Working Healthy

I Can See Clearly Now

For techs over 40, seeing up close can become difficult. Here’s how several are coping with presbyopia — and some advice from eye doctors on the latest treatments and techniques to restore sharp vision.

“Despite your best intentions, your body will betray you,” says Ginger Wong, a New York City nail technician who will only admit to being “slightly over 40.” “And it usually starts with the eyes. First you can’t read magazines or menus anymore. Pretty soon your clients point out spots you missed. Next thing you know, you’re wearing glasses.”

Because seeing small details close-up is critical to a nail tech’s success, finding the right treatment for presbyopia (a Greek word that means “old eye”) is important — and often as close as the neighborhood drugstore. When near vision starts to decline, many turn to magnifying reading glasses, also known as “cheaters” because they allow viewers to see without undergoing an eye exam and getting a proper prescription.

“Yes, I wear cheaters,” admits Rose Kerekes, a 47-year-old nail tech from Trenton, Mich., who works at VIP Nails & Spa in Riverview. “But I’m considering going to the eye doctor.” While the cheaters help, Kerekes also uses a special overhead light with a 60-watt bulb to illuminate her workstation. “I don’t know how the other girls manage,” she says. “How can you see? When doing nails, you have to have it right there.”

But Kerekes brings up another problem with using cheaters: the dust. “I have to constantly wipe them off.” Mary Metscaviz of Awesome Nails in Grayslake, Ill., agrees. Metscaviz, who first noticed that “everything in the world seemed to be getting darker” in her early 40s, first turned to drugstore reading glasses. “I’m doing more gels, so the glasses get coated with dust, and you can’t use towels to clean them due to the oil.”

Metscaviz saw her optometrist, and now wears bifocal soft contact lenses for work. She also uses a special lamp from Dick Blick Art Supplies with two high-powered bulbs because, as she notes, “I need all the light I can get. All of my techs use them.” Even with the magnifying lamp and special contacts, she still dons reading glasses to do nails.

Magnifying lamps are an expensive solution, with basic models starting around $50 and fancier options topping out near $150. Many replicate daylight and outdoor conditions, and they are highly praised by artists who must carefully select and match colors.

For techs like Metscaviz, who need vision correction for distance anyway (a condition known as myopia, or nearsightedness), a trip to the eye doctor is in order. And even those who rely on over-the-counter solutions to correct their close-up vision should see an optometrist or ophthalmologist regularly to monitor eye health.

“I denied it for years,” says Shari Finger, owner of Finger’s Nail Studios in West Dundee, Ill. “Before I became a nail tech, I was a graphic artist, so I’ve always done really close-up work. I built up the muscles to look at things closely, so it affected me early. I started with cheaters at 35, and graduated to bifocals at 42. I’d be working at my table, someone would walk into the salon, and I couldn’t see them. I was always looking over the tops of my glasses, and I couldn’t focus.”

Now 45, she watches younger techs work without glasses or special lights and is wistful. “I remember when I could do that. My sight was so good. Now, it’s frustrating. But,” she laughs, “I’m going to be one of those old ladies, hunched over the table doing nails with a magnifier.”

Will It Happen to You?

“Presbyopia happens to everyone,” says Dr. Jeffrey L. Weaver, O.D., director of clinical care for the American Optometric Association (AOA). “It respects no race or gender. Also, the age at which people start to need reading glasses, 40 to 45, also happens to be the age when a lot of eye diseases start to crop up. It’s important to have a diagnosis as early as possible.” The American Optometric Association recommends that people older than 40 with no vision problems have their eyes examined every two years.

For most people, an optometrist, or O.D., will be the right doctor to examine the eyes and prescribe the proper correction. Optometrists can diagnose and treat most eye conditions, using corrective lenses, vision therapy, and a select list of medications. They prescribe and fit glasses, contact lenses, and other protective eyewear. For patients who need more extensive eye care or are considering surgery, an ophthalmologist (a physician or surgeon who specializes in the eye) will be a better choice. While most ophthalmologists can and do prescribe glasses or contacts for patients who need correction, this part of the exam, known as refraction, is almost never covered by medical insurance.

What Exactly Is Presbyopia?

“As we age, the lens inside the eye loses elasticity,” explains Dr. Jacquelyn Guida, O.D., an optometrist who practices on Long Island. “It loses the flexibility needed to focus from far to near, and this affects your ability to see up close. You need spectacle correction to help the lens focus.”

Presbyopia affects people with good vision or myopia (nearsightedness), but is more problematic for those who are hyperopic (farsighted). Prior to becoming presbyopic, hyperopes can naturally accommodate by bringing things into focus at any distance. Suddenly, after 40 years of living without needing vision correction, they often lose both distance and near vision at the same time because their eyes can’t compensate any longer.

Dr. Guida suggests that multifocal and bifocal contact lenses are the best option for nail technicians. For those who can’t tolerate contacts, progressive glasses (often called no-line bifocals) work well. “Single-vision reading glasses will allow a tech to focus close-up at the table, but she’ll constantly have to look up over the glasses to see new people coming into the salon.”

Patients who are slightly myopic have an advantage, says Dr. Guida. “If their distance prescription falls within -1.00 and -2.50, they can usually just take off their glasses to see perfectly.

