different purposes,
(23:07):
and that's OK. We all wear different clothing
based on the weather. When it's cold or outside, we
wear coats and when it's warmer,we wear lighter clothes.
So you can adjust that with your, I guess you'd call it your
eyewear as well. Doctor Lyerly.
Absolutely. I have lots of patients who will
do multiple contact lens prescriptives for when we're
playing sports or when they're out at the beach.
(23:28):
They won't distance contact lenses with really clear vision.
And then when they're working ontheir regular 9:00 to 5:00 at
work, they prefer Monday throughFriday to have lenses more
shifted towards the computer clarity.
They could still drive home in, but the clarity is more set for
that indoor vision. And that's fine.
Don't be so rigid with yourself.But like you said, as a doctor,
(23:48):
we have to be listeners and makefor our patients know like this
is a conversation. This is not just, oh, here's
your number, this is your prescription.
This is a consistent discussion happening where I'm listening to
your feedback, I'm offering helpYou tell me how that's working.
So it's a collaboration. Yes, yes, so well said Doctor
(24:09):
Lyerly. So well said.
So now let's talk about some of the latest advancements in
presbyopia management. In the past few years, there
have been some pharmaceutical drops that have been FDA
approved to treat presbyopia andthen some that are in the
pipeline. So can you explain to us, Doctor
Larry, what do these drops do and what has been your
(24:32):
experience? Have you prescribed them for
patients? What do they say?
Are they happy with them? Do they use them on a regular
basis or do they not find them useful?
So the way these presbyopia eye drops work is they make their
people temporarily small. You might have remembered
earlier when we talked about yousee better typically reckless
and bright lighting when you're going through presbyopia because
(24:53):
in bright light are people constricts and it pulls in our
maximum eye muscle focus to get that lens maximally adjusted.
Now the other cool thing about asmall people is you're going to
get less peripheral distortion and what we something we call
extended depth of focus. So if you've ever looked
through, it's called a pinhole at the doctor's office, they
hold this little thing up as a tiny hole to look through and
(25:14):
you're like, oh, I see amazing. Look at this little point.
A pinhole, if we're able to create it, would give you great
vision at multiple locations, but you have to make a pretty
small point of focus to do that.So the first drop that got FDA
approved back in 2020, it was called Unity.
It is 1.25% pilocarpine and it shrinks the people.
(25:35):
Now, there was still much excitement and eye care when
this came out. It's the first time ever we were
going to be able to talk about an eye drop instead of just
glasses and contact lenses to improve vision.
I wrote several prescriptions when things got started and my
person was heard. They tell me like, yeah, help,
but it was a bit underwhelming. And So what we've learned with
(25:56):
Pilocarping and it was right here in the study data for FDA
approval, we were probably really excited that the study
data told us this was going to happen too.
So when it got approval, the study data showed only around 20
to 30% of people had a three line improvement in their
uncorrect in their visual acuityfor the first couple of hours
and then it wore off. So it's just a small amount of
(26:18):
improvement for a short amount of time.
They went out back to the FDA and to get approval for a second
time of day drop to try to extend that effect.
But maybe after each drop, a maximum of six hours on three
lines. Let's say you're 2050 without
anything. All right, so you're going to
get down to 2025. But if you just put your reading
glasses on, you'd be 2020. So many of my patients were
(26:40):
comparing it to varying their reading glasses, like, yeah, but
it's not as good. And that was some of the cons.
In addition to side effects, pilocarping can cause headaches.
It can make your vision feel dimbecause it is making the people
really small. It can cause redness.
And while there were no studyingdata in the clinical chorus
pervuity saying that a retinal detachment was caused, we know
(27:02):
that pilocarping as a molecule can be associated with the risk
of retinal detachment. So I'm very careful about the
patients that I will mention it to you in their study data, they
only prescribed for people between plus one to -4 and
obviously no history of surgery,no retinal health pathology.
And I really stick to that very narrow movement window to make
sure I minimize the risk of retinal attack map.
(27:25):
I have to share. I tried view it in myself
because I was like, this is really interesting when it first
came out and I wanted to experience it before I
prescribed it to patients and what it didn't really 'cause me
headache or redness or anything like that.
One interesting thing that caused me this is again a
personal anecdote is I have floaters and it really increased
my awareness of the floaters. For whatever reason, even though
(27:48):
my pupil was smaller, I really noticed my floaters a lot more.
And so I say, you know what, this isn't for me.
I'll stick with my multifocal contacts or my progressive
lenses. And many of my patients, like
when they asked me about this particular drop, I will explain
to them it can work, but but it's short acting.
So what I would say is don't useit every day.
If you have a special event thatyou're going to and you really
(28:11):
need to have that really crisp, clear vision, use it for that.
But it's not from my perspective, it's not something
I would suggest that people use it on a daily basis for.
What are your thoughts about that?
You know what, I totally it's also not inexpensive day instead
of just picking up a pair of reading glasses.
It's probably not practical for people as alternative.
(28:33):
So I completely understand that mindset where it's kind of like,
hey, when I need a lecture kick or some special occasion, are
minimizing glasses for this XX event.
Got it. Now what else is in the pipeline
for Presbyopia? I know that there's a couple of
other interesting options that are soon going to be available.
Yeah, So back last year closely is the newest drop.
(28:54):
It's FDA approved now. It's not yet available for me to
write a prescription in my HR electronic healthcare system.
How do you spell that? It is spelled QLOSI and I was
told it's like close C so closely and so it is also
(29:16):
pilocarpine but at a lower concentration 0.4%.
It's also preservative 3, which when you look at the side of
prep profile is causing a littleless headaches, less redness,
less site irritation. They also were able with the
molecule they're using as a carrier to help with better
penetration to get more action. So with something around 40% of
(29:37):
patients, but right, we're getting that three liner or more
near vision improvement within the first couple of hours.
And so this is one of those where if you're open minded to
it looks like it might be more effective, maybe worth retrying.
But it is also pilocarpine. One thing that a lot of doctors
that are interested in is the new molecule that's slated for
(29:58):
an FDA decision in August. So this is called a PDUFA date.
