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How Menopause and Midlife Affect Your Eyes

eye health Feb 15, 2023

If you can read this (without corrective lenses) you’re lucky!


By Selene Yeager


Sometime after your 40th birthday, you start noticing this annoying blurry type everywhere…in phone messages, food packaging, novels, you name it, there’s this itsy-bitsy print that you have to hold at arm’s length or whip out a pair of magnifying glasses to read.


It’s called presbyopia, the gradual loss of your eyes' ability to focus on nearby objects, and it comes for all of us, women and men. But for women, we also have menopausal changes to contend with. So, whether you’ve worn glasses since you were a kid or you’ve had 20/20 all your life, changing hormones and the passage of time can lead to changes in your vision and the health of your eyes.


We sat down with Christine Begley, OD, an optometrist with more than 21 years of experience who practices at Marion Eye Centers and Optical and is passionate about menopausal eye health to tell us all about it. (For even more eye health information, check out Hit Play Not Pause episode 74 The Eyes Have It.) Here’s what you need to know.


Our Focusing System Starts to Malfunction


Nearsightedness (myopia) and farsightedness (hyperopia) are generally diagnosed in childhood and they’re the result of our eyes being a bit longer or shorter than they should be so the light that comes in isn’t focusing directly on the retina. Presbyopia is when our focusing system – which allows us to switch back and forth from seeing objects both far away and close up clearly – starts to malfunction. It happens to everyone. The reasons why are still not fully understood, but the theory is that the lens in charge of that focusing hardens, changes shape, and/or loses some of its flexibility. The result is that when we turn our eyes to close-up tasks like reading, things are blurry.


You can bring the world back into focus with corrective lenses. “Readers,” the magnifying glasses you can buy pretty much everywhere these days, are an easy option for most women. If you already wear glasses, you can get a prescription for progressive lenses with near and distance prescriptions worked into the lenses. 


There are also contact lens solutions, which may be preferable for women who already wear lenses. Monovision is one strategy. In monovision, the doctor adjusts one lens for near vision and the other for far, and your brain adapts. (I have personally used monovision very successfully for several years, but you can only push it so far before depth perception suffers.) Another is multifocal contact lenses, which are like bi- or tri-focal glasses right on your eyes. Some people wear these very successfully. Others have a more difficult time adjusting to them. If one brand doesn’t work for you, it’s worth trying another manufacturer, Begley says, because not every eye does well with every contact lens and there are a lot of options available. 


The shape of your cornea can also start to change, Begley says. “In postmenopausal women, sometimes the cornea steepens a little bit. That means the contact lens that maybe you’ve worn for the last 20 years that has been super comfortable all the sudden starts to feel a little tight or uncomfortable in your 50s, and you may need to switch to a different brand.”


Unfortunately, there’s still not a great surgical fix for presbyopia. LASIK works well for near-sightedness, but you’ll still need reading glasses for up-close vision. There is a surgery for presbyopia where the surgeon performs a corneal inlay that allows more focusing, but it has very mixed results, Begley says. “The biggest hit as far as finally fixing presbyopia is attached to cataract surgery,” she says. When you have cataract surgery, they replace the lens, and they have gotten good at replacing that lens to correct vision. 


If you really hate reading glasses and need to do up-close work during much of the day, the FDA recently approved eye drops that are designed to temporarily relieve presbyopia. They’re called Vuity and they’re a repurposed glaucoma medication that makes the pupil smaller to increase the depth of focus. “They’ve gotten mixed reviews,” Begley says. “Some people report that they go all day without needing reading glasses. Others only get a few hours. I think it works for a certain subset of patients. It’s worth talking to your doctor if you’re interested.”


Finally, seeing in dim light also becomes more challenging. The colorful iris of our eye is a muscle. And just like our other muscles, it changes over time, making it harder for it to fully expand in low light conditions. That’s why it’s harder to read a menu in a dim restaurant or to see clearly when driving at night. Research on yellow-lens night driving glasses doesn’t support their use. The best strategy is to be sure your prescription is current and, if you wear glasses, to wear a pair with an anti-reflective coating.