“There is one other option,” she says. “Occupational glasses, which are like progressive glasses, affect intermediate and close vision, so a tech can look at the client in front of her and then down at her nails.” Occupational glasses were originally offered for computer users, but in recent years, have become popular with artists and others who must quickly switch from close to mid-range vision.

According to Dr. Kent Daum, O.D., who teaches at the University of Alabama at Birmingham School of Optometry, “There are simple solutions to age-related changes in vision.” He cautions older techs to watch for symptoms such as headaches, blurry or double vision, tired or irritated eyes, and stiff or aching neck and shoulder muscles. He recommends that people over 50 get prescription glasses focused for intermediate use. For techs who wear monovision contact lenses (one lens focused for near vision and the other focused for distance vision), he suggests reading glasses that are focused for intermediate distance be worn over the contact lenses.

“Monovision lenses work well if your task is not excessively intense,” he says. Metscaviz, the tech mentioned above who wears bifocal contacts in the salon, switches to monovision lenses for the weekend.

Surgical Options — the Wave of the Future

Nail techs who want a more lasting solution have limited options. “They’re working on surgical treatments to put in implants for reading,” says Dr. Guida, “but they’re still undergoing clinical trials.”

One procedure, however, has been approved by the FDA and has been performed on thousands of adults with excellent results. Known as conductive keratoplasty, or CK, this speedy, non-invasive option is offered by trained ophthalmologists who use a probe thinner than a strand of hair that releases radiofrequency energy. Applied to the cornea in a circular pattern, the radio waves shrink small areas of collagen to create a constrictive band (like the tightening of a belt) that increases the curvature of the cornea and makes it steeper, bringing near vision back into focus.

Paula Allen, a 50+ nail tech who works with Rose Kerekes at VIP Salon & Spa in Michigan, had the CK procedure in October 2003 and is still raving about it. “I love it,” she says. “My vision has improved so much. I can read any fine print. I never need glasses in a grocery store or restaurant — and I don’t wear them to do polish or pedicures, either.”

Allen does wear glasses while doing detailed work in the salon. The left side has a plano (uncorrected) lens; the right side helps her to see better doing close-up work like gels. “They protect me from dust and flying objects, and also help with perception,” she says.

“I recommend CK for anyone over 40,” says Allen, who has been doing nails since 1982. “It was absolutely painless.” Her physician, Dr. Michelle Akler of Castleman Eye Center in Taylor, Mich., did the procedure on one eye “in about two minutes,” and Allen drove herself home that afternoon. “I missed one day of work,” she laughs, “just so I wouldn’t get anything in my eye.”

Allen’s CK procedure cost $1,500 and was not covered by insurance, but most ophthalmologists who offer it have interest-free payment plans available. “They make it so easy,” she says. “It was the best thing I’ve done in my life. Immediately after the procedure, I could read small print. It was amazing.”

While Allen hasn’t noticed any deterioration in her vision since the procedure, Refractec, the ophthalmologic technology company that offers the NearVision CK equipment and trains physicians in its use, cautions that the level of improved vision may be temporary.

Like Allen, CK patients can return to work the next day, and most notice the improvement in their vision after a week. There are nominal complications involved with the CK procedure; however, because no cutting or lasers are involved, these are minimal. For a few days following the procedure, some patients notice side effects, including:

  • discomfort and/or foreign body sensation
  • glare
  • halos
  • overcorrection
  • tearing

    Researchers are currently conducting clinical trials to determine the safety and success of CK on patients who have already undergone LASIK surgery to correct distance vision. According to Refractec, 96% of the patients involved in the trial have been satisfied with their results. “The baby boomers who were first to enjoy the benefits of LASIK to correct the vision problems of their youth now face the gradual reduction of near vision as they age,” said Dr. Daniel S. Durrie, M.D., lead investigator of the study. “Fortunately for these post-LASIK patients, initial results from this study indicate NearVision CK may be a good treatment option.”

    Less popular than CK is the laser thermal keratoplasty, or LTK, which uses a laser to reshape the cornea in one eye. Because the results are permanent, potential patients are advised to try wearing monovision contact lenses for a period before the procedure to ensure they will adjust well to using one eye for distance and the other for near vision.

    For techs who suffer from cataracts and presbyopia, surgically implanted intraocular lenses, or IOL, are the newest treatment option. Approved by the FDA in March 2005, The AcrySof ReSTOR lens combines traditional cataract surgery with new technology that gives patients a full range of vision — near through distance — so they can regain their visual freedom. Because it doesn’t work with the muscles of the eye, it’s not dependent on the patient’s natural anatomy to function correctly. And, unlike CK, the procedure is usually performed on both eyes instead of just one. It is expensive, with fees averaging $4,600 per eye and is usually not covered by insurance.

    Whether you choose to treat your presbyopia with cheaters or invest in the latest surgical techniques, consulting a qualified eye doctor is a wise move, experts say. “Getting old is inevitable,” says Wong. “But it won’t stop me from doing good nails.”

    Pamela Yaeger is president of Scarlet Communications, a Long Island-based agency that provides editorial and design services to clients in the U.S. and Europe.

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