What Is Presbyopia?

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Presbiopia is farsightedness—a loss of close-up vision. This typically comes on between the ages of 40 and 60 as the lenses of your eyes naturally lose elasticity due to the aging process. Presbiopia is often corrected with reading glasses, bifocal lenses (for people who are also nearsighted), or contact lenses. Surgery is also an option for some people.

Presbyopia Symptoms

When presbyopia starts, it may seem like small print gets harder and harder to read. You may feel that it takes your eyes longer to focus on things that are close up.

Symptoms of presbyopia include:

  • Blurry text at a distance that used to be comfortable to read
  • Needing to hold things farther from your eyes to see details clearly
  • Needing brighter light to see details
  • Difficulty reading when you're tired or under stress
  • Eye strain or fatigue from close work
  • Headaches from doing close work

Presbyopia typically progresses slowly, meaning you may notice a need for stronger vision correction every couple of years.

Causes

Presbyopia is so common that most people you know either have it to some degree or will eventually. It is a natural consequence of aging and it's not reversible. It's not fully understood why it happens, but doctors are learning more about it all the time.

For you to see clearly, the crystalline lens of your eye bends and focuses light on the retina. Around the lens is a muscle called the ciliary muscle. This muscle contracts and relaxes, allowing the lens to stretch out and become thinner or shrink and become fatter in the middle. These contractions allow the lens to change shape, which allows it to make small, quick, dynamic changes to your focusing ability asyoue look from far to near and all distances in between.

The lens continues to add layers of cells throughout your life, which takes away some of its ability to flex. Control over the ciliary body muscle also lessons and it becomes less elastic. Scientists believe a combination of these factors add up and cause presbyopia.

Diagnosis

A lot of people don't need a professional diagnosis to know they have presbyopia. Because it's a gradual progression, it's fairly common for people to put off going to the eye doctor until the vision changes become a problem in day-to-day life. Some may even purchase drugstore magnifying glasses without ever having seen an eye doctor.

It doesn't hurt you to put off treatment for presbyopia, but it's safer to see an eye doctor whenever you notice a change in your vision. Just because it may seem like a normal, age-related vision change doesn't mean it is. It could be something more serious, in which case delaying diagnosis and treatment could have consequences.

Once you do talk to your doctor about the loss, they'll take a complete medical history, have you hold something at the distance necessary for you to read it clearly, and give you a standard eye exam to determine the extent of change in your vision. To dial in the prescription you'll need, they'll test your vision with different lenses (that "Which is better, one...or two?" test).

Eye doctors typically start with what's considered a "standard" strength for you age and adjust from there in small increments. If you're trying to find a pair of drugstore reading glasses, you can use the same method.

Treatment

Treatment for presbyopia is generally corrective lenses, but it can include an ever-growing array of surgeries. Someday, something as simple as eyedrops may provide a simpler option, but for now, glasses and contacts are much more common.

Glasses

Depending on your overall vision and what, if any, corrective lenses you already wear, your doctor may recommend one of several different types of glasses.

Reading Glasses

If your vision is otherwise good, you may only need reading glasses, and you'll only need to wear them when doing close-up work. Your doctor can give you a prescription or you can buy drugstore readers in the correct strength.

Bifocals

Bifocals are for people with presbyopia who are also nearsighted, as they combine two different prescriptions in a single lens. Your distance-vision prescription goes on top and your reading prescription goes on the bottom.

With bifocals, you can see the seam between the two prescriptions. Some people may need trifocals, which have separate areas for distance, middle-ground, and close-up.

Progressive Lenses

Progressive lenses are like bifocals or trifocals but with a more gradual change between prescriptions. Many people prefer these lenses because they do not have a visible line across the lens.

If you spend a lot of time at a computer, you may want to ask your optical shop about office progressives, which have a larger close-work area than standard progressives. Note, however, that you will still need another pair of glasses since the reduction in space for distance vision will be an impairment once you're away from your desk.

Contact Lenses

Contact lenses are also an option for correcting presbyopia if you have pre-existing vision problems. (If all you need are reading glasses, the continuous correction of contact lenses isn't right for you.) Different types of contact lenses include:

  • Bifocal or multifocal contacts: A bifocal contact lens gives you two focal points, a near and a far, whereas multifocal contacts can include an additional point for the intermediate range.
  • Monovision contacts: With monovision lenses, one eye has a lens for distance vision and the other has one for close work. It takes time for your brain to adjust to this set of lenses.
  • Modified monovision contacts: As with monovision, your eyes use different lenses. However, the modification means that one eye wears a multifocal lens to see well at all distances while the other wears one that's specific to close or distance vision correction. This also requires an adjustment period.