Your Tears Change…and Kinda Dry Up


Dry eye is a huge, prevalent problem in general because of all the time we spend staring at screens. But it is especially difficult for women, Begley says. “Women are dropping out of contact lens wear in their 40s or 50s because they can’t find anything that’s comfortable enough because their eyes are so dry.” 


Just like you may need more hand cream or vaginal moisturizer, you may find that you need more artificial tears. For some women, over-the-counter artificial tears do the trick for dry eyes. If over-the-counter drops aren’t cutting it, you can ask your eye doctor about prescription drops like Restasis, which help increase your eyes’ natural ability to produce tears. 


The composition of your tears also changes. We think of our tears as being really watery, but they’re more like salad dressing, in that they’re both oil and water, Begley says. “Just like you need a bit of oil in your salad dressing to stick to your lettuce, you need that oily component so your tears can stick to your cornea and not evaporate too quickly.” We lose that oily part because we often develop a bit of what is called meibomian gland dysfunction. Meibomian glands are at the base of the eyelashes on both the upper and lower lids. They’re what make-up artists call “the water line,” because that’s where these little glands secrete an oily secretion that contributes to the tear film. They get damaged over time and we have less oil in our tears. If you wear makeup, be sure to clean it off at the end of the day and avoid putting makeup on the waterline to keep those glands clear.


Menopausal hormone therapy can be helpful if your dry eyes are caused by meibomian gland dysfunction. Some studies show that omega-3 fatty acids can also improve dry eyes and tear quality, so consider a supplement if you don’t regularly eat fatty fish. Finally, consider an eye mask, Begley says.


“My favorite tip is the TheraPearl Eye Mask,” Begley says, which is a gel-filled eye mask that can be heated or chilled. “The hot application is wonderful for meibomian gland dysfunction. You put it on for 5 to 10 minutes. It’s very relaxing, and it really keeps those little meibomian glands flowing.”


If you’re a longtime contact lens wearer who is now having trouble because of drier eyes, consider daily disposable lenses. With daily disposables, you don’t have to worry about protein and other types of build-up, which can aggravate dry eyes. They may also be more hydrating. 


Eye Conditions Become More Prevalent 


With age, the risk for eye conditions and diseases like cataracts and macular degeneration goes up.


Cataracts happen to every single person if we live long enough. Our eye’s focusing lens is very clear early in life. Over time with exposure to UV light and blue light, it starts to yellow and becomes more cloudy. You’ll notice it as a glare when driving at night. Oncoming headlights may have a starburst effect. That’s because the light that’s going into your eyes isn’t going straight through a clear lens, but scattering because the lens is getting cloudy. That’s repaired by removing the lens and replacing it with a new one. 


In our older years, the risk of age-related macular degeneration (AMD) increases, especially if we have family members who have had it, as there is a genetic predisposition for it. Macular degeneration is when waste builds up in the part of the eye called the macula, the bulls-eye focal point of the retina that processes sharp, clear, straight-ahead vision. So we develop little lumps called drusen in the macula, which can lead to AMD and distort or interfere with our vision. That form of AMD is called “dry” AMD and accounts for about 85 to 90 percent of the disease. Some people develop “wet” AMD, which happens when blood vessels grow under the retina and leak. There’s no cure for either form, but you can take steps to prevent and slow the progression of the disease. And there are treatments your doctor can perform to improve vision and limit the damage.


A diet rich in antioxidants, which are found in bright-colored fruits and vegetables (yes, like carrots) can help protect your eyes. There are also special supplements that may be able to slow the progression of dry AMD. They’re called AREDS2 (named after the clinical trials: Age-Related Eye Disease Studies) and they contain high amounts of specific eye-protecting vitamins and minerals. You can buy them over the counter, but don’t take them without consulting your eye doctor, because in a small percentage of people, they can increase the risk of worsening disease. Your doctor can determine if you’re at risk with genetic testing.


Finally, protect your peepers with sunglasses. Dermatologists have done a great job of educating us about the potential skin damage of too much sun exposure. Begley believes eye doctors should be doing the same for our eyes. “UV light has been associated with cataracts and age-related macular degeneration,” she says. Wear sunglasses with UV protection. If you wear contacts, you can even get contact lenses that transition in the sunlight to create UV protection.   


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