HACKER Q&A
📣 jason_slack

At 45, I can't seem to read as well anymore


Howdy HN Friends,

I've gone back to school into a medical degree.

However, I am realizing that I have trouble reading well. I used to not have trouble with any topic, but now I have to re-read text several times, I have to take a ton of notes (40+ pages per chapter), I am skipping lines and transposing characters.

I went to a specialist for academic learning and they did a battery of tests and told me my reading level is very low and were surprised I am even in a medical program.

I went to a development/behavioral ophthalmologist and they prescribed new lenses and cognitive eye therapy. The lenses seem to help but the eye therapy isn't.

I am at risk of needing to withdrawal. Perhaps pausing this education is the best thing while I get this under control, but I don't see a path to start on.

Any advice?

Edit: I have talked with my advisor and instructors and they don't have advice except to seek more help, ask even more questions.

Edit 2: Taking no meds for the last 9 months, never had Covid, my PCP referred me to the development/behavioral ophthalmologist.

Edit 3: no alcohol, no drugs, no ADHD medications.


  👤 labrador Accepted Answer ✓
I'm older than you and also have trouble reading but I figured out the problem. I've spent so many years skimming articles on the web that I'm having a hard time breaking the habit. I'm reading "Spare" today by Prince Harry and it's a struggle, but I'm managing to slow down and comprehend each sentence and each word if necessary before moving on. I'm doing this because I want to start reading books again in my retirement.

You case sounds different though, like it might be something organic. Are you taking a medication that makes you less sharp? Bipolar meds certainly do that. Do you have headaches that might indicate some problem? Have you had Covid so maybe have brain fog from long Covid? Are you depressed and anxious? Do you drink a lot? Etc... Good luck figuring it out.


👤 etrautmann
I suspect that this is true for a number of people and you're being honest with yourself. I find that frequently skimming social media, mostly twitter and IG, makes deeper reading harder. If you do that even 30 min a day, you're untraining reading and training skimming. the rapid cognitive switching involved with skimming a wide range of topics that fly by on a timeline also trains the neural grooves for rapid context switching over attending to something for a while.

Good luck - might take a few months, but with good sleep and restricting phone use, I would imagine you'll see improvements. Med school is also very hard - my wife's a doctor so I see this up close. Don't be too hard on yourself.


👤 cdelsolar
You almost have to learn to read again. I regrettably stopped reading for years (other than web articles, email, skimming, etc). In the last few years I started reading novels for pleasure again, and I swear if I stop for a couple of weeks when I get back to it I have to take my time and be slow. Something that has helped is reading books in my native language (Spanish). Since I'm not as strong as I used to be in Spanish, I find that reading in Spanish really forces me to take my time reading every single word. Resist the urge of your brain / eye saccades to skip ahead a bit. Keep reading and soon you'll realize you can do this for many pages.

Edit: I saw that you read plenty for pleasure, so it's probably not this :/


👤 WalterBright
I realized in my 50s that I had been reading less and less for many years. I didn't know why, and it bothered me. Then, one day in the drug store, they had these reading glasses on one of those wire displays. On a whim, I tried one on. My gawd! I could see! My vision had declined so gradually I didn't notice it, but the reason I wasn't reading anymore was because of the effort to make out the letters.

The reading glasses solved that problem, and I was reading again. I also had been in denial and finally got progressive lenses for my glasses.

I know this is not your particular issue, what's happening to you sounds awful.


👤 bretthowell
I had a similar situation/concern a few years back… went to Dr and Optician got glasses, light therapy etc. No improvement and became exasperated.

What solved the mental focus for me was light movement while reading (walking on treadmill etc) and/or laying down to relax most core muscles. Second, shockingly NOT chewing gum or doing too much downward facing iPhone reading made a massive difference to my vision.

Causality? The impact of posture and/or movement on breathing has a big impact on brain focus. If you have a blood O2 meter you can test this while your are reading. Ironically the more worried you become about not focusing the more you hold your breath and the more clenched your posture. It’s a vicious cycle.

Gum was the shocker, I would habitually chew in the morning for an hour or two (mindlessly) and it turns out it was over taxing the jaw and neck muscles. This caused the eye muscles to be impacted and resulted in blurry strained vision. Cutting out gum for a week almost entirely removed my need for glasses. Lastly, I would still get blurry vision occasionally and finally narrowed it down to iPhone “texting neck”.

I’ll post a couple of refs in a minute. May be unrelated but if there’s a thread to pull on here I hope it helps.


