What Is Presbyopia?
Presbyopia is an eye condition in which your eye
slowly loses the ability to focus quickly on objects that are close. It’s a
disorder that affects everyone during the natural aging process.
When light enters your eye, it passes through your cornea. Then,
it passes through your pupil. Your iris is the colored ring in your eye that
opens and closes your pupil to adjust the amount of light passing through it.
After passing through your pupil, the light passes through your lens. In its
healthiest state, your lens changes shape so it can bend the light rays further
and focus them on your retina at the back of your eye. However, your lens
becomes less flexible with age. Then, it can’t change shape as easily. As a
result, it’s unable to bend the light properly to focus it on your retina.
Symptoms of Presbyopia
The most common symptoms of presbyopia occur around age 40 for
most people. The symptoms of presbyopia typically involve a gradual
deterioration in your ability to read or do work up close.
Common symptoms of presbyopia are:
- having eyestrain or headaches after reading or
doing close work
- having difficulty reading small print
- having fatigue from doing close work
- needing brighter lighting when reading or doing
- needing to hold reading material at an arm’s
distance to focus properly on it
- overall problems seeing and focusing on objects
that are close to you
Hyperopia, or farsightedness, is a condition that has symptoms
similar to presbyopia. However, they’re two different disorders. In both
conditions, distant objects are clear but closer objects appear blurred.
Hyperopia occurs when your eye is shorter than normal or your
cornea is too flat. With these malformations, the light rays focus behind your
retina, as in presbyopia. However, hyperopia is a refractive error that’s
present at birth. It’s possible to have hyperopia and then develop presbyopia
Causes of Presbyopia
When you’re young, the lens in your eye is flexible and
relatively elastic. It can change its length or shape with the help of a ring
of tiny muscles that surround it. The muscles that surround your eye can easily
reshape and adjust your lens to accommodate both close and distant images.
With age, your lens and the muscle fibers surrounding your lens
slowly lose flexibility and stiffen. As a result, your lens becomes unable to
change shape and constricts to focus on close images. With this hardening of
your lens, your eye gradually loses its ability to focus light directly onto
Risk Factors for Presbyopia
The most significant risk factor for presbyopia is age. Most
people lose some ability to focus on close objects by age 40. It affects
everyone, but some people notice it more than others.
Certain diseases or drugs can cause presbyopia in people younger
than age 40. When the symptoms of presbyopia occur earlier than usual, it’s
called premature presbyopia. If you notice the symptoms of presbyopia at an age
earlier than normal onset, it may be a sign of an underlying medical condition.
You’re at a higher risk of premature presbyopia if you have:
- anemia, which is a lack of enough normal blood
- cardiovascular disease
- diabetes, or difficulties metabolizing blood
- hyperopia, or farsightedness, which means you
have a greater difficulty seeing objects nearby than objects that are far away
- multiple sclerosis, which is an autoimmune
disease that affects your spine and brain
- myasthenia gravis, which is a neuromuscular
disorder that affects your nerves and muscles
- eye trauma or disease
- vascular insufficiency, or poor blood flow
Some prescription and over-the-counter drugs can reduce your
eye’s ability to focus on close images. Taking the following drugs can put you
at a higher risk of premature presbyopia:
- antianxiety drugs
Other factors that may put you at a higher risk of premature
- being female
- having intraocular surgery, or surgery done on
the inside of the eye
- eating an unhealthy diet
- having decompression sickness, or “the bends,”
which results from rapid decompression and typically occurs in scuba divers
that surface too quickly
Diagnosis of Presbyopia
Contact your doctor or eye specialist if you have any of the
symptoms of presbyopia. Even if you’re not experiencing symptoms, you should
have an eye examination by age 40.
According to the Foundation of the American Academy of Ophthalmology,
adults who don’t have any symptoms or risk factors associated with eye disease
should have a baseline examination at age 40. An eye screening can identify
early signs of disease and vision changes that can begin, sometimes without any
symptoms, around this age.
Presbyopia can be diagnosed as part of a comprehensive eye
examination. A typical exam will include tests to evaluate your eyes for the
presence of diseases and vision disorders. Your pupils will probably be dilated
with special eye drops to allow your doctor to examine the inside of your eye.
