Presbyopia

Published May 6, 2020

What is presbyopia?

Presbyopia is the most common reason most adults begin to wear eyeglasses.

Presbyopia gradually develops overtime, beginning at around age 40it is considered a normal stage of the aging process.

Presbyopia is the loss of ability to focus on near objects, such as words on a page, numbers on a phone, or text on a computer. In a young eye, the flexible lens inside your eye, is able to shift focus between close objects and objects at a distance. However, as you age, this lens thickens and begins to harden— losing its flexibility and affecting your near vision. Presbyopia does not cause pain or significant discomfort.

When presbyopia begins to develop, you will notice the need to hold books or other objects, such as your phone and restaurant menus, farther from your eyes to improve their clarity.

Presbyopia can also affect the visual clarity required for crafts, hobbies and other interests.

Signs of presbyopia

  • Needing to hold reading material at arm’s length to see clearly
  • Moving laptop of phone away to see clearly
  • Needing to increase font size on digital devices
  • Blurry vision for reading, especially small print
  • Reduced reading vision in low lighting— such as in a restaurant
  • Eye fatigue or eye strain
  • Headaches when reading or doing work up-close— such as knitting
  • Difficulty focusing on crafts and hobbies
  • Needing brighter lighting for clearer near vision

Is there a treatment for presbyopia?

A prevention or reversal of presbyopia has yet to be discovered. However, there are treatments that can help alleviate the discomfort you are experiencing.

Eyeglasses 

Reading glasses contain lenses that act in place of your natural lens to provide clear and sharp near vision. These lenses also have a magnification effect to enlarge what you are looking at. Reading glasses are only worn as needed, and can be worn simultaneously with contact lenses meant for distance vision.

Bifocal glasses have two lens prescriptions— the bottom section for near vision, the top section for distance, and a bisecting line on the lens. The downside of bifocals is that they only provide two lens powers for clear vision—near and distance.

Multifocal glasses with progressive addition lenses (PALs) are similar to bifocals, but contain multiple lens powers to provide vision at all distances— distance, reading, and the intermediate area. Multifocal lenses gradually blend the lens powers together without a bisecting line, making them more attractive than bifocals. The downside of multifocals is that the width of the clear zone for each part of the lens may appear to be narrowed.  

Contact lenses

Bifocal and multifocal contact lenses are available in both soft and hard varieties. Many people prefer contact lenses over glasses because they eliminate the need to wear eyeglasses and allow for a full field of vision.

Monovision is another contact lens option in which the dominant eye wears the lens for distance vision, while the less dominant eye wears the lens for near vision.  This method can cause reduced visual acuity and some loss of depth perception.

Surgery

Surgery is usually not recommended for correction of presbyopia alone, as surgery carries the risk of complications that can permanently affect your vision.  For those who prefer not to wear eyeglasses or contact lenses, there are several surgical options to treat presbyopia, some of which can be combined with other common eye surgeries;

Cataract surgery is the most common eye surgery performed. When replacing your cloudy lens with a new intraocular lens (IOL), the surgeon will usually choose powers that correct your vision. The intention is to give you clear vision for all distances without needing eyeglasses.

LASIK eye surgery follows the monovision method (discussed above) by correcting the distance vision of the dominant eye and giving the non-dominant eye clear focus for all near vision.

Corneal inlay involves a procedure where a tiny lens is implanted into the cornea of the non dominant eye to increase depth of focus in that eye. It reduces the need for reading glasses, while preserving the quality of distance vision.

Refractive lens exchange (RLE) is a surgical procedure that is performed before your cataracts develop, and involves replacing the old, hardened natural lenses with new intraocular lenses (IOL).

 

Presbyopia is a normal part of growing older and usually occurs gradually over many years, without causing any pain or significant discomfort.

If you are beginning to notice changes to your near vision, make an appointment with your doctor to discuss the best treatment option for you.