Then when the FDA makes a decision about approval, so
August of 25, it's called a seclidine.
It doesn't have a name brand yetbecause it's not approved, but
it's from a company called Blends Therapeutics.
Now it's piclodine, not polycarpine, and it's a
selective meiotic, so there's less pulling on the stellarium
muscles when it creates a very small pinhole, much smaller
(30:20):
pupil size than either the polycarpine drops.
And in their clinical studies they were showing something
towards 70% of patients had the three line or greater near
visual acuity and the lasting we're up to 10 hours.
At 10 hours, 40% of people were still having that three line of
improvement or more to be maybe more effective, maybe longer
lasting, potentially a lower side effect profile.
(30:42):
But we'll know more, you know ifwe're when it ever does actually
kind of come to market. So if it's a lot to be excited
about. Yeah.
No, that is really exciting. But I do have one question.
The drop that you just mentioned, the second drop that
is slated to be FDA approved, ifit constricts the pupil so much,
doesn't it cause decreased contrast trouble, more trouble
and dim lighting? What are some of the trials
(31:03):
show? Are there any side effects to
that? Yeah, same thing.
So it can cause dimming of vision, interestingly enough.
And this specific acyclodyne trial that was submitted to the
FDA, very few people rated it assomething that was a concern.
The cytokine cripple was very low. 90% of people said at the
end of the study, I'd rather continuing to use this drop.
(31:23):
So everything side effect was whether it's headache or the
dimming of vision or any initialside irritation when you put the
drop in was rated as very low and mild with this drop.
Interestingly also we know physics wise if you make a true
pinhole people you might be ableto get some improvement to
distance this into and that's what their clinical data shows
(31:45):
that they submitted to the FDA. Interesting.
Wow. These are really exciting
developments in the eye care space for treatment of
presbyopia. I know that some people, I've
had patients who come in and say, well, if the pinhole works
so well, why don't I just get those pinhole glasses?
And yes, you can buy these pinhole glasses.
I believe you can buy them online.
(32:06):
Why would a patient not just wear pinhole glasses if they're
trying to read? Yeah, So here's the crazy.
All right, Let's say you look their pinhole like everything
that you're seeing is total black except for that one small
point of clarity. So Can you imagine trying to
drive in that walk around? You're going to be tripping over
everything. It's like a horse wearing
blinkers. So in practicality, pinhole
glasses pretty limited in usefulness.
(32:28):
You're only going to be seeing asmall point straight ahead of
you. However, a pinhole inside your
eye, the optically is going to work a whole lot different
because it's inside your eye much closer to the retina.
You'll have a wider peripheral field of view potentially.
We've had ten holes, surgical devices before that didn't work
all that well. I think about the camera in
(32:49):
length, for example. So the pin holes are something
we're trying to replicate in thereal world for a while, and we
just haven't really been able tonail it yet, it feels like.
Yeah, I always tell my patients when they want to buy those
pinhole glasses, I always tell them we use them in the office
diagnostically to help determineyour best potential visual
acuity. But practically, it just does
not make sense to walk around with pinhole glasses for the
(33:12):
reasons you just described. It's just.
After they bust all their teeth out on the curb leaving the
office, they'll regret that decision.
Yes, yes, I agree. Well, Doctor Larry Lee, this has
been such an incredible, exciting, fun and discussion.
I wanted to ask you where we just have a few minutes left,
but I wanted to ask you, is there a common myth or
(33:34):
misconception you often hear from patients about presbyopia
that you would love to dispel today for our audience, I think.
People have a lot of unfounded anxiety about presbyopia coming
from, oh, if I wear glasses to help, to make my eyes feel
better, to help me see better, I'll get dependent on them.
My muscles will continue to weaken, they'll continue to
(33:56):
decline. And I think that's why I make
it. Every time I talk to a patient
about this, I make it a point ofdiscussion.
Earlier in this conversation, I made a point of discussion.
The muscles actually aren't weakening, so that's why you're
doing eye muscle exercises. It's not going to hurt anything,
that's for sure. But it is not going to curve
your presbyopia to exercise it away.
Also, wearing reading glasses isn't going to decline your
(34:18):
vision or make things worse because the muscles aren't
getting weaker. That's not what's happening.
It's just the lens stiffening and you're wearing glasses or
not wearing glasses doesn't change the lens thickness at
all. And so that's why they can sell
reading glasses over the counterat the grocery store, at the
dollar store, at Target. No prescription needed.
I could pick up those glasses and start wearing them and would
(34:39):
their vision look weird? Probably, but it's not going to
hurt them at all and that's why you're able to sell them without
a prescription. All they are are magnifying
lenses. But carrying around a magnifying
glass has some cons. You have to hold it all the
time. So someone had the genius idea,
let me take magnifying glasses and put them into glasses holes.
So now you're just wearing the magnifiers instead of holding
(35:00):
it. Isn't that genius?
And that's all that is. And so when I tell people
they're just magnifying glasses but put into eye holes, they
feel a lot safer about what wearing glasses does.
Yeah. I find that there are some
patients who really just feel like they're, they don't want
this to happen and they feel, I don't know if it's necessarily
(35:21):
shame or just with this, there'sa huge movement towards anti
aging these days. I'm not going to get older.
I'm not going to wear those glasses.
There is this almost like a stigma around wearing reading
glasses. And I tell my patients, like, if
you're struggling, yes, you can do certain things without
wearing the reading glasses, butif you wore the reading glasses,
your life would be so much easier.
(35:44):
You would be so much more comfortable doing what you love
to do, whether it's on a screen,on your phone, reading,
etcetera. All those daily tasks would be
so much easier. So I really tried to separate
that kind of notion that this islike a weakness that's within
us. What you were saying, it's not
getting weaker. It's a physiologic change in the
(36:04):
lens of the eye, not the muscles, the lens of the eye.
Yeah, and here the great news is, right, If you don't wear the
reading glasses, it doesn't matter.
Your eye isn't going to get better.
It isn't going to get worse. It's going to keep feeling worse
no matter what. But that's just birthdays.