👤 kubectl_h
Do you live in North America? Have you possibly been exposed to Lyme disease? These are all common symptoms of early Lyme and possibly even long term exposure.

👤 jacquesm
Dumb question: have you had your eyes checked? I had serious reading issues, massive headaches and whole pile of other assorted symptoms and someone on HN suggested I go to an eye exam. A set of +2 reading glasses later and everything was fine again for many more years. 45 is roughly the age at which you can start to expect that kind of thing.

👤 jedberg
Have you had a brain scan? I don't want to scare you but that sounds like it may be a tumor. Or at least I know two people who had brain tumors that had similar symptoms.

👤 fswd
You should definitely be able to read freely and fine at 45, and definitely see a doctor.

Something you can do in the in between time is order a full blood panel, kidney, liver, thyroid, hormones, etc, online or through your doctor's office. Then get a copy of this (you can often download a PDF from the lab company that does your panel, or doctor's office) and visit a natural path (ND). You might be able to find one through your school. Bring up what foods you eat, your lifestyle, exercise, sleep habits. Then, try and see if any adjustments work.

When you finally do get an appointment for a medical doctor (you said in 9 months) bring this information, so your doctor has something to go on. Your MD will probably just re-order the labs again, but now you will have some previous data, and some experience tweaking your lifestyle with what worked and didn't.


👤 gnicholas
For line skipping and visual tracking more generally, try BeeLine Reader. [1] It is used as a speed reading tool by some, but is also used as an assistive technology by people with visual tracking issues, attention issues, and dyslexia. The Chrome extension has a 2-week free trial, and the iOS extension is completely free. It's also now available on textbooks, though may not be available on medical textbooks.

Disclosure: I am the founder (and am happy to send you a free pass to our Chrome extension, if you find it helpful).

1: http://www.beelinereader.com


👤 sandworm101
Questions: If you could read well during your undergrad, but decades later now cannot, what happened in between those times? Did you read regularly? Is this simply a bad case of skill fade masquerading as a medical issue?

Are there types of reading that are not so difficult? Can you read articles on your phone or screen without these issues? Do you remember material that you don't directly read such as an audio lectures?

If you are reading in a new field, you might not be used to actually reading every letter of a word. If you only read in a narrow subject matter then your mind can memorize word shapes rather than reading through every letter. When you then switch to a new field with unfamiliar words things slow down as you downshift into letter-by-letter reading. But they will speed up again once you get a grip on those new words. (This is a common law student complaint. The children of lawyers who grew up around words like "constitutionality", "relevancy" or "admissibility" temporarily seem to be faster readers because their brains have already memorized those word shapes. By second year this advantage disappears.)


👤 tw600040
I don't have much to add on the reading issue, but huge respect for "I've gone back to school into a medical degree." at 45

👤 IAmGraydon
You could have an attention deficit brought on by spreading your attention too thin for a long period of time. You're reading fine, but you aren't absorbing/comprehending the information because that requires singular focus. Today's world with all of its distractions trains us to do the opposite - multitask with our attention on multiple things at once.

The solution? It seems to me that the opposite of spreading your attention in every direction is meditation. Sitting quietly and silencing your mind. Perhaps if you can learn and become comfortable in that state of mind, you can evoke it to some degree while you're reading to help achieve focus.


👤 purpleblue
I'm in my 50s. The cognitive decline in my mid to late 40s was very, very real. I'm hanging on hard because I work at a FAANG and I have to keep my job, but I'm literally dumber than I was 10 years ago.

I don't know if there's anything you can do about it. I did start drinking those energy drinks with nootropics, at least the caffeine helps.

Some other suggestions are: get a lot of sleep, cognitively I declined tremendously when I got sleep deprivation. I would also get an MRI. I just read your comment about slurring words and I would spend the money and get an MRI on your own money just to be sure.


👤 neilv
This is the second time today that an HN front page post about some perceived decline has started the headline with their 40+ age.

Even when the problem might have nothing to do with their age.

I suspect that an effect of headlines like this is that it reinforces ageism in tech.

Ageism has been a problem in tech since the the modern flavor of Internet startups started. (AFAICT, with the "drop out of college to be a founder, because you have fewer commitments, and will work harder" essays.) And we're still seeing mutated versions of that.


👤 fnordpiglet
Are you burned out? Depressed? Anxious? All of these also lead to an inability to focus and reduced comprehension.

Have you tried a concentration based meditation such as vipassana?


