What is Presbyopia – Symptoms, Treatments and Causes

Presbyopia, or age-related farsightedness, is the gradual change in the eyes that cause nearby objects to appear blurry. Most patients who begin to develop presbyopia experience difficulty reading up close.

Patients may also report that they have to move reading material further away from their face to see it clearly. Sometimes, patients will go to their optometrist and say, “My arms just aren’t long enough, Doc!”

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What causes presbyopia?

The cause of presbyopia is age. It typically begins to develop around age 40 and remains unchanged after about age 60. Presbyopia is a natural process that happens to everyone, regardless of gender or race. 

There is a small crystalline lens in the eye that sits behind the iris, the colored part of the eye. The lens is about the size of a pumpkin seed, and its job is to keep vision clear by changing shape when the eyes want to look at something up close. With age, the lens naturally becomes more rigid and less pliable. 

Presbyopia causes blurry near vision because the eyes lose their ability to focus up close or “accommodate.” This is how the eye allows you to see things that are far away and close up!

This process relies on the lens inside of the eye being able to change shape, focusing our vision.

Young eyes can accommodate very easily, and it is a mechanism that happens automatically when you look from far to near.

Treatments: how is presbyopia corrected?

Treating presbyopia is as simple as prescribing glasses or contact lenses. With a little bit of added power in the prescription, or an “add,” presbyopic patients can see clearly again at a comfortable reading distance.

If you’ve ever noticed ‘readers’ or reading glasses near the checkout of a grocery store or other big-box store, then you know how common presbyopia is.

An optometrist can prescribe separate reading glasses, a bifocal on a pair of distance glasses, or a Progressive Lens without a bifocal line.

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Can you reverse presbyopia?

Presbyopia develops with age as the lens becomes more firm and unable to easily change shape to focus. This makes it difficult for patients to focus on objects at varying distances.

This process cannot be reversed by medication. Bifocal and progressive lenses, as well as reading glasses, can help presbyopic patients to see both near and far. Once cataracts are mature enough and are visually significant, cataract surgery can be done, and several different intraocular lens options are possible to aid in near and distance vision.

Can presbyopia lead to blindness or other eye problems?

Presbyopia is not a cause of blindness. Patients with presbyopia don’t suffer vision loss that can not be corrected with prescription lenses. The only eye problem that can occur with presbyopia is age-related cataracts. That is because the crystalline lens also becomes cloudy as it slowly hardens with age. The process of age-related cataracts is also a slow, gradual change.

Cataract surgery is the most commonly performed surgery in the U.S., with approximately 3 million patients requiring it annually. This surgery is relatively short, and the surgeon will replace your lens with an IOL or intraocular lens.

The good news is that IOLs exist that are made specifically for patients with presbyopia, so if you have cataracts and presbyopia, this may very well be something to consider.

What should I do if I think I have presbyopia?

If you think you have presbyopia, an eye care professional can evaluate your vision and examine your crystalline lens during a comprehensive eye exam. By describing your symptoms of difficulty when reading, or blurry vision up close, your optometrist will determine the best treatment option for you. It would be helpful to also tell your doctor about all of your near tasks that require clear close-up vision, such as embroidery or reading sheet music.  

Can I wear contact lenses if I have presbyopia?

Yes! There are many contact lens options for patients with presbyopia. Contact lenses can be a great alternative to glasses for most patients, regardless of age. Knowing which option is best for you can be determined by your doctor during a contact lens exam.

There are contact lenses called Multifocals that are designed to work like bifocal glasses with added power on the bottom to ensure the eye can focus while reading. Another option is called monovision, where an Optometrist can correct one eye for distance and one eye for near. With monovision, the brain learns to use the clearer eye when looking at things at different distances.

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Is it possible to have presbyopia and astigmatism?

It is possible and very common to have presbyopia and astigmatism. Astigmatism is a word that means that the front of the eye is not shaped like a perfect sphere.

Instead, it is slightly flatter or slightly steeper horizontally than it is vertically. An eye without astigmatism can be compared to a golf ball, while an eye with astigmatism can be compared to an egg.

eye diagram of astigmatism

Can cataract surgery, LASIK, or PRK correct for presbyopia?

Cataract surgery involves removing the crystalline lens and replacing it with a clear lens implant. There are many designs of lens implants available, including those that can correct for presbyopia. The ophthalmologist performing the cataract surgery can implant a lens that will allow for clear distance and near vision or implant a different type of lens in each eye to achieve monovision. Some patients prefer to still wear reading glasses after cataract surgery, and they do not have their presbyopia corrected during surgery. 

LASIK surgery is performed on the cornea, which is the clear front part of the eye in front of the iris. It corrects for astigmatism, myopia (near-sightedness), or hyperopia (far-sightedness). This kind of surgery does not involve the crystalline lens and does not typically correct for presbyopia. Patients who undergo LASIK surgery will still develop presbyopia when they are in their 40’s. 

PRK is also a type of refractive surgery for astigmatism, myopia, or hyperopia correction. Like LASIK, it is also performed on the front surface of the eye, the cornea. Therefore, it is typically not used as a correction for presbyopia.

With that being said, some patients can have their doctor perform LASIK or PRK to achieve monovision. Like with a monovision contact lens prescription, one eye would be set to see clearly at near, and the other eye would be set to see clearly far away. This decision is made by the patient and the doctor, depending on the patient’s goals and their eye anatomy.

In summary, don’t be alarmed if you have presbyopia. Eventually, most people will develop it as they age.

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