So it's not like you're hurting yourself by not wearing the
glasses, but if you did give yourself some help, it would
(36:27):
help with eye strain and headaches and maybe even those
wrinkles from squinting and like, maybe you can enjoy
reading more. So yeah, if it makes your life
easier, let your body have some help, that's OK.
And like you said, it's not defeating to do great news.
If you choose not to do it and just make your thought bigger,
give yourself goodbye. I won't hurt anything either.
(36:47):
Yeah, absolutely. Thank you for those reminders
and the reassurance there. Doctor Layer Lee, that's really,
really helpful and great information.
Again, this has been a wonderfuldiscussion.
I really appreciate all your insights and sharing your
experiences helping people with presbyopia.
Doctor Larry, if any of our audience wanted to reach out to
you to get more resources from you, learn more from you, maybe
(37:09):
even become a patient, how couldthey find you?
So probably the easiest place tofind me is online.
I'm at Idolatry. It's EYE dot DOLATRY on
Instagram. I'm also like Doctor Bondick
said earlier, the Co founder of the Defocused Media podcast.
And we have social media at Defocused Media or you can check
(37:31):
out our podcast. If my partner Darrell is here,
he would sell you iTunes, GooglePlay, Apple, anywhere you can
hear the podcast. You can listen to the Defocused
Media podcast and we have quite a few podcasts around Presbyopia
if you guys are interested. And if you live in the Raleigh,
NC area I would love to help you.
I'm at True Vision eye care so phone call away.
(37:52):
Excellent, thank you so much. We will share all of those links
right below your interview. And I hope people do reach out
and learn more from you because you're an incredible resource.
And thank you all for tuning in.And please stay tuned for the
next episode coming up very soon.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new
(38:13):
to help you boost your IQ. Leave us a review and share the
podcast with your family and friends.
Stay connected with me for more eye opening insights on ihealth,
nutrition and lifestyle. Until next time, keep your
vision clear and your IQ sharp.
Your eye muscles are being tasked to do a lot of work when
that lens is getting stiffer. So we can try to make some
things easier on the muscle. I'm going to go ahead and put
this out there. I exercise.
You're not going to be able to make your eye muscle stronger.
Like we talked about, the muscles aren't the problem, it's
the thick lens. So doing eye exercises isn't
going to hurt you. You knock yourself out.
(00:21):
But if you could fix this problem with eye muscle
exercises we would all be doing on muscle therapy in our
practices to solve this instead of fucking pot glasses and
contact lenses. OK, so it's not something you
can train your muscles in to be able to cure, right?
Welcome to the IQ podcast. I'm Doctor Ronnie Bannock, here
to help you boost your IQ with powerful insights that connect
(00:44):
your eyes, your brain, and your whole body Wellness.
This episode was recorded duringthe Eye Health Summit, where the
world's leading experts shared breakthrough insights in vision
and holistic eye care. Welcome back everyone.
Today I'm so excited to welcome Doctor Jennifer Lyerly as our
expert guest on Presbyopia to talk about ways to manage this
(01:07):
issue that happens to almost everyone once you reach a
certain age. Welcome, Doctor Lyerly, we're so
excited to have you here. Thank you so much for having me.
I'm really excited to talk aboutthis because every single person
is going to have to deal with this in some extent in their
lifetime. Absolutely, it's inevitable for
the vast majority of people. But before we get to that topic
(01:29):
of presbyopia, Dr. Lyerly is an optometrist.
She practices in Raleigh, NC at Truevision Eye Care.
She's also the founder, Co founder of Defocused Media and
she has her own podcast educating many other people,
including lots of eye care providers about some of these
topics that we're going to be talking about today.
So we are again, so honored to have you join us.
(01:52):
So first of all, doctor, could you just give us a little bit of
background about what drew you to the field of optometry?
Like why was it that you wanted to be an eye doctor and and what
drew you to this particular areaof expertise, which is
presbyopia? So you can see I wear glasses.
I also wear contact lenses. Growing up, I one of four kids
and I was the oldest. So when we went to the eye
(02:13):
doctor, we were there for a verylong time, and my childhood
optometrist was such a nice guy.He let me help on the eye exams,
he let me play with the equipment, and they really
sparked some joy in me around this profession.
I wanted to grow up and do that too.
As far as specializing in presbyopia, I think I just do it
because that's part of what optometrists do.
We're helping people see, and ifyou're seeing anyone over the
(02:36):
age of 4045, this is something that you're going to have to
help and be really versed in talking about.
But maybe what makes me a littlebit different is I'm really
willing to try new things. I think outside the box.
So I've embraced presbyopia and all the different ways of
correcting it. Maybe that's one of my
colleagues, but I'm here to encourage that today.
Absolutely, and your story is not unlike many other eye care
(02:57):
providers. Many of us did have vision
issues as children or teens or young adults, and that's what
drew us into the field because we saw the tremendous benefit of
some of the treatments that we received to help us see better.
Now we want to pass along that information to our patients and
help others as well. So I love that doctor Lyerly.
So for our audience, let's just give us a 30,000 foot overview.
(03:20):
What is presbyopia? Why does it happen?
Who tends to develop this problem where I call it like my
arms just aren't long enough Syndrome, but the medical term
is presbyopia. Think of presbyopia as just a
normal birthday related change. It is really no different than
getting wrinkles on our face, our hair turning white is
(03:42):
happening sometime in those middle years of life.
But there's no magic world. We usually see around 40, some
of my patients start having trouble sitting up close, feel
like they have to hold their arms out further away in their
30s. And some of them it doesn't hit
them until their 50s, maybe even60s.
But sometime in that time in life, you're going to notice
like it's a little harder to adjust.
I think what's really important to understand about this is that
(04:05):
the eye focusing system has a few different parts.
So there's a lens inside of our eyes.
It's right behind the iris or the color part of the eye, and
its job is to focus in and out just like the lens on the
camera. So every time you move your
focus far away that close, that lens is adjusting in and out.
(04:25):
From the day we are born, the lens is one of the only body
parts in the human body that never stops growing.
