Have you reached the time in your life where your arms just don’t feel long enough? Welcome to presbyopia. Presbyopia is a condition that results from the normal age-related decline in our eyes’ ability to focus on nearby objects.
The symptoms of presbyopia include:
- Blurred vision when viewing nearby objects, such as when reading.
- A need to hold reading material further away to improve clarity.
- Eyestrain or headaches during or after close-up work.
These symptoms tend to begin in your forties and become more pronounced over the years following, before eventually stabilizing. However, if a person is naturally nearsighted, these symptoms may be delayed or absent. Conversely, if you are naturally farsighted, your symptoms may onset sooner and become more problematic.
Presbyopia can be an especially difficult realization for those who have always had clear vision and never needed vision correction. These individuals may find this already frustrating condition to be particularly exasperating.
When viewing a close-up object, the crystalline lens inside the eye normally takes on a rounded shape, which aids in focusing. As you age, the crystalline lens hardens, making it more difficult for the lens to change shape. This loss of flexibility of the lens progresses over time, causing increasing difficulty with near vision.
Eyeglasses are the easiest and most common treatment for presbyopia. If you don’t need glasses for any other activity, you may buy over-the-counter reading glasses or have prescription reading glasses made for you.
If you already need glasses for other activities, you may need bifocal or progressive lenses. These lenses have a different correction in the top portion versus the bottom, to allow for both far and near viewing. Bifocal lenses have a line in them, while progressive lenses do not. Bifocals are limited to two powers, one for far away and one for near. Progressive lenses allow for an additional intermediate zone between the two, which can be useful for computer work.
Alternatively, you can have two separate pairs of glasses: one for distance and another for close-up. Some people may even choose to have a third pair for computer use.
Contact lenses come in multifocal options, which correct for presbyopia. There are many different designs of multifocal contact lenses.
Alternatively, you can be prescribed a system called monovision in contact lenses. Monovision involves wearing a contact lens that corrects for distance in one eye and a contact lens for near in the other eye. The brain learns which eye to use for which task. Some people adapt to monovision better than others.
Refractive surgery can also use the monovision system, with one eye corrected for close-up and the other for distance. It’s usually advisable to have tried monovision in contact lenses first before committing to this type of surgery, as not everyone tolerates the difference between the two eyes.
Over time, the natural crystalline lens becomes cloudy, forming a cataract.
People over the age of 60 tend to have some development of cataract. Most cataracts progress relatively slowly over several years. Once cataracts have a significant impact on visual clarity and quality of life, surgery is recommended.
In cataract surgery, the cloudy lens is removed and a synthetic replacement called an intraocular lens is implanted in its place. Some people choose to have intraocular lenses implanted to correct for distance vision, so they’ll still need glasses to see up close. Others may choose to have intraocular lenses implanted for near vision, so they’ll still need glasses to see far away.
There are also options to enable both distance and near vision. These multifocal intraocular lenses aim to provide balanced vision.
Alternatively, monovision correction is available, where one eye is corrected for distance and another for near. Again, if monovision is being considered, this should be tried in contact lenses first.
Some people choose to have this type of surgery before the development of cataracts. This is called a refractive lens exchange.
The newest treatment for presbyopia involves the use of a prescription eye drop. Vuity is the first and only eye drop treatment approved by the US Food and Drug Administration (FDA) for presbyopia. This medication is called pilocarpine, and it has been used at a different strength for the treatment of glaucoma for over a hundred years. Vuity reduces pupil size, which helps to focus light rays to improve near vision. It’s used once daily in both eyes.
Presbyopia is a normal part of your vision as you age. When small text becomes hard to read, it’s time to have your eyes checked. Treatment can include everything from eyeglasses to contacts, surgery and eye drops.
Presbyopia is an inevitable part of the aging process in your eyes.
While some people may be less symptomatic than others, everyone is eventually affected by this frustrating condition to a certain extent.
While glasses are the most common treatment, contact lenses are also an option.
There are surgical possibilities as well. The newest treatment involves the use of prescription eye drops to temporarily improve vision.
Everyone’s treatment preference will differ, but plenty of options are available and more are in the pipeline.
Boyd, K. (2021). What Are Cataracts? American Academy of Ophthalmology.
American Optometric Association. Presbyopia.