Presbyopia

What is presbyopia?

Presbyopia is the medical term for your eye losing the ability to change its focus. This affects how well you can see close-up objects. It occurs as your eye’s natural lens grows less flexible with aging.

Presbyopia generally starts to develop around age 40 and gets worse until your mid-60s. You’ll notice that reading or other close-up tasks are harder than they used to be. You might need to hold your book or phone out at arm’s length to see the words clearly. You may also have symptoms like headaches or sore, tired eyes.

Presbyopia is part of the natural aging process, and it’s not a disease. It’s a common type of refractive error that eye care specialists can easily correct with glasses, contacts or surgery.

How common is presbyopia?

Presbyopia is very common. Globally, about 1.8 billion people had presbyopia in 2015. Researchers estimate this number will rise to 2.1 billion by 2030.

What are the symptoms of presbyopia?

The main signs and symptoms of presbyopia include:

• The need for more light when you’re 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, which makes your eyes feel sore or tired.

What causes presbyopia?

Age-related changes to your eyes cause presbyopia. During the first few decades of life, your eye’s lens is soft and flexible. It easily changes its shape when you shift your vision from something far away to something close-up. This ability (accommodation) allows light to land on your retina so you can see objects clearly.

As you get older, your lens grows less flexible and has trouble focusing light as it should. This leads to symptoms of presbyopia that begin in your 40s and level off in your mid-60s.

Think of your eye like a camera. The lens in a camera can autofocus on objects that are near or far. Your lens works together with your cornea (your eye’s clear, outer “window”) to do this job and help give you clear vision. To understand presbyopia, it helps to know a bit about this process:

1. Your cornea bends light as it enters your eye.
2. A tiny, circular muscle surrounding your lens either contracts or relaxes. These actions change the shape of your lens to bring things into focus. If the object is far away, the muscle relaxes. If it’s near, the muscle contracts.
3. Light lands on your retina. This is a layer of tissue at the back of your eye that translates light into electrical signals. Your optic nerve sends these signals to your brain, allowing you to see the image.

Your lens continues to grow as your eye ages. New layers of cells form (picture an onion). This process thickens your lens and makes it less flexible. As a result, light can’t land properly on your retina, and your close-up vision grows blurry.

What are the risk factors for getting presbyopia?

The main risk factor is being older than 40. However, certain medications and medical conditions can cause presbyopia to appear in people younger than 40. This is called premature presbyopia.

Risk factors for premature presbyopia include:

• Having farsightedness.
• Taking certain medications, including antihistamines or antidepressants.
• Having certain conditions, including diabetes, multiple sclerosis (MS) or cardiovascular disease.

How is presbyopia diagnosed?

An eye care specialist can diagnose presbyopia with an eye exam.

An important part of this exam is a refraction assessment to measure how well you see objects at specific distances. This assessment tells your provider whether you have presbyopia and/or astigmatism and also whether you’re nearsighted or farsighted.

How is presbyopia corrected?

Depending on your health, lifestyle and preferences, your eye care specialist may suggest any of the following methods to correct presbyopia:

• Eyeglasses.
• Contact lenses.
• Surgeries.
• Eye drops.

Eyeglasses

Whether or not you’ve been wearing eyeglasses for other vision issues, now may be time to switch to a more comfortable type for your changing eyes. Options include:

• Reading glasses (readers). These are ideal for people who don’t have nearsightedness, farsightedness or astigmatism. You can buy readers from the store without a prescription (but it’s a good idea to ask your provider the magnification power you need). You can also choose to get prescription reading glasses tailored to your eyes.
• Bifocals. Often prescribed for presbyopia, bifocals are glasses that have two different prescriptions in one spectacle lens. The upper part of the lens has a distance prescription, while the smaller, lower part has a prescription to help you see objects up close.
• Trifocals. Trifocals have three lenses: one each for seeing close-up, in-between and far away.
• Progressives. Progressives are multifocal lenses, similar to bifocals, but with a more gradual shift between the prescriptions. Many people choose progressives when they don’t want a visible line on their glasses.
• Office progressives. These glasses are designed for doing near work in the office, like computer work or writing. When you get up from your desk, you remove them so you can see into the distance.