Every year of your life it is laying down layers.
It's getting thicker. Things are like a little P trunk
and there is just laying down rings and rings and rings to
around 40. It's getting so thick.
Those muscles are trying to adjust it to focus in and out
(04:46):
and that thing is thick. It doesn't bug quite as easy as
it used to. And next year a thicker and next
year a thicker and next year a thicker.
We don't have any way to stop that thickening from happening.
That's what science is trying tobreakthrough, of course.
But every year that we're alive,that lens keeps thickening up
and it's actually the same process when you get to 6070
eighty and causes a cataract to develop.
(05:07):
So I think there's this misnomerthat it's, oh, my muscles are
weakening. Actually, the muscles are as
strong as they've ever been. They've lost nothing but what
they're having to do to adjust. This really stiff thick lens is
getting harder and harder until eventually it's impossible.
I Doctor Larry Lee. I love that analogy.
I've actually never heard that particular analogy before about
(05:28):
the lens being similar to a treethat's growing and every year
there's a new layer that's addedto it.
And like when you talk about theflexibility of the lens and how
it gets stiffer, it's like when you think of a young tree like a
sapling, it easily can bend in the wind, right?
But as the tree gets older, it gets thicker.
The trunk, it's more sturdy and it doesn't bend as much to the
wind, or at least the trunk of it doesn't bend.
(05:50):
So that's a wonderful analogy ofhow this change happens in our
eyes, and it is physiologic. It's part of aging.
You can't get away from it. I always tell my patients, if
you live long enough, three things are going to happen to
your eyes, right? You're going to develop
presbyopia, you're going to develop cataracts, and you're
going to develop these fine lines and wrinkles around your
eyes. It's going to happen.
(06:12):
So rather than try to fight it or struggle with it, I really
try to encourage my patients to embrace this aging change and
try to find ways to adapt. So let's talk about the best
ways to manage presbyopia. What are some simple things
before we talk about corrective lenses or anything like that?
(06:33):
What are some simple things people can do to manage it when
they're they're they just can't hold things close up to hold
things really far away to focus.Yeah, your eye muscles are being
tasked to do a lot of work when that lens is getting stiffer.
So we can try to make some things easier on the muscle.
I'm going to go ahead and put this out there.
I exercise, you're not going to be able to make your eye muscles
(06:56):
stronger. Like we talked about, the
muscles aren't the problem, it'sthe thick lens.
So doing eye exercises isn't going to hurt you.
You knock yourself out. But if you could fix this
problem with eye muscle exercises, we would all be doing
eye muscle therapy in our practices to solve this instead
of talking about glasses and contact lenses.
OK, so it's not something you can train your muscles in to be
(07:17):
able to cure, right? All right, so back to but how
can we help? Let's reduce how much the eye
muscles are having to do. And one of those things is
making sure you have good light.If you are a person that's going
through presbyopia or even the earliest parts of it, you're
going to have noticed that lightreally makes a difference.
If you're looking at small print, if you have good bright
lighting, it's going to be a loteasier to focus than it is in
(07:39):
dim lighting. And the reason why that is, is
our eye muscles that control thelens adjusted in and out.
The purpose they call the ciliary muscles, their other job
is to adjust the size of your people.
And so in bright light, they're constricting people with smaller
and that's cranking in your maximum eye muscle strength or
focusing up close. And then light people have to
(08:02):
relax. It's dilating.
You got to get more light in there so you can be able to see.
But those eye muscles then can engage the full amount of focus.
So it's harder to focus up closeto give yourself good light.
Make it easy to get on your eyesand then try not to hold things
so close. Like your computer for example.
An arm length away is a great setup.
Try as the closer you are to think the more your eyes have to
(08:23):
work. And then taking breaks.
I know this is easier said than done but I highly recommend to
my patients set a little timer every 20 minutes, every 30
minutes, something like that. If you know you work on the
feeder 8 hours straight a day, take some breaks during the day.
Look across the room, close youreyes, blink a few times.
Let your eyes have a chance to refocus.
Otherwise, your eye muscles are going to be really tuckered out
(08:45):
and it's going to make it even harder for you to focus up
close. Now, those are some amazing
tips. Doctor Lyer Lee.
The other thing I oftentimes tell my patients is when they're
using a device, there are so many settings you can adjust to
help you read better, right? So we know technology can be our
friend in the scenario of presbyopia.
So what are some tips who give patients for their devices?
(09:07):
Good point. Don't feel defeated about
changing the size on things. I've had several patients in
their 60s tell me I don't have any trouble seeing that close.
You're going to be talking aboutI'm going to need reading
glasses, I never need anything. And then they have their phone
out and they've got 2 words on the screen per text message.
So if you make the size bigger, you'll find you might not need
(09:28):
reading glasses. It's a tip that a lot of my
patients are doing right now. Another really cool tip is the
flashlight on your phone. If you're having a hard time
seeing something, you can use the light on your phone for
extra visibility or even put it on the camera.
Hover over what you're looking at and make it bigger.
It's like a built in magnifying device just right there in your
hand. Also changing the contrast of
(09:51):
let's say you're reading on a tablet.
I love putting things into more of a night mode.
Black background, white text. It's a little easier to focus
added contrast, but it you can find softer ways of looking at
things that are less tiring on the eyes.
Yeah, I love all of those tips. I've tried them myself.
And actually, initially I used to feel a little embarrassed
about increasing the font size on my phone.
(10:13):
My daughter used to laugh at me like, oh, mom, you're so old you
can't see you have to increase the font size.
But you know what? If it helps you do it right,
that's you're the one who's has to, who has to suffer if you
can't read properly. So there is no shame, there is
no stigma in increasing the fontsize on your phone.
Trust me, I've been there. The other thing I wanted to just
(10:33):
ask you about Doctor Lyerly is you mentioned like using the
flashlight and the camera or taking a photo and then it
magnifying it. There are also some apps that do
that as well. Do you recommend just doing your
natural phone settings or using an app?
There are a couple of out there that I've tried, which is your
preference. I've just been having patients
use their built in camera, but yeah, it's fair about the axe
(10:55):
because I'm not familiar with them.
