Presbyopia occurs due to changes in the thickness and flexibility of the natural lens inside the eye.
The lens is a small, nearly spherical part that sits inside the eye and helps to focus the light coming in. It is made of layers of cells. When you are younger, the lens has the ability to change shape easily. Tiny muscles (called ciliary muscles) contract and relax to control changes in the shape of the young lens, and this flexibility allows your eyes to focus over a broad range of distances. The action of changing the shape of the lens to focus on near objects is called accommodation.
With time, more and more layers of cells develop, causing the lens to become thicker. Even though the ciliary muscles still function as you age, the thickened lens becomes less flexible and less able to change shape, which limits accommodation and causes vision problems.
You may first notice signs and symptoms of presbyopia after