Conditions

Presbyopia and its causes, symptoms and treatment

A woman wearing eyeglasses reading a book
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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.

Illustration of the eye anatomy where the eye's lens hardens with age, narrowing your focal point

The eye's lens stiffens with age, so it is less able to focus when you view something up close. [Enlarge]

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.

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

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.

If you can still see close objects pretty well, 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 an age-related process. It is 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, it gets difficult for the eyes to focus on close objects.

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.

Another presbyopia treatment option is eyeglasses with bifocal lenses, but bifocals provide a more limited range of vision for many people with presbyopia.

It's also 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.

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 contact lenses are in. You may purchase reading glasses at an eyewear 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. Anti-reflective coating eliminates reflections that can be distracting and cause eye strain. It also helps reduce glare and increase visual clarity for night driving.

Contact Lenses

People with presbyopia 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.

While some people are delighted with this solution, others complain of reduced visual acuity and some loss of depth perception. Because the human eye change as you grow older, your presbyopia glasses or contacts prescription will need to be increased over time as well. You can expect your eye doctor to prescribe a stronger correction for near work as you need it.

Surgery to treat presbyopia

If you 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.

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.

Presbyopia is a part of growing older

We are all getting older, and we’re all going to have to deal with the effects of presbyopia. Whichever option you choose – eyeglasses, contact lenses or surgery – you’ll be able to easily read messages on your phone or a book to your granddaughter without any trouble.

Page updated February 2019

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