Yeah, I think there's one calledBig Magnify and it can, it can
do a lot of the things you just mentioned.
So it shines the flashlight, it can take a photo, it can really
blow it up and it can also invert the colors so you can see
white lettering on a black background.
So it does, there are a couple of them out there and I would
just say experiment and see whatworks best for you.
(11:17):
What are some of the most commonway is that you treat it in your
office as an optometrist? So, you know, the original, if
you will, the first thing you'reprobably going to get talked to
about if you're coming with these visual complaints is, all
right, how do we correct this with glasses?
And I think there's kind of two main categories of glasses
options. You've got what's called single
(11:39):
vision glasses, and this would be something like computer only
glasses, reading only glasses. When you put them on, they be
clear at that specific location.So like really clear here.
If they're reading glasses, if you look across the room now,
they'll be blurry. And that's when you have people
taking their glasses on and off or wearing them down here on
their nose. Really classic with reading
(12:01):
glasses to see this happening. So you can look over them far
away and look through them for reading.
Listen, you don't want to do that, OK?
You can wear progressives, whichas you can see, they are
invisible. There is nothing delineating the
distance from the reading. What's cool about, let's say for
example, a full progressive is at the center of your glasses,
(12:21):
the whole top portion, you're going to have all your far away
vision. And then when you look down,
you'll get gradually more and more help with the upflows.
So let's say you're a -, 3 prescription.
So in your progressive glasses you're going to have a -3, A
-275, A -250, A -225, A -2 all the way down to your reading
prescription. All of that's in there, but the
(12:42):
con is all of that's in there. So when you're looking at
different places, there's only going to be a small amount
dedicated to individual tasks. And that's why for some of my
patients, they'll find that a combination of progressives for
out and about and specific task classes like computer glasses or
reading glasses that make a widespace for that activity.
It's like a useful combo to havethose.
(13:05):
Yeah. And I also find that when
patients first get their progresses, let's say their very
first prescription, they have toadjust to it, right, Because if
they're not looking in exactly the right spot for that right
target distance, it's blurry. And also with the progressive
part, now correct me if I'm wrong, Doctor Larryly, but you
said the top parts for distance was pretty wide, but the bottom
(13:25):
part is it's going down, gettingto your reading prescription is
very narrow, right? It has this like hourglass
shape. So again, if you're looking just
a little bit off to the side, ifyou're outside of that zone of
the prescription, it can be a little blurry.
And all progressives have that same design where, and that's
how they're able to change, because they have to change the
power of the lens from distance to up close without a visible
(13:49):
line separating them. That'd be a bifocal, right?
But the only way they can make that change happen is to have
this peripheral defocus down. Now, depending on the design and
how old or new the design is, you can get wider and wider
peripheral defocus, wider and wider central zones, smaller
purple defocus zones. But even the very top design
(14:10):
progresses on the market. There's going to be an area out
here along the edge that's not got clear vision where the power
is changing in the glasses. Yeah, no, I've definitely
experienced that where I've gotten progresses and it's taken
me a while to get used to them. It also depends on where it sits
on your face and how large the frame is, etcetera.
I wanted to just ask you something earlier about what you
(14:31):
said about myopia. So let's say somebody has
myopia, which is near sightedness and they have a -3
prescription and they don't wantto work.
Progressives. Let's say they're not
comfortable with them. What else can they do?
Yeah, 1 great option that many of my maps will do is wear
distance glasses and take them off the seat close.
(14:52):
This is why people ask me all the time like why haven't I had
LASIK? I do.
My job is a lot of up close workand I seem fabulous up close.
So being a low Maya has a lot ofperks and the fact a lot of my
patients are struggling. Most are low myos because they
seem so perfectly up close without anything, and they only
have trouble when they're wearing their glasses and
(15:13):
contact lenses. When you have something focusing
your eyes for far away, your lens can't adjust its focus, so
that's when you create the problem of not being able to see
it up close. Got it.
And actually that's what I do iswhen I most of the time I wear
my contacts and will and I actually wear multifocal
contacts sometimes and we'll talk about that.
But when I'm wearing my glasses at night, I just take them off
(15:35):
to read and use the computer because my natural focal point
is here so I don't really need anything.
So why strain your eyes with wearing glasses and having to
accommodate if you don't need to?
Doctor Larry Lee, this has been such an intriguing conversation.
I'm sure that you've really created some eye opening
insights for many people about presbyopia.
What causes it? What are some base options for
(15:58):
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(17:02):
So thus far, Doctor Lyerly, we talked about some basic
approaches for presbyopia, whichwould be single vision, reading
glasses or work glasses and thenprogressive lenses.
Let's talk about contact lenses.What are some options with for
contact lens wearers and presbyopia so.
You've got 2 main categories of contact lens options.
(17:23):
Multifocal contact lenses where you're going to get a blend of
up close and far away vision or monovision contact lenses, which
is where one contact lens is going to be for far away and one
contact lens is going to be for up close.
Now as soon as I describe that, you see maybe 1 sounds like it
has a clear advantage over the other.
Multi focal contact lenses are the newer version.
(17:45):
They've been on the market for about 15 years now, but really
only really good for the last decade.
And we definitely see a mindset change because they have gotten
so good and prescribing doctors personal preference, a lot more
multi focal because it's preserving the binoculars, the
ability to move the two eyes together and both eyes get to do
both things. They're multifocal.
So you want to share your experience a little bit?
(18:07):
Yeah. So basically in my mid 40s, I
was really struggling with presbyopia and I started with a
multifocal that was a low ad. So they come in different
powers, low, mid and high. And what happened was it worked
really well for a couple years. Then I had to graduate to the
mid level and that worked well for a couple of years.
Then I had to graduate to the high level and after a few years
(18:28):
that that no longer worked for me, I was still having a lot of
trouble. And then I went to the second
option you described. So then I switched over to
monovision and I'd love it. It was a little bit of an
adjustment, but I'm so happy. Like I can see my phone clearly,
I can read clearly with monovision.
