How is presbyopia treated?

Presbyopia cannot be cured. But today you can choose from a wide variety of options to correct your vision. Discuss the best choice for you with your eye care provider. Depending upon your overall health and lifestyle, your provider may suggest any of the following, including prescription glasses, contact lens, reading glasses, progressive addition lenses, bifocals or several types of eye surgery to help you see things up close again.

Your many vision correction options include:

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

  • Prescription readers. If you have no other vision issues, reading glasses may be all you need. They should be worn only for doing up-close work, like reading.
  • Bifocals. Often prescribed for presbyopia, bifocals are eyeglasses that have two different prescriptions in one spectacle lens. The upper part of the lens contains the distance prescription, while the smaller, lower portion of the lens holds 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 have a more gradual shift between the prescriptions. Many people choose progressives when they don't want a visible line on their glasses.
  • Office progressives. Like their name suggests, these glasses are designed for doing near work in the office, such as computer work or writing. When you get up from your desk, you remove them so you can see into the distance.

Readers. Yes, we all call them cheaters. Welcome to the club. If you didn’t need eyeglasses before turning 40 for distance or any other reason, readers may be all you need to read a menu or thread a needle. You can pick them up at most drugstores. Nonprescription readers range from powers of +1.00 diopter (D) to +3.00 D. Choose the lowest magnification that makes small print look clear. You’ll probably want more than one pair to keep handy on your nightstand or any other place you may read or do up-close work, like sewing.

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 materials (gas permeable).
  • Multifocal contact lenses. Multifocal lenses are similar to bifocal lenses and the terms are often used interchangeably, but a multifocal lens can include more than two focal points, including the intermediate zone of about 3 feet. They also come in soft or gas permeable versions.
  • Monovision contact lenses. With a set of monovision lenses, one eye wears a lens that aids in seeing objects at a distance, while the other wears a lens that aids in near vision. It can take up to two weeks for your brain to adjust to this method of seeing.
  • 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.

Refractive surgery.

Discuss your eye health, family history and lifestyle with your provider before you decide if surgery is right for you, and which option fits your lifestyle best. If you use glasses only part of the time, such as only for reading, eye surgery may be more risk than reward — even though refractive surgery is considered a minimally-invasive outpatient surgery with low risk in the hands of a trained ophthalmologist.

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, or LASIK, is a popular surgical approach used 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. PRK is a slightly shorter, simpler laser surgery that removes less corneal tissue than LASIK.
  • 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 the cornea that can be removed through a small incision.

Lens replacement: Some people are better suited for procedures that remove the natural lens in a technique similar to cataract surgery, called refractive lens exchange (RLE). Depending upon what type of implant is used, all forms of vision correction can be achieved, including nearsightedness, farsightedness, astigmatism and presbyopia.

Corneal inlays: This is a newer, but less common option for surgically correcting presbyopia. Your ophthalmologist inserts a very small plastic ring into your cornea to allow your eye to achieve both distance and near vision. It works by creating a “pinhole camera effect” and effectively reduces blur (similar to squinting your eyes to see better). The inlay is typically inserted in only one eye.

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