What is presbyopia?

The medical term presbyopia is Greek for “old eyes.” As if you needed one more reminder of how many candles there were on your last birthday cake, right? But before you start obsessing about your ebbing youth, relax. Remember that the loss of clear up-close vision happens to all of us eventually. It’s not a disease, it’s as normal as wrinkles. And there’s an upside! There are eyeglasses — even funky fashionable ones! Or those clever “studious type” specs you’ve been eyeing. Today, whether it’s contact lenses or vision correction surgery, there are so many choices that it may make this rite of passage a little less of a bummer. Don’t worry, whatever you choose, you’ll be reading menus again in no time.

Presbyopia is part of the natural aging process of the eye, and can be easily corrected. Technically, presbyopia is the loss of the eye's ability to change its focus to see objects that are near. Presbyopia generally starts to appear around age 40 and gets progressively worse until around your late 60s, when it usually levels off. It doesn’t usually affect your baseline distance vision.

Presbyopia generally affects men and women equally. Since presbyopia will continue throughout your life, it’s important to understand that it can complicate other common vision conditions like farsightedness, nearsightedness and astigmatism. Eye experts call these common eye focus conditions refractive errors. But there’s good news ahead.

Understanding your eye health and getting regular eye exams will help you continue to see clearly and comfortably.

What are the symptoms of presbyopia?

Curse dim lighting! That along with being tired seem to make it even harder to focus on every tiny little thing. When did everything get so small? Even though it seems like these changes came on all of a sudden, slight changes in the lens of your eye and your focusing ability have been happening since you were a child.

Symptoms of presbyopia you might notice:

  • The need for more light while reading.
  • Blurred vision at a normal reading distance.
  • The need to hold reading material at arm's length.
  • Headaches from doing close work.
  • Eye strain.

What causes presbyopia?

Presbyopia occurs when the aging lens of your eye becomes less flexible and can no longer focus on objects up-close.

Think of your eye like a camera. The lens in the camera has the ability to autofocus on objects whether they are near or far. The lens in your eye works much the same way. It works together with your cornea to focus light. First, your curved cornea bends light into your eye. Then a tiny circular muscle surrounding your lens either contracts or relaxes to change its shape to bring things into focus. If the item is far away, the muscle around your lens relaxes. If it’s near, the muscle contracts, allowing you to focus on nearby items, like a menu or a book. As your eye ages, however, the lens continues to grow and add layers of cells — resembling an onion! This process thickens the lens and makes it less able to flex the way it once did. This causes close items to blur.

What are the risk factors for getting presbyopia?

Although the primary risk factor for getting presbyopia is age, certain drugs and disorders can cause presbyopia to appear in people under age 40. When this happens, it’s called premature presbyopia.

If you haven’t turned 40 yet and notice you can’t focus on things up close, you may have an underlying ocular or health issue and should contact a healthcare provider as soon as possible.

Risk factors for premature presbyopia include:

  • Farsightedness (see the next section below).
  • Medications. Some medications can increase your risk, including allergy medications, attention-deficit medications, antianxiety drugs, antidepressants, antipsychotics, antispasmodics and diuretics.
  • Diseases. Diabetes, multiple sclerosis, dysautonomia and others increase your risk of developing premature presbyopia.
  • History of head trauma.

If I am already farsighted, will I develop presbyopia sooner?

Maybe. Being farsighted is one of the risk factors for getting premature presbyopia. Farsightedness (hyperopia) is often confused with presbyopia, but the two are different. Presbyopia occurs when the eye's lens loses flexibility. Farsightedness occurs when the eyeball is too short. This results in an underfocused image that requires the help of the lens to re-focus it. If the farsightedness is significant, you can experience blurry near-vision much younger than age 40.

Can I have presbyopia and myopia (nearsightedness) at the same time?

Yes, and this is very common, given that nearly a third of Americans of all ages are nearsighted to some degree. Nearsightedness means that you’re eyes are naturally “over-focused”, allowing for clear near-vision but blurred distance-vision. However, even if you are nearsighted and in your 40s, you will still feel the effects of presbyopia while wearing either your glasses or contacts. On the plus side, people with glasses who are mildly nearsighted take advantage of their “built-in readers” and often take their glasses off to read!

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