So try out different things. That's my recommendation from my
personal experience is what may work for you also at one stage
(18:52):
of your life may not work for you at a different stage of your
life. So true.
I'd love to dig in a little bit about what's different about
these in case someone's considering it but wants to know
more. So multifocal contact lenses, I
think sometimes there's this misconception that it's always
progressives, like it's like your glasses, but they function
in two totally different ways. When we're talking about
(19:13):
glasses, we talked about and progressives the distances on
the top. Then you get into the computer,
then you get into the ringing and you move your eyes up and
down to get to different places.You think about a contact lens,
you move your eye up and down. The contact lens just stays in
the center. You're always looking through
the center of a contact lens, soyou couldn't possibly design it
in that same way. So the way that it gets around
(19:33):
that is in a multi physical contact lens, you actually have
layered rings stacked into the center of the contact lens.
So at any one moment your brain is seeing both a distance and
then up close vision stacked on top of each other.
I like to describe it to my patients is like looking through
a screen door. You can look through the screen
and see outside. You can focus on the screen and
(19:54):
then you'll notice outsides blurry behind it.
But it when you're looking through a screen door, you can
always see those things, right? It's not just like a perfect
crisp outside. So I tell people like there's
always something you're looking through.
So it's not your Crispus clearest 2020 vision of your
life. It's a blend of focus.
And that's why I think they purposely say they don't call
them progressive contact lenses for a reason.
(20:17):
And like you said, many people will notice on the lower eye
powers when their eyes don't need as much help, maybe a
little easier to use as your eyes mean more and more help.
It's really hard to get enough reading blend, have great up
close without it hurting your distance blend.
So there's these compromises. That's a word I hate to use, but
I always tell people it's like aseesaw.
(20:37):
The more distance I put in there, the less reading, the
more reading I put in there, theless distance.
So we're just trying to find theright blend for you.
And I like phrasing it that way instead of what are we
compromising homeless focus positive here We have a pretty
high success rate. It's like an 80% success rate
now Monovision, pretty similar success rate.
It's about 75%. When you look at the study data
(20:59):
and patients like yourself and honestly have a similar
prescription probably we really can take to monovision.
If you see great up close without glasses or contact
lenses, any contact lens I put on your eye to help you see far
away is going to take away some of that ability to see up close.
So if you're naked eye is perfect for up close, just
wearing one contact lens for faraway would preserve that great
(21:20):
thing that's happening over here.
It like you said, takes me getting used to.
I always hope people give it a good two weeks.
You're going to hate it the first couple of days.
Hang in there. Nobody says, oh, it feels great
natural to look out of one eye. The other con with monovision
that you might have been this isif you do a lot of computer
work, we do not have 3 eyeballs,we only have two.
(21:41):
So I have to pick one eyes, probably going to pick driving
because that's important. So then the other eye has to
pick is it going to be good for reading or is it going to be
good for computer? And for some people, they can do
either one, but some people's eyes are very specific on what
they need for each distance. And one of those two things is
going to be out of focus. So here's the great news.
You can always supplement with glasses over the top.
(22:03):
So let's see, it's really good at this one thing, but you'd
love to use two eyes to look at your computer for 8 hours a day
with another computer. Hey, let's do some computer
glasses over top of your contactlenses.
I think just going into it with an open mindset of there's not
one-size-fits-all. These are not time machines.
The glasses aren't time machines.
The contact lenses aren't time machines.
None of these is going to give me my normal 25 year old vision.
(22:24):
This is my 40 year old vision, but if I'm open minded to
solutions there's a lot of creative thinking we can do.
Absolutely. And I think the other thing I
heard you say as you were explaining this is you really
need to 1st determine what your own needs are, right.
So are you spending most of yourday at computer arm's length
distance? Or is most of your day up close
(22:45):
on your phone? Or are you outside?
Do you work outdoors? Are you not really up close?
And then relay that information to your eye doctor because
that's really important for youreye doctor to know what your
daily needs are. And maybe they change.
Maybe you have different needs during the week than on
weekends, and that's totally fine.
Maybe you have a couple of different pairs of glasses or
different types of contact lenses for different purposes,
(23:07):
and that's OK. We all wear different clothing
based on the weather. When it's cold or outside, we
wear coats and when it's warmer,we wear lighter clothes.
So you can adjust that with your, I guess you'd call it your
eyewear as well. Doctor Lyerly.
Absolutely. I have lots of patients who will
do multiple contact lens prescriptives for when we're
playing sports or when they're out at the beach.
(23:28):
They won't distance contact lenses with really clear vision.
And then when they're working ontheir regular 9:00 to 5:00 at
work, they prefer Monday throughFriday to have lenses more
shifted towards the computer clarity.
They could still drive home in, but the clarity is more set for
that indoor vision. And that's fine.
Don't be so rigid with yourself.But like you said, as a doctor,
(23:48):
we have to be listeners and makefor our patients know like this
is a conversation. This is not just, oh, here's
your number, this is your prescription.
This is a consistent discussion happening where I'm listening to
your feedback, I'm offering helpYou tell me how that's working.
So it's a collaboration. Yes, yes, so well said Doctor
(24:09):
Lyerly. So well said.
So now let's talk about some of the latest advancements in
presbyopia management. In the past few years, there
have been some pharmaceutical drops that have been FDA
approved to treat presbyopia andthen some that are in the
pipeline. So can you explain to us, Doctor
Larry, what do these drops do and what has been your
(24:32):
experience? Have you prescribed them for
patients? What do they say?
Are they happy with them? Do they use them on a regular
basis or do they not find them useful?
So the way these presbyopia eye drops work is they make their
people temporarily small. You might have remembered
earlier when we talked about yousee better typically reckless
and bright lighting when you're going through presbyopia because
(24:53):
in bright light are people constricts and it pulls in our
maximum eye muscle focus to get that lens maximally adjusted.
Now the other cool thing about asmall people is you're going to
get less peripheral distortion and what we something we call
extended depth of focus. So if you've ever looked
through, it's called a pinhole at the doctor's office, they
hold this little thing up as a tiny hole to look through and
(25:14):
you're like, oh, I see amazing. Look at this little point.
