TORONTO - The hands or the neck give away a woman's age, so people say. But in Stephanie Palisek's case, it's the eyes.
Ultra fit and slender as a teenager, Palisek could easily pass for younger than her 44 years. But if she wants to read a menu or scan the ingredients of a food purchase, she has to reach for reading glasses or resort to the telltale trick of holding something out to arm's length in order to bring it into focus.
"Distance is fine. It's anything close at hand," Palisek, a Toronto-based information technology project manager, says ruefully.
"When you're looking at ingredients on cans and things. You know, who actually wrote this? Surely they weren't thinking someone could actually read it? But I know there was a time when I didn't have an issue with it."
Palisek started noticing her problem with print when she was about 41. That's pretty much the textbook time for people to become aware they've developed a vision peculiarity very few would know the proper name for.
Presbyopia - the b-y combination is pronounced 'bee,' not 'bi' - is a cruel name for a condition that makes itself known right around the time people are coming to grips with being on the downhill side of 40.
The cruelty lies in the word's Latin roots. Presby means old people and opia refers to the eye. Old people eyes.
Like death and taxes, presbyopia is unavoidable. If you are in your 40s or older, you've got it. If you are younger, you're going to get it.
"It's a biological universal," says Dr. Donald Kline, director of the Vision and Aging Laboratory at the University of Calgary. "There's nothing you can do to stop presbyopia."
Actually, people over 40 who are myopic don't experience the problem to the same degree if their vision is uncorrected. But the glasses or contact lenses they wear to see objects at a distance render them presbyopic in the process. That's why you actually see some middle-aged people remove their glasses to read a label.
In order to be able to focus on objects at a variety of distances, the eye must change the shape of the lens that sits behind the cornea, focusing light and images onto the retina at the back of the eye.
When objects are at a distance, the lens flattens out. But to focus at close range the lens must become more convex or spherical - a process called accommodation. The ciliary muscles in the eye allow for the tensing or relaxing that lets the lens change shape.
As we age, it's believed those muscles still play their part. But the lens itself becomes progressively less elastic, losing the ability to bulge out in a spherical fashion. Eventually we have to help the eyes artificially, either by equipping them with special lenses or by moving the item we want to see to a distance where the eye can focus on it.
Because we start to notice the effects of presbyopia in our 40s, it would be natural to assume that is when the problem arises. But in fact the process begins decades earlier, Kline explains.
If you think of accommodation like vocal range, kids' eyes are the visual equivalent of Celine Dion's voice. Their lenses can flex like crazy, allowing them to focus on things virtually at the end of their noses.
Picture the way young kids read, with their books almost plastered to their faces. They have no problem seeing print that would be a total blur for an adult.
But by as early as the mid 20s, the eye has lost about half of the range of focus, which is measured in units called dioptres. Where a child of 10 might have 20 dioptres of accommodation, that range will be halved by the time he or she reaches the quarter century mark.
"At age 25, I'm already half-way shot, which is sort of interesting because you don't notice it," Kline says.
It does become apparent by the 40s and continues to decline, albeit more slowly, until about age 60 at which point "that's it," Kline says. "There's nothing left."
While it is hardening, the lens is also yellowing - affecting the aging eye's perception of some colours - and becoming more cloudy. The latter phenomenon is what we know of as the formation of cataracts. If we live long enough, most of us will undergo cataract surgery to have our cloudy, yellowed and hardened lenses removed and replaced with artificial intraocular lenses.
Currently, those artificial lenses are not flexible and therefore can't restore accommodation. But researchers are trying to develop a new generation of the devices that can bend, meaning someday cataract surgery might also reverse presbyopia.
"You'd solve two problems at once. One is you clarify the lens right away. And the other is you would restore ... the ability to focus again," Kline says.
In the meantime, people who hit the presbyopia stage of life have a number of options, says Vancouver ophthalmologist Dr. Simon Warner.
People with good distance vision - in other words, people who don't already wear glasses or contacts - will need reading glasses. And yes, the inexpensive ones at the local drugstore will probably do just fine.
"There's nothing harmful about those glasses," says Warner.
He suggests, though, that people first see an eye professional for a checkup to make sure everything else related to their vision is in proper working order. In the process, they should ask if they can simply use off-the-rack reading glasses and what strength they need, he advises.
"Some people need more strength in their reading glasses than others," explains Warner, who has a practice but also teaches at the University of British Columbia.
"And sometimes it depends on what people do. If you're a gardener, you might not need very strong reading glasses. But if you're sitting in front of a computer all day, you might find that you need reading glasses more frequently."
People who wear glasses for distance will need bifocals or even trifocals - glasses that allow the wearer to focus at a distance, at mid range and close up.
For those who go the bifocal route, Kline has a word of warning.
People who've been wearing glasses can have real trouble negotiating stairs when they first start wearing bifocals, he says. That's because when they look down to check the location of the stair, they are actually looking through the portion of their lens meant for reading. As a result, the stair could be a blur.
Contact lens wearers can also switch to bifocal contacts. But they may have another option open to them as well, Warner explains.
For some, under-correcting one eye - using a contact lens that is slightly less powerful than the eye actually needs for distance vision - will allow them to get by without reading glasses. The properly corrected eye brings distant items into focus while the under-corrected eye allows the wearer to focus at close range.