👤 somberi
I am 50. I was telling my wife last week, the thing I miss the most about being young(er) is the ability to sit in a corner and be lost in the pages of a book - really entrenched.

Now, it is hard. I am constantly writing my comments at the end of each page, and pausing to re-read a line.

One thing that helps is to read important content right after working our or meditating, when the mind is at it's most focused. I live close to a park and a river, and leaving my phone behind and reading at either of these places, brings that boy in me back now and then. I also keep a small notepad where I mark down all the distractions that assume fake urgency, and I get back to reading.

However it is not all negative though. I am able to make sense of what I read in a _different_ way than I did when I was in my 20s. I am able question what I read, toss it around, swirl it in my mind more and reflect on what I read. Years ago, what would have appeared as a stand-alone fountain of new knowledge, now gets bunched to an vestibule of other knowledge I have accumulated over years about a field I am reading about. I learn more by contrasting with what I know, than de novo.

All the best.


👤 jonahbenton
Sorry to hear, thanks for reporting. Am in my 50s. I did notice a drop off in deep reading and attention capacity in my early 40s, including seemingly physical issues like line skipping, transposing and other weirdnesses that I never had before.

I definitely feel like I am back to higher functionality in my 50s, though the reading process is definitely different.

If you are familiar with Kahneman metaphors of System 1/System 2, my reading when I was younger used to be System 1 (quick, ingestion for memory rather than concept, etc) and now it is almost entirely System 2 (slow, conscious, model building). So it is slower, but definitely deeper, and maybe on balance more efficient.

In terms of what helped- I recall noticing this reading issue and being unhappy about it, and making a conscious effort to practice...which means what exactly? Not sure.

I don't experience those seemingly physical issues anymore of transposing or skipping. And while I have had distance glasses since my teens, I still don't require reading glasses. Am sure at some point I will.

One odd association here fwiw is that I am very careful these days about staying fully hydrated when doing intellectual work. I drink very large quantities of water- up to and over a gallon some days. I never feel thirsty but when I start to notice subtle intellectual deficiencies, or my attention is sagging, I go and drink 16 or 32 ounces of water, and then often performance improves. Sometimes I take a bit of salt as well. Seems bizarre to me, I don't understand the biochemistry. But it works like a charm. This is a recent practice for me- last 5-10 years. After sleep, staying very hydrated is the top of the maintenance list.

Good luck to you.


👤 AdrianB1
What I see most often, there are 3 main causes that I was able to identify, probably a lot more than I am not aware of.

1. Eye glasses. At this age (~ 42-43, more precise) most people start to have degrade vision that requires some correction, mostly for reading. Even if you can read without glasses, it is not really efficient.

2. Information overload in the Internet age made us learn to skim instead of read. This is involuntary and it is very difficult to correct, but at least you can do something about it.

3. Age shows for your brain, this is why we do school very young. There is nothing you can do about this particular point, just learn to live with it and handle the consequences. This applies also to coding, there was a question yesterday about coding and focus at 40 years old.


👤 shanebellone
So visual therapy takes years. It took me 3+ years before I noticed improvement. You are likely rebuilding neural pathways which takes time and effort. It's a process and it's awful.

It sounds like you have a "tracking" problem?


👤 EvanAnderson
I’m 45 as well. I’ve read aloud to my daughter regularly for the last 9 years. I started reading novels to her 5ish years ago. It was a challenge at first to say every word and not to skim the text. I’m able to put myself into “read aloud mode” now (without actually speaking) and it helps me with dense text. I’m probably subvocalizing when I read this way, and it’s definitely slower than my “normal” reading, but I get more out of text. (I’ve gotten more out of novels that I read when I was younger just reading them aloud to her. It was kind of shocking to read mindfully and see what I was missing.)

👤 the_angry_angel
Coming up to 37 and for the last few weeks I’ve had the same sort of realisation - reading novels seems to take more concentration than it should, and I’ve become lazy with maths.

I’ve had an eye check, a few months back a general medical. Both were fine/no significant changes. I rarely drink, no drugs. I feared a series of migraines might been response but I’ve been assured otherwise.

I so far figured it’s too much skim reading, a lot of very poor sleep, being on the edge of burn out and maybe a touch of post COVID brain fog.

Your post is encouraging me to start doing something about it.

I don’t have much to add but it’s reassuring to know that I’m not alone


👤 trws
If the issue is visual tracking and comprehension, consider seeking an audio version of the textbook. These are often prepared as part of accessibility for the blind or visually impaired, but can also be a great help to people with other issues like dyslexia. It’s not ideal, because medical terms and dense topics tend to be harder in that form, but it could really help with ensuring that you can ingest all the content, possibly with access to the physical text for cross referencing.