A pinhole, if we're able to create it, would give you great
vision at multiple locations, but you have to make a pretty
small point of focus to do that.So the first drop that got FDA
approved back in 2020, it was called Unity.
It is 1.25% pilocarpine and it shrinks the people.
(25:35):
Now, there was still much excitement and eye care when
this came out. It's the first time ever we were
going to be able to talk about an eye drop instead of just
glasses and contact lenses to improve vision.
I wrote several prescriptions when things got started and my
person was heard. They tell me like, yeah, help,
but it was a bit underwhelming. And So what we've learned with
(25:56):
Pilocarping and it was right here in the study data for FDA
approval, we were probably really excited that the study
data told us this was going to happen too.
So when it got approval, the study data showed only around 20
to 30% of people had a three line improvement in their
uncorrect in their visual acuityfor the first couple of hours
and then it wore off. So it's just a small amount of
(26:18):
improvement for a short amount of time.
They went out back to the FDA and to get approval for a second
time of day drop to try to extend that effect.
But maybe after each drop, a maximum of six hours on three
lines. Let's say you're 2050 without
anything. All right, so you're going to
get down to 2025. But if you just put your reading
glasses on, you'd be 2020. So many of my patients were
(26:40):
comparing it to varying their reading glasses, like, yeah, but
it's not as good. And that was some of the cons.
In addition to side effects, pilocarping can cause headaches.
It can make your vision feel dimbecause it is making the people
really small. It can cause redness.
And while there were no studyingdata in the clinical chorus
pervuity saying that a retinal detachment was caused, we know
(27:02):
that pilocarping as a molecule can be associated with the risk
of retinal detachment. So I'm very careful about the
patients that I will mention it to you in their study data, they
only prescribed for people between plus one to -4 and
obviously no history of surgery,no retinal health pathology.
And I really stick to that very narrow movement window to make
sure I minimize the risk of retinal attack map.
(27:25):
I have to share. I tried view it in myself
because I was like, this is really interesting when it first
came out and I wanted to experience it before I
prescribed it to patients and what it didn't really 'cause me
headache or redness or anything like that.
One interesting thing that caused me this is again a
personal anecdote is I have floaters and it really increased
my awareness of the floaters. For whatever reason, even though
(27:48):
my pupil was smaller, I really noticed my floaters a lot more.
And so I say, you know what, this isn't for me.
I'll stick with my multifocal contacts or my progressive
lenses. And many of my patients, like
when they asked me about this particular drop, I will explain
to them it can work, but but it's short acting.
So what I would say is don't useit every day.
If you have a special event thatyou're going to and you really
(28:11):
need to have that really crisp, clear vision, use it for that.
But it's not from my perspective, it's not something
I would suggest that people use it on a daily basis for.
What are your thoughts about that?
You know what, I totally it's also not inexpensive day instead
of just picking up a pair of reading glasses.
It's probably not practical for people as alternative.
(28:33):
So I completely understand that mindset where it's kind of like,
hey, when I need a lecture kick or some special occasion, are
minimizing glasses for this XX event.
Got it. Now what else is in the pipeline
for Presbyopia? I know that there's a couple of
other interesting options that are soon going to be available.
Yeah, So back last year closely is the newest drop.
(28:54):
It's FDA approved now. It's not yet available for me to
write a prescription in my HR electronic healthcare system.
How do you spell that? It is spelled QLOSI and I was
told it's like close C so closely and so it is also
(29:16):
pilocarpine but at a lower concentration 0.4%.
It's also preservative 3, which when you look at the side of
prep profile is causing a littleless headaches, less redness,
less site irritation. They also were able with the
molecule they're using as a carrier to help with better
penetration to get more action. So with something around 40% of
(29:37):
patients, but right, we're getting that three liner or more
near vision improvement within the first couple of hours.
And so this is one of those where if you're open minded to
it looks like it might be more effective, maybe worth retrying.
But it is also pilocarpine. One thing that a lot of doctors
that are interested in is the new molecule that's slated for
(29:58):
an FDA decision in August. So this is called a PDUFA date.
Then when the FDA makes a decision about approval, so
August of 25, it's called a seclidine.
It doesn't have a name brand yetbecause it's not approved, but
it's from a company called Blends Therapeutics.
Now it's piclodine, not polycarpine, and it's a
selective meiotic, so there's less pulling on the stellarium
muscles when it creates a very small pinhole, much smaller
(30:20):
pupil size than either the polycarpine drops.
And in their clinical studies they were showing something
towards 70% of patients had the three line or greater near
visual acuity and the lasting we're up to 10 hours.
At 10 hours, 40% of people were still having that three line of
improvement or more to be maybe more effective, maybe longer
lasting, potentially a lower side effect profile.
(30:42):
But we'll know more, you know ifwe're when it ever does actually
kind of come to market. So if it's a lot to be excited
about. Yeah.
No, that is really exciting. But I do have one question.
The drop that you just mentioned, the second drop that
is slated to be FDA approved, ifit constricts the pupil so much,
doesn't it cause decreased contrast trouble, more trouble
and dim lighting? What are some of the trials
(31:03):
show? Are there any side effects to
that? Yeah, same thing.
So it can cause dimming of vision, interestingly enough.
And this specific acyclodyne trial that was submitted to the
FDA, very few people rated it assomething that was a concern.
The cytokine cripple was very low. 90% of people said at the
end of the study, I'd rather continuing to use this drop.
(31:23):
So everything side effect was whether it's headache or the
dimming of vision or any initialside irritation when you put the
drop in was rated as very low and mild with this drop.
Interestingly also we know physics wise if you make a true
pinhole people you might be ableto get some improvement to
distance this into and that's what their clinical data shows
(31:45):
that they submitted to the FDA. Interesting.
Wow. These are really exciting
developments in the eye care space for treatment of
presbyopia. I know that some people, I've
had patients who come in and say, well, if the pinhole works
so well, why don't I just get those pinhole glasses?