Contact lenses

There are a variety of contact lenses that can help you see better with presbyopia. Choose the contacts that help you see most comfortably:

• Bifocal contact lenses. A true bifocal lens helps you with just two focal points, usually near and far. They come in soft or hard (gas-permeable) materials.
• Multifocal contact lenses. Multifocal lenses are similar to bifocal lenses, and people often use the terms interchangeably. But a multifocal lens can include more than two focal points, including the in-between zone of about three feet. They also come in soft or gas-permeable versions.
• Monovision contact lenses. With a set of monovision contacts, one eye wears a lens that helps you see objects at a distance, while the other eye wears a lens that helps with near vision. Your brain gradually adapts to this method, but it can take up to two weeks for it to feel comfortable to you.
• Modified monovision contact lenses. With modified monovision, you wear one lens for either near or far vision. In the other eye, you wear a multifocal lens that helps you see at all distances.

Surgeries

Discuss your eye health, family history and lifestyle with your provider before you decide if surgery is right for you. People who only wear readers may find surgery has more risks than rewards for them.

The following three laser procedures correct presbyopia by using monovision (one eye corrected for distance, the other corrected for near vision):

• LASIK surgery. Laser in-situ keratomileusis (LASIK) is a popular surgical approach to correct vision in people who are nearsighted, farsighted or have astigmatism.
• PRK surgery. You may be a good candidate for a photorefractive keratectomy (PRK) procedure if you have moderate to high nearsightedness, farsightedness and/or astigmatism.
• SMILE surgery. With a small-incision lenticule extraction (SMILE) procedure, your surgeon uses a very precise laser to create a disc-shaped piece of tissue inside your cornea that they remove through a small incision.

Eye drops for presbyopia

Eye drops are a good option for some people with presbyopia. Pilocarpine eye drops (Vuity®) make your pupil smaller to improve your depth of focus and give you clearer close-up vision. These are the first eye drops the U.S. Food and Drug Administration (FDA) has approved for presbyopia. Red eye and headaches are the most common side effects, and you may also have trouble with night vision.

Some research links the use of these eye drops with retinal detachment. If you’ve had this condition or have risk factors for it, talk to your provider about your risks and if this is a good treatment option for you.

Can I prevent presbyopia?

You can’t prevent presbyopia since it’s a part of the natural aging process. But you can take steps to protect your eye health. Tips include:

• Wear sunglasses to shield your eyes from harmful ultraviolet (UV) rays.
• Eat foods rich in nutrients that promote eye health, including vitamin A, vitamin C, vitamin E and lutein.
• Learn about computer vision syndrome and make adjustments to your routine to ease eye strain.

What can I expect if I have presbyopia?

Talk to an eye care specialist about your symptoms and their impact on your daily life. They’ll help you find the most suitable corrective methods. You may need to try several different methods before finding one that works well for your needs and lifestyle.

When should I seek care?

See an eye care specialist if you have symptoms of presbyopia or other trouble with your vision. Blurred vision can be a sign of many issues. So, it’s important for a specialist to evaluate your eyes and identify the cause.

Even if you don’t have symptoms, you should have your eyes and vision checked regularly. How often you need an eye exam usually depends on your age, eye health and underlying medical conditions. Most adults need an exam every one to two years. Ask an eye care specialist what’s appropriate for you.

What is the difference between presbyopia and hyperopia (farsightedness)?

Presbyopia and farsightedness (hyperopia) are both refractive errors that cause blurry close-up vision. But they have different underlying causes. Presbyopia occurs when your eye’s lens loses its flexibility. Farsightedness occurs when your eyeball is too short or your cornea is too flat.

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

Yes, and it’s very common. Nearsightedness (myopia) means your eyes are naturally over-focused, causing clear close-up vision but blurred distance vision. However, if you’re nearsighted and over age 40, you’ll still feel the effects of presbyopia while wearing your glasses or contacts. Your eye care specialist can update your lens prescription to correct for both presbyopia and myopia.