👤 odysseus
One thing you might try is reading aloud. Ref: https://www.bbc.com/future/article/20200917-the-surprising-p...

I find this really helps me both focus and retain what I'm reading, even though it takes a bit longer. It also helps tremendously when reading ancient texts, the Bible, etc.


👤 stuff4ben
I've noticed my reading ability has been impaired as I've gotten older, but I think it's just a concentration thing. Have you thought about ADHD drugs?

👤 tinglymintyfrsh
I'm 44, too sedentary, out-of-shape, and wasting time on video games lately. I'm ADHD-PI with timeblindness, tangents, procrast, and overfocus. I have monofixation syndrome (MFS) that I never knew I had until my new old-timer opth found incidentally.

Stress maybe? How's your Maslow's sleep, diet, exercise, and mood?

Also, consider that age comparing now with peak performance of say 15-20's is unfair. Give yourself a break.

Maybe a sabbatical is in order.


👤 zxexz
I would definitely seek medical advice. Start with your PCP. They’ll be able to refer you to a relevant physician, maybe a neurologist or psychiatrist. Anecdotal, but your experience sounds similar to a friend of mine who’s dyslexic + ADHD. AFAIK that would have have shown earlier but I’m not a doctor!

On another note, have you tried any text to speech software? I used to do that in school when my eyes were tired or I just felt like listening.


👤 blobbers
Were you ever considered to be a strong reader? You mention you used not have trouble with any topic, but were you academically 'excellent'? Depending on where you are, your curriculum may not have been all that rigorous in reading.

Not asking in a facetious way, but is this medical program a level up from what you've done in the past?


👤 argc
If I were you I'd get a neurological test and try to rule out all serious possibilities. Not because they are likely but because its good to catch many of those possibilities early and the fact that you are posting here suggests it is at least a possibility. IANAD

👤 oa335
Consult a neurologist, specifically.

👤 eterps
Probably not related, but just to be sure: check the quality of your display/monitor. Recently I experienced a lot of improvement in investing in a much better monitor (an Eizo in my case, which isn't cheap, but made quite the difference).

👤 victorbstan
Maybe the reading material is just not engaging? I know I can be selective about what topics I can concentrate on and which require me to reread every other paragraph again and again because I start daydreaming. Never going to be a chemist.

👤 mullingitover
It might be a good idea to check your sleep - there are apps like SnoreLab that can tell you if you're snoring heavily, and if you are, you should get a sleep study done to see if you have apnea.

👤 JimtheCoder
How much were you reading before you had this realization?

Have you been a lifelong reader? Or did you read a lot, and then stop for a few years, and are now getting back into it and having trouble...?


👤 dv_dt
Do you read for fun? I had declined in the amount I read purely for pleasure over the years, and recently re-upped my time spent in it, and subjectively I think it improved my reading in general. There are some studies that seem to support that: https://neurosciencenews.com/reading-aging-memory-22011/

On a more active path, you might also consider consulting a neurologist and describe to them your the differences between past and current reading performance as well as observations of the problems you're having now.


👤 2devnull
Mental illness is a possibility. You may think that’s impossible, but anosognosia is a common symptom. Adult onset ADD is possible and can be diagnosed with a brain scan.

👤 Fire-Dragon-DoL
What about setting a very large font and read on the phone? This way there is at most 1 line at a time

👤 SkyMarshal
Learning some speed reading improved my focus when reading. Google it and look into the different methods available, see if any work for you.

👤 axus
To add to the pile of random medical advice, finally getting my wisdom teeth removed helped my thinking and attention a bit.

👤 jareklupinski
curious, does something like https://www.spreeder.com/app.php?intro=1 make it easier to read for you? click the Spreed button if it doesnt start automatically

👤 smitty1e
I bought a gadget to magnify and backlight the text.

Small hardcopy print just gives me a headache.


👤 Decabytes
I'm starting to think everything we do has a use it or lose it quality. I remember reading how people who haven't spoken in their native language in awhile (for example because of a study abroad) have difficulty speaking their language when they come back. They also end up using simpler vocabulary as well.

So it wouldn't surprise me if skills like reading also fall under this. But to be fair the stuff you are probably reading is probably really dense and full of lots of medical terminology so it might not be surprising that you have to reread it.


👤 influx
What's your exercise regimen?

👤 msie
You can also try asking reddit medical group for advice. r/diagnoseme