Presbyopia is the gradual loss of your eyes’ ability to focus on nearby objects. It’s a natural, often annoying part of aging. Presbyopia usually becomes noticeable in your early to mid-40s and continues to worsen until around age 65.
You may become aware of presbyopia when you start holding books and newspapers at arm’s length to be able to read them. A basic eye exam can confirm presbyopia. You can correct the condition with eyeglasses or contact lenses. You might also consider surgery.
Presbyopia develops gradually. You may first notice these signs and symptoms after age 40:
- A tendency to hold reading material farther away to make the letters clearer
- Blurred vision at normal reading distance
- Eyestrain or headaches after reading or doing close work
You may notice these symptoms are worse if you are tired, drank alcohol or are in an area with dim lighting.
Presbyopia is caused by a hardening of the lens of your eye, which occurs with aging. As your lens becomes less flexible, it can no longer change shape to focus on close-up images. As a result, these images appear out of focus.
When to see an ophthalmologist
See an eye doctor if blurry close-up vision is keeping you from reading, doing close work or enjoying other normal activities. He/she can determine whether you have presbyopia and advise you of your options.
The goal of treatment is to compensate for the inability of your eyes to focus on nearby objects. Treatment options include wearing corrective lenses, undergoing refractive surgery or getting lens implants.
Eyeglasses are a simple, safe way to correct vision problems caused by presbyopia. You may be able to use over-the-counter (nonprescription) reading glasses if you had good, uncorrected vision before developing presbyopia. Ask your eye doctor if nonprescription glasses are OK for you.
Most nonprescription reading glasses range in power from +1.00 diopter (D) to +3.00 D.
Prescription reading glasses. If you have no other vision problems, you can have prescription lenses for reading only.
Bifocals. These glasses come in two styles — those with a visible horizontal line and those without a line (progressive lenses). When you look through progressive bifocals at eye level, the lenses correct your distance vision. This correction gradually changes to reading correction at the bottom.
Trifocals. These glasses have corrections for close work, middle-distance vision — such as for computer screens — and distance vision.
People who don’t want to wear eyeglasses often try contact lenses to improve their vision problems caused by presbyopia. This option may not work for you if you have certain conditions related to your eyelids, tear ducts or the surfaces of your eyes.
Several lens types are available:
- Bifocal contact lenses. Bifocal contact lenses provide distance and close up correction on each contact.
- Monovision contact lenses. With monovision contacts, you wear a contact lens for distance vision in one eye (usually your dominant eye) and a contact lens for close-up vision in the other eye.
- Modified monovision. With this option, you wear a bifocal or multifocal contact lens in one eye and a contact lens set for distance in the other (usually your dominant eye). You use both eyes for distance and one eye for reading.
Refractive surgery changes the shape of your cornea. For presbyopia, this treatment is used to improve close-up vision in your nondominant eye. It’s like wearing monovision contact lenses. Even after surgery, you may need to use eyeglasses for close-up work.
Talk with your doctor about the possible side effects, as this procedure is not reversible. You might want to try monovision contact lenses for a while before you commit to surgery.
Lens implants or intraocular lenses IOL
Once presbyopia has started any treatment to the cornea, such as laser eye surgery, will only work for a short while as the lens will continue to change. For this reason we prefer to remove the ageing lens and replace it with a new lens which has the ability to see near and far which will last forever. Nearly 15 million lens implant procedures are carried out worldwide each year and it is as safe if not safer than laser eye surgery.
Many types of IOLs are available for correcting presbyopia:
-Multifocal IOLs. Multifocal IOLs use either diffractive or refractive techniques to allow for 2 focal points: one for distance and one for reading. Multifocal IOLs are best for patients who desire both good distance and good reading vision without glasses.
One weakness is that they currently do not correct astigmatism; therefore, patients with significant astigmatism after the surgery may not have as good vision as they desire. In this case, now its available the toric multifocal IOL. Other weakness is that patients usually experience halos or glare around light sources at night. This is usually mild and tolerable for most patients. A third weakness is that although currently available multifocal IOLs may allow for acceptable intermediate vision in most patients, some patients find that their intermediate vision is not as good as they would like, affecting intermediate range tasks, such as reading on a computer or seeing prices on store shelves.
-Accommodating Lens Implants. Lenses which incorporate a hinge type mechanism which allows flexing via contraction of the ciliary body, thus shifting the focal point from distance to intermediate, and from intermediate to near. Accommodative IOLs are best for patients whose goals include good uncorrected distance and intermediate vision, but who find it acceptable to wear glasses for extended periods of reading.
-Presbyopia-correcting intraocular lens (Trifocal IOLs). These new lenses allow 3 focal points: near (40cm), intermediate (60cm) and long distance. The IQ PanOptix trifocal IOL is indicated for adult patients with and without presbyopia undergoing cataract surgery who desire near, intermediate and distance vision with increased spectacle independence.
These lenses allow the surgeon to choose the best surgical option for each case.
Some people have had success with a presbyopia treatment that involves inserting a small plastic ring at the edge of each cornea to change its curve.