Older woman reading a newspaper

Presbyopia

Age-related farsightedness

Presbyopia is the natural regression of vision with age that usually begins at the age of 40 and older. The process of aging causes the natural lens to lose its flexibility and thus the ability to focus objects at different distances. As a result, close objects appear blurry.

What vision is like with presbyopia

Distant objects are sharply focused; close objects are out of focus.

What Is Presbyopia?

Presbyopia is an age-related condition that causes close objects to appear blurry. At a young age, the natural lens is flexible and able to change its shape to focus on both close and distant objects. This process is called accommodation. As people age, accommodation no longer functions to its full degree. The natural lens gradually becomes harder and less flexible and loses its ability to change shape and focus the light directly onto the retina. This causes the focal point to lie behind the retina, resulting in a blurry image.

If diagnosed with presbyopia, light passes the cornea (1) and the lens (2), but the focal point (3) of incoming light is behind the retina (4).

If diagnosed with presbyopia, light passes the cornea (1) and the lens (2), but the focal point (3) of incoming light is behind the retina (4).

When Presbyopia Starts

The onset of this condition usually happens from age 40, but varies from person to person. The deterioration of your vision might seem sudden, but the inflexibility of the natural lens, the cause of presbyopia, progresses over a number of years.

When presbyopia develops and to what degree depends on your individual anatomical conditions and your previously existing prescription.

Presbyopia can be easily diagnosed in an eye exam

You can recognize presbyopia when reading small text close up becomes difficult.

Symptoms of Presbyopia

Presbyopia can be diagnosed in a basic eye exam by an ophthalmologist or optometrist. You can also recognize presbyopia yourself from some common signs and symptoms, such as:

  • Not being able to read small text or figures
  • Needing to read menus, smartphones and other reading materials by holding them at an arm's length away

Other symptoms may include headaches, eyestrain and eye fatigue. It is important to visit an ophthalmologist or optometrist for regular eye exams.

Options to Correct Presbyopia

If you suffer from presbyopia, there are multiple ways your vision could be corrected. You should consult with your ophthalmologist to determine which options are available to you. The most common ways are:

  • Glasses can be a convenient way to improve vision. You can choose between three types of eyeglasses: Bifocal lenses have two lens powers and allow you to see both close and distant objects clearly. Trifocal glasses have an additional lens segment for an intermediate zone of vision. All segments are separated by visible lines within the glass. The third option, progressive lenses, allows you to seamlessly see near, far and intermediate, without any visible lines between the segments. Prescription glasses can fix refractive errors by altering the angle the light rays enter the eye. Depending on your style and budget, there is a large selection of frames and eyeglass lenses to choose from.
  • Contact lenses work under the same principles as glasses. There are bifocal contact lenses specifically designed for presbyopia that allow you to see both close and distant objects clearly. Trifocal lenses allow you to see near, far and even intermediate objects clearly. Contact lenses differ in materials and duration of use. Your selection of contact lenses may be limited because your prescription usually involves a compromise in favor of aiding proximity or distance. For contact lenses, your doctor can also set you up with lenses for monovision: One eye set to near and the other to distance. It is important to note that contact lenses are not without risks.
  • Laser eye surgery procedures like SMILE or LASIK cannot treat presbyopia. There is currently no full treatment solution available, however there is the option to partly compensate for the loss of accommodation of the eye. LASIK and PRK/LASEK can be used for correcting one eye for nearsightedness and one for farsightedness. It is a treatment option known as conventional monovision. In conventional monovision the depth perception for intermediate distances might be decreased and the level of overall tolerance might differ from patient to patient. You might still have difficulties performing tasks that require high precision or are performed in areas without much lightning. Therefore, conventional monovision may not completely eliminate your need for glasses or contact lenses for all distances and during activities such as night driving or reading small print for extended periods of time. Laser Blended Vision (LBV) is an advanced form of LASIK, which surgeons use to treat patients with presbyopia. Unlike conventional monovision treatments, the LBV procedure takes care of all distances and allows you to see near, far and even intermediate. Like all surgeries though, it is not without risks.
  • Intraocular lens (IOL) exchange is another option that a doctor may recommend correcting severe presbyopia in certain patients. This is a surgical procedure in which an artificial lens is transplanted in place of the natural lens. IOL exchange is a common procedure for patients suffering from cataracts, while refractive or clear lens exchange refers to patients without cataract. Your doctor can recommend this if it is an option for you as well as which IOL is right for you and your refractive error. Specific IOL designs for sharp vision at varying distances do exist, and are called: Multifocal, diffractive or extended depth of focus IOLs. Like all surgeries though, it is not without risks.
  • Intracorneal inlays are a surgical option where an artificial lens or diaphragm is implanted into the cornea. It improves near vision of the non-dominant eye for reading and other near-distance tasks. The pockets, in which the inlays are inserted, can be created with a mechanical device (microkeratome) or a femtosecond laser. The procedure changes optical properties of the cornea and does not remove any corneal tissue. Like all surgeries though, it is not without risks.

 

Consult with an ophthalmologist to determine which treatment option suits you best.

When diagnosed with presbyopia, different treatment options are available.

Visual Aids

Living with glasses and contact lenses

Well over half the world’s population relies on glasses or contact lenses to see well. For many people, this starts becoming an issue around the age of 40, when the deterioration of the natural lens leads to needing reading glasses.

For many of these people, this may be the best option for them, and today, with advancements in medical technology there are a variety of options available for a wide range of vision needs. Bifocals and surgeries such as conventional monovision or intraocular lens exchange, provide an alternative solution for presbyopia, although they may compromise your ability to differentiate between distances. The use of trifocals and Laser Blended Vision however, enables you to switch easily between all distances.

Laser eye surgery can therefore provide a possible alternate solution to glasses and contact lenses. Consult with your eye doctor to determine the best option for your vision and daily life.