And yes, you can buy these pinhole glasses.
I believe you can buy them online.
(32:06):
Why would a patient not just wear pinhole glasses if they're
trying to read? Yeah, So here's the crazy.
All right, Let's say you look their pinhole like everything
that you're seeing is total black except for that one small
point of clarity. So Can you imagine trying to
drive in that walk around? You're going to be tripping over
everything. It's like a horse wearing
blinkers. So in practicality, pinhole
glasses pretty limited in usefulness.
(32:28):
You're only going to be seeing asmall point straight ahead of
you. However, a pinhole inside your
eye, the optically is going to work a whole lot different
because it's inside your eye much closer to the retina.
You'll have a wider peripheral field of view potentially.
We've had ten holes, surgical devices before that didn't work
all that well. I think about the camera in
(32:49):
length, for example. So the pin holes are something
we're trying to replicate in thereal world for a while, and we
just haven't really been able tonail it yet, it feels like.
Yeah, I always tell my patients when they want to buy those
pinhole glasses, I always tell them we use them in the office
diagnostically to help determineyour best potential visual
acuity. But practically, it just does
not make sense to walk around with pinhole glasses for the
(33:12):
reasons you just described. It's just.
After they bust all their teeth out on the curb leaving the
office, they'll regret that decision.
Yes, yes, I agree. Well, Doctor Larry Lee, this has
been such an incredible, exciting, fun and discussion.
I wanted to ask you where we just have a few minutes left,
but I wanted to ask you, is there a common myth or
(33:34):
misconception you often hear from patients about presbyopia
that you would love to dispel today for our audience, I think.
People have a lot of unfounded anxiety about presbyopia coming
from, oh, if I wear glasses to help, to make my eyes feel
better, to help me see better, I'll get dependent on them.
My muscles will continue to weaken, they'll continue to
(33:56):
decline. And I think that's why I make
it. Every time I talk to a patient
about this, I make it a point ofdiscussion.
Earlier in this conversation, I made a point of discussion.
The muscles actually aren't weakening, so that's why you're
doing eye muscle exercises. It's not going to hurt anything,
that's for sure. But it is not going to curve
your presbyopia to exercise it away.
Also, wearing reading glasses isn't going to decline your
(34:18):
vision or make things worse because the muscles aren't
getting weaker. That's not what's happening.
It's just the lens stiffening and you're wearing glasses or
not wearing glasses doesn't change the lens thickness at
all. And so that's why they can sell
reading glasses over the counterat the grocery store, at the
dollar store, at Target. No prescription needed.
I could pick up those glasses and start wearing them and would
(34:39):
their vision look weird? Probably, but it's not going to
hurt them at all and that's why you're able to sell them without
a prescription. All they are are magnifying
lenses. But carrying around a magnifying
glass has some cons. You have to hold it all the
time. So someone had the genius idea,
let me take magnifying glasses and put them into glasses holes.
So now you're just wearing the magnifiers instead of holding
(35:00):
it. Isn't that genius?
And that's all that is. And so when I tell people
they're just magnifying glasses but put into eye holes, they
feel a lot safer about what wearing glasses does.
Yeah. I find that there are some
patients who really just feel like they're, they don't want
this to happen and they feel, I don't know if it's necessarily
(35:21):
shame or just with this, there'sa huge movement towards anti
aging these days. I'm not going to get older.
I'm not going to wear those glasses.
There is this almost like a stigma around wearing reading
glasses. And I tell my patients, like, if
you're struggling, yes, you can do certain things without
wearing the reading glasses, butif you wore the reading glasses,
your life would be so much easier.
(35:44):
You would be so much more comfortable doing what you love
to do, whether it's on a screen,on your phone, reading,
etcetera. All those daily tasks would be
so much easier. So I really tried to separate
that kind of notion that this islike a weakness that's within
us. What you were saying, it's not
getting weaker. It's a physiologic change in the
(36:04):
lens of the eye, not the muscles, the lens of the eye.
Yeah, and here the great news is, right, If you don't wear the
reading glasses, it doesn't matter.
Your eye isn't going to get better.
It isn't going to get worse. It's going to keep feeling worse
no matter what. But that's just birthdays.
So it's not like you're hurting yourself by not wearing the
glasses, but if you did give yourself some help, it would
(36:27):
help with eye strain and headaches and maybe even those
wrinkles from squinting and like, maybe you can enjoy
reading more. So yeah, if it makes your life
easier, let your body have some help, that's OK.
And like you said, it's not defeating to do great news.
If you choose not to do it and just make your thought bigger,
give yourself goodbye. I won't hurt anything either.
(36:47):
Yeah, absolutely. Thank you for those reminders
and the reassurance there. Doctor Layer Lee, that's really,
really helpful and great information.
Again, this has been a wonderfuldiscussion.
I really appreciate all your insights and sharing your
experiences helping people with presbyopia.
Doctor Larry, if any of our audience wanted to reach out to
you to get more resources from you, learn more from you, maybe
(37:09):
even become a patient, how couldthey find you?
So probably the easiest place tofind me is online.
I'm at Idolatry. It's EYE dot DOLATRY on
Instagram. I'm also like Doctor Bondick
said earlier, the Co founder of the Defocused Media podcast.
And we have social media at Defocused Media or you can check
(37:31):
out our podcast. If my partner Darrell is here,
he would sell you iTunes, GooglePlay, Apple, anywhere you can
hear the podcast. You can listen to the Defocused
Media podcast and we have quite a few podcasts around Presbyopia
if you guys are interested. And if you live in the Raleigh,
NC area I would love to help you.
I'm at True Vision eye care so phone call away.
(37:52):
Excellent, thank you so much. We will share all of those links
right below your interview. And I hope people do reach out
and learn more from you because you're an incredible resource.
And thank you all for tuning in.And please stay tuned for the
next episode coming up very soon.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new
(38:13):
to help you boost your IQ. Leave us a review and share the
podcast with your family and friends.
Stay connected with me for more eye opening insights on ihealth,
nutrition and lifestyle. Until next time, keep your
vision clear and your IQ sharp.
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