Menopause's impact on presbyopia and eye health with Dr Jessica Crooker

As women enter their 40s and 50s, many notice two profound shifts happening at once: the hormonal changes of perimenopause and menopause, and the onset of presbyopia and other vision changes. While hot flashes and mood swings are widely recognized, the impact of fluctuating estrogen levels on eye health is often overlooked—leaving patients confused about whether their dry, uncomfortable, or fluctuating vision is “just aging,” too much screen time, or something more.

In an exclusive interview with Optometry Times, Jessica Crooker, OD, explored the under-discussed connection between menopause and ocular health, highlighting how symptoms like dry eye, light sensitivity, and variable vision emerge, and why many women feel dismissed or hesitant to ask questions. Crooker believes this knowledge can aid eye care providers in becoming trusted guides by proactively addressing these concerns and offering modern solutions, such as multifocal contact lenses.

Transcript

Edited lightly for clarity and length.

Jordana Joy: What do we currently know – research-based, patient care-based – on presbyopia and menopause? What's the approach and what's the data behind it?

Jessica Crooker, OD: So I think the biggest thing that we're noticing is menopause is coming in for our patients anywhere between 40s and 50s, and we're starting to see that that's around the same time as changes in vision with presbyopia kick on in. So a lot of times your hormonal changes during perimenopause and menopause particularly different fluctuations and things like estrogen can affect, impact aspects of eye health, including, say, tear production and visual comfort, and how comfortable people feel being able to look at their computer for extended periods of time. Some patients might have dry eye. They might have kind of weird fluctuations in their vision that they may have never experienced before, or maybe even a sensitivity to light that they've never had before. So I think a lot of times patients are thinking, “Is this something wrong with me? Is this something that's maybe because it's me spending 10 hours a day on the computer, or is it something that maybe it's something to do with these changes in my body. So I think a lot of times patients are unsure what's going on with their body, whether it's something to do with something like perimenopause or menopause, or if it's just something that's a natural change.

Joy: So given those hormonal shifts over the journey that a patient will experience with perimenopause and menopause, is it that it's more specific to an individual patient? Are there any trends that you see and how hormonal shifts happen that that physicians can follow?

Crooker: Sure. So I think that a lot of times patients will come in in their maybe early 40s, and maybe they've been to their primary care doctor and ask questions about, “Am I starting to experience some symptoms of perimenopause?” and oftentimes be shut out. I am 43 years old myself, and I know I have some friends that you know are experiencing different symptoms, and every time I have anything that might potentially be a symptom, I kind of get nervous about it myself. I think that's the same with our patients, and if they're going their primary care and saying, “You're too young for perimenopause at 42, 43,” I think oftentimes when they come in to see me, they're afraid to ask about it, or afraid to ask if maybe the symptoms they're having might have something to do with perimenopause or menopause, or anything like that. So I think that's one of the biggest things that I always try to stress with my patients. Feel free to ask any questions, feel free to go over anything that you might have concerns about. I think a lot of times women in their perimenopause and menopause years, we're so busy. You know, we're doing everything for kids. We're doing everything for our family. We're working. So oftentimes we put ourselves last. And then when you're having issues with perimenopause, like some dry eye issues, or you're having issues with your vision, maybe fluctuating, you don't know, is it something that I'm doing wrong, or is it something that you know someone might be able to help me with? So I think that's the biggest thing, just not being afraid to ask any questions.

Joy: So you had gotten a little bit into what a patient can experience with those effects from menopause. What are some of the early signs if a patient may be experiencing menopause affecting their their eye health, and how do those hormonal shifts specifically influence that eye health?