Treatment of Presbyopia
No cure exists for presbyopia. However, there are several
treatments available to correct your vision. Depending on your condition and
lifestyle, you may be able to choose from corrective lenses, contact lenses, or
surgery to correct your vision.
If you didn’t need eyeglasses before getting presbyopia, you
might be able to use nonprescription reading glasses. These readers are
typically available at retail stores, such as drug stores. They typically work
best for reading or close work.
When selecting a pair of nonprescription reading glasses, try
different degrees of magnification. Choose the lowest magnification that allows
you to read a newspaper comfortably.
You’ll need prescription lenses for presbyopia if you can’t find
an appropriate magnification from the nonprescription offerings. You’ll also
need a prescription if you already have lenses to correct another eye problem.
There are several variations of prescription lenses, such as the following:
- Prescription reading glasses can be prescribed
if you have no eye problems other than presbyopia and prefer not to purchase
your glasses off the shelf.
- Bifocals have two different types of focus,
with a noticeable line between them. The upper portion is set for distance
while the lower portion is set for reading or close work.
- Progressive lenses are similar to bifocal
lenses. However, they don’t have a visible line, and they offer a more gradual
transition between the distant and close portions of the prescription.
- Trifocals have three different points of
focus. The portions are set for close work, mid-range, and distance vision, and
they can be made with or without visible lines.
- Bifocal contact lenses provide the same
option as bifocal glasses.
- Monovision contact lenses require you to
wear a contact lens set for distance vision in one eye and a different contact
lens set for close work in your other eye.
- Modified monovision contact lenses require
you to wear a bifocal contact lens in one eye and a contact lens for distance
in your other eye. Both eyes are used for distance, but only one eye is used
for reading, and your brain adjusts as needed to process the image.
Your eyes will continue to gradually lose their ability to focus
on close objects as you age. As a result, your prescription will have to be
reviewed and changed according to the advice of your eye specialist.
There are several surgical options to treat presbyopia. For
- Conductive keratoplasty (CK) involves using
radiofrequency energy to change the curvature of your cornea. While it’s effective,
the correction may diminish over time for some people.
- Laser-assisted in-situ
keratomileusis (LASIK) can be used to create monovision. This adjustment
corrects one eye for near vision and the other eye for distance.
- Refractive lens exchange involves the
removal of your natural lens. It’s replaced with a synthetic lens, called an
intraocular lens implant, inside your eye.
Complications of Presbyopia
If your presbyopia is undiagnosed or uncorrected, your vision
will likely deteriorate gradually. It will increasingly affect your lifestyle
over time. You may experience a significant visual disability if a correction
isn’t made. You’ll develop problems maintaining your usual levels of activity
and productivity at work and in everyday activities. When tasks such as reading
small print become difficult and remain untreated, you’re at risk of headaches
Since everyone develops presbyopia as they age, it’s possible to
have presbyopia in addition to another type of eye problem. Presbyopia can
- astigmatism, which is an imperfection in the
curvature of your cornea that causes blurred vision
- hyperopia, or farsightedness
- myopia, or nearsightedness
It’s also possible to have a different type of eye problem in
Outlook for Presbyopia
In most cases, the vision you’ve lost to presbyopia can be
corrected with eyeglasses, contact lenses, or surgery. The gradual decline of
the elasticity required to focus your lens on near objects continues until
about age 65, which is when most of the elasticity is gone. However, even at
that point, correction to see close objects is possible.
How to Prevent Presbyopia
There’s no proven technique for preventing presbyopia. The
gradual decline of the ability to focus on near objects affects everyone.
However, you can help protect your vision with these steps:
- Get regular eye examinations.
- Control chronic health conditions that could
contribute to vision loss, such as diabetes or high blood pressure.
- Wear sunglasses.
- Wear protective eyeglasses when participating in
activities that could result in eye injury.
- Eat a healthy diet with foods containing
antioxidants, vitamin A, and beta carotene.
- Make sure you’re using the right strength of
- Use good lighting when reading.
Talk to your doctor or eye specialist about any changes in your
vision or eye health. Many eye diseases and conditions can benefit from early
intervention and treatment.