Surgery

Surgery can be used to correct presbyopia as well. However, the risks may outweigh the benefits for people who only need reading glasses or have mild vision changes.

When considering surgery, it's important to weight the pros and cons with your medical team and take your overall health into account.

Several types of surgery are available and new techniques and technologies are making them safer and more effective. Since options are minimally invasive outpatient procedures, you won't have to stay overnight after having your surgery.

Corneal Inlays

Corneal inlay is a newer option made possible by innovative new materials and methods. During the procedure, the ophthalmologist inserts a very small plastic ring into one cornea to reduce blurry vision. It's typically placed in the non-dominant eye, which leaves your other eye's long-range vision unchanged.

The surgery is done by using a laser to make a small incision that creates a flap or "pocket" into which the ring can be inserted.

Corneal inlay surgery has several benefits, including:

  • It's minimally invasive.
  • Corneal tissue doesn't need to be removed.
  • Implantation is relatively simple.
  • Implants are removable.

The success rate of this surgery is high, but every procedure comes with some risks. Be sure to go over them with your doctor.

Common types of corneal inlays are called Kamra, Raindrop, and Microvue. Your eye doctor and surgeon will determine the best type for you.

Laser Surgeries

Two different laser surgeries, called LASIK and PRK, are used to correct presbyopia. Both of them correct one eye for distance and one for close vision (similar to how monovision contact lenses work). These procedures are considered effective treatments for mild to moderate vision problems.

  • LASIK: Laser-assisted in situ karatomileusis (LASIK) has been around for decades and is a common choice. The surgeon corrects distance vision in your dominant eye and makes the other eye mildly nearsighted, which allows it to see close objects clearly. Using a laser, they create a thin corneal flap, remove microscopic pieces of tissue that are responsible for your vision loss, and then replace the flap.
  • PRK: Photorefractive keratectomy (PRK) is similar to LASIK except that the surgeon permanently removes an even thinner outer layer of the cornea rather than creating a flap. Once the corneal tissue is re-shaped, a contact lens is put in place to protect the cornea until the outer layer grows back.

The results of these two techniques are quite similar. However, they do have some distinct differences.

LASIK
  • Patient's cornea may be too thin to have procedure

  • Repeat LASIK may not be possible in some patients

  • Risk of too much tissue being removed by the laser

  • Possible complications due to the flap itself

PRK
  • Longer recovery (outer layer of tissues takes a few days to re-grow)

  • Early vision may be more hazy

  • May experience more discomfort post-surgery

  • Slightly higher risk of infection

A newer technique, called multifocal LASIK or PresbyLASIK, was not yet approved by the U.S. Food and Drug Administration (FDA) as of mid-2020, but it is available in several other countries. It creates zones on the surface of the eye that can correct both distant and close-up vision. Clinical trials are ongoing.

Intraocular Lens Implantation

This technique was first developed for people with cataracts but is now used for a wide array of vision problems, including presbyopia.

During this surgery, the lenses of your eyes are removed and replaced with artificial lenses, which are typically made of silicone or acrylic. These lenses can be designed for monovision (one eye seeing far, the other seeing near) or multifocal vision (both eyes seeing well at both distances).

A drawback of multifocal lenses is that you may see rings around light at night and have less-clear mid-range vision.

If you have cataracts or are over age 60, lens replacement might be a good choice because other surgeries don't prevent or treat this condition.

Better Vision With an Eyedrop?

In the future, presbyopia may be corrected by eyedrops. Several are currently in development, including one that restores flexibility to the crystalline lens and three that reduce your pupil size. They may be a good option for people who are between age 40 and 60 and who don't have cataracts. A drawback to the pupil reducers is that you may need to use them several times per day.

Coping

While presbyopia can't be cured and does generally get worse as you age, it typically stabilizes around age 65. Proper treatment and some lifestyle adaptations can help you live a full life despite this vision impairment.

Some things you may want to consider are:

  • Keeping several pairs of reading glasses in places you frequently need them
  • Reading large-print books that may be easier on your eyes
  • Increasing the font size on your computer, phone, and other devices
  • Increasing light levels in places where you often do close work

If your eyes tire easily, you may want to consider audio books.

A Word From Verywell

Whether you experience presbyopia as a mild frustration or a significant impairment, you have a lot of options for correcting your vision—and more are being developed. Get a proper vision assessment and learn what options may be best for you given your results and personal preferences. There is no need to struggle to see clearly.

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Article Sources
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