Presbyopia is the normal loss of near focusing ability that occurs with age. Most people begin to notice the effects of presbyopia sometime after age 40, when they start having trouble seeing small print clearly — including text messages on their phone.
You can't escape presbyopia, even if you've never had a vision problem before. Even people who are nearsighted will notice that their near vision blurs when they wear their usual eyeglasses or contact lenses to correct distance vision.
The eye's lens stiffens with age, so it is less able to focus when you view something up close. [Enlarge]
Presbyopia is on the rise in the United States as the population continues to age. According to the U.S. Census Bureau, approximately 112 million Americans were presbyopic in 2006. This number is expected to increase to 123 million by the year 2020.
Worldwide, an estimated 1.3 billion people had presbyopia in 2011. This number is expected to increase to 2.11 billion by 2020, according to Market Scope, a leading vision and analytics company.
Though presbyopia is a normal change in our eyes as we age, it often is a significant and emotional event because it's a sign of aging that's impossible to ignore and difficult to hide.
Presbyopia Symptoms And Signs
When you become presbyopic, you either have to hold your smartphone and other objects and reading material (books, magazines, menus, labels, etc.) farther from your eyes to see them more clearly. Unfortunately, when you move things farther from your eyes they get smaller in size, so this is only a temporary and partially successful solution to presbyopia.
Also, even if you can still see pretty well up close, presbyopia can cause headaches, eye strain and visual fatigue that makes reading and other near vision tasks less comfortable and more tiring.
What Causes Presbyopia?
Presbyopia is caused by an age-related process. This differs from astigmatism, nearsightedness and farsightedness, which are related to the shape of the eyeball and are caused by genetic and environmental factors. Presbyopia generally is believed to stem from a gradual thickening and loss of flexibility of the natural lens inside your eye.
These age-related changes occur within the proteins in the lens, making the lens harder and less elastic over time. Age-related changes also take place in the muscle fibers surrounding the lens. With less elasticity, the eye has a harder time focusing up close. Other, less popular theories exist as well.
Presbyopia Treatment: Eyeglasses
Eyeglasses with progressive lenses are the most popular solution for presbyopia for most people over age 40. These line-free multifocal lenses restore clear near vision and provide excellent vision at all distances, regardless of what refractive errors you may have in addition to presbyopia.
Another option is eyeglasses with bifocal lenses. But bifocals are much less popular these days because they provide a more limited range of vision for many presbyopes. Also, most people don't want to show their age by wearing eyeglasses that have a visible bifocal line.
Also, it's common for people with presbyopia to notice they are becoming more sensitive to light and glare due to aging changes in their eyes. Photochromic lenses, which darken automatically in sunlight, are a good choice for this reason. They are available in all lens designs, including progressive lenses and bifocals.
Reading glasses are another choice. Unlike bifocals and progressive lenses, which most people wear all day, reading glasses are worn only when needed to see close objects and small print more clearly.
If you wear contact lenses, your eye doctor can prescribe reading glasses that you wear while your contacts are in. You may purchase readers over-the-counter at a retail store, or you can get higher-quality versions prescribed by your eye doctor.
Regardless which type of eyeglasses you choose to correct presbyopia, definitely consider lenses that include anti-reflective coating. AR coating eliminates reflections that can be distracting and cause eye strain. It also helps reduce glare and increase visual clarity for night driving.
Presbyopia Treatment: Contact Lenses
Presbyopes also can opt for multifocal contact lenses, available in gas permeable or soft lens materials. Another type of contact lens correction for presbyopia is monovision, in which one eye wears a distance prescription, and the other wears a prescription for near vision. The brain learns to favor one eye or the other for different tasks. But while some people are delighted with this solution, others complain of reduced visual acuity and some loss of depth perception with monovision.
Because the human lens continues to change as you grow older, your presbyopic prescription will need to be increased over time as well. You can expect your eye care practitioner to prescribe a stronger correction for near work as you need it.
Presbyopia Treatment: Surgery
Don't want to wear eyeglasses or contact lenses for presbyopia? A number of surgical options to treat presbyopia are available as well.
One presbyopia correction procedure that's gaining popularity is implantation of a corneal inlay. Typically implanted in the cornea of the eye that's not your dominant eye, a corneal inlay increases depth of focus of the treated eye and reduces the need for reading glasses without significantly affecting the quality of your distance vision.
Currently, the sole corneal inlay that's FDA approved for presbyopia surgery performed in the U.S. is the Kamra inlay, marketed by AcuFocus. [Read more about corneal inlays and implants for presbyopia.]
Other options for surgical correction of presbyopia include:
- NearVision CK. This conductive keratoplasty procedure marketed by Refractec uses radio frequency waves to alter the shape of the cornea of one eye to improve near vision.
- Monovision LASIK. This modified LASIK procedure creates the same effect as monovision with contact lenses, but without the need to wear contacts.
- PresbyLASIK. This multifocal LASIK procedure is similar to wearing multifocal contact lenses. PresbyLASIK has been performed for several years in Europe, but this procedure is not yet FDA-approved for use in the U.S.
- Refractive lens exchange. Also called RLE, refractive lens exchange is virtually the same as cataract surgery, but the natural lens that is being replaced has not yet become clouded by a cataract. The surgeon can select a multifocal IOL or an accommodating IOL to restore near vision. [Read answers to frequently asked questions about presbyopia-correcting IOLs.]
The first step to see if you are a good candidate for presbyopia surgery is to have a comprehensive eye exam and a consultation with a refractive surgeon who specializes in the surgical correction of presbyopia.
More Presbyopia Articles
Other Presbyopia Treatments: Combining Options for Presbyopia
About the Reviewer: Vance Thompson, MD, FACS, is the director of refractive surgery at Vance Thompson Vision in Sioux Falls, S.D. He also is professor of ophthalmology at the Sanford USD School of Medicine, a leading researcher in technologies for laser and implant vision correction and a member of All About Vision's editorial advisory board.
Page updated February 2019