Crooker: So as we have a woman who's going through perimenopause or menopause, we see fluctuations in estrogen that can definitely cause many different changes in how people perceive their vision or their visual comfort. I think the biggest thing that we see is tear production. We'll see some issues with patients having dry eye problems where they've maybe have never had dry eye problems before. I just had somebody earlier today, and she says, “You know, all of a sudden, my eyes are super dry. I feel like I want to rub them all the time, I feel like I'm using artificial tears way more than I ever did before.” And I think a lot of times they're they're wondering, “Is this normal? Is this me?” I think it really affects someone's visual comfort and how well they go about their day if they've got that moisture on the front part of the eye, if they've got some comfortable eyes, versus eyes that are dry or feeling uncomfortable. But I think the biggest things that I see are issues with dry eye, because we've got issues as though the hormonal changes are happening. We've got issues with estrogen affecting that tear production – also fluctuating vision. I think that's a huge one that we see. We'll have patients that are like, “It must be because I was on a computer all day, or must be because I was driving a long distance, but my vision is just not the way that it used to be, today versus yesterday.” So that's one of the biggest things. And patients are scared when they have that happen, like, maybe I've been in the same prescription for forever, and all of a sudden, in the morning, things are different than the afternoon. So that fluctuating vision, I think, is a huge thing that we see in. This age group of perimenopause and menopause also increased sensitivity of light. That's another big thing that we'll see, and our visual changes, which some of them kind of overlap with presbyopia. So, maybe holding things a little bit further away having increased headaches or difficulties when you're reading or looking at something up close for a while.

Joy: So how might your approach as a physician to patient care be different for a patient that either you suspect or they know that they're either perimenopausal or menopausal, that you know may have presbyopia or has presbyopia, differentiated to a patient that is not menopausal?

Crooker: There's many different options for patients to be able to have excellent visual comfort. And I think being able to ask the questions to a patient: “Are you having any difficulties that may be new? Are you having anything you know that maybe you don't maybe necessarily think is a problem with your eyes?” But you know, I have a lot of patients that will come in and they'll say, “You know what? Now that you mention it, I do notice that my vision has been fluctuating. Now that you mentioned it, I have been feeling like my eyes are dry right in the morning from the moment that I wake up, which is something that I've never experienced before.” So I always just make sure to ask some pointed questions to any women. I mean, even we're seeing women with perimenopausal issues or complaints in their mid 30s. So I'm not afraid to ask those questions and just see how a patient is feeling. But I think a lot of the questions that I usually ask her about how the eyes feel: “Are they watering a lot? Are they feeling dry? Are they feeling uncomfortable? Are you having the fluctuating vision?” I think that's the hugest one that I will see. You know, not only just issues with up close, like with presbyopia, but also issues with distance as well.

Joy: So if there was one nugget of information that you wish that all eye care providers knew more about eye health and menopause, what would that be?

Crooker: I think the biggest thing is, we want to be a trusted resource for our patients. I think a lot of women in this age group, the perimenopausal/menopausal age group are getting a lot of their information from Instagram or from the mom groups. My daughters do gymnastics. I always hear the mom groups talking about different things, and some things are good, that they mentioned. Some things I see on Instagram are good, some are bad. But I always want to be the the person to be able to give my patients information first. I don't want them to say “I heard this on Instagram. How come you didn't tell me about this?” So I think one of the biggest things that I find is women – any age group, 30s, late 30s, early 40s, late 40s – I'll always ask them the questions, like, “Are you feeling okay today?” “Yeah, I'm not having any issues with dryness, not having any issues with that fluctuating vision. I'm doing great today,” and always say, “But if you do, feel free to reach out to me, because I've got some things that might be able to help you out.” So then it makes it so it's not as uncomfortable of a conversation. It's more like you're just talking with a trusted friend. So I think the biggest thing is, when you have a patient that you know, you think is in that perimenopausal, menopausal age range, what I would do is ask them how they're feeling, ask those pointed questions: “Are your eyes feeling dry? Are they watering? Is your vision fluctuating?” And if they say yes, then you know exactly where to take them and where to be able to guide them. If they say no, say, “Hey, these might be things that happen to you in the future, and if so, come on in. I'm happy to take a look and happy to give you some advice.”

Joy: Anything else that you want to add that we haven't touched on yet.

Crooker: If we're talking about presbyopia, I think the biggest thing is I don't think a lot of people know what to do once they start having issues with up close. And I think a lot of people think that it's just over the counter readers, the grandmother string around your neck with the glasses. And I always try to let them know, we have so many other options for you. I think one of the biggest things is a lot of people don't know that we have contact lenses available nowadays, and the contact lenses are multifocals, which they're able to correct both distance and near. So I think a lot of patients, when I mentioned that, they say, “I've never even heard of that before. I never knew that that was available. I was just resigned to thinking that I was just going to need readers.” So I think it's all about that trust again. I always want my patients to know even if today's not the day, if today they're not ready for something, they might need it in the future, and here's what we have in our back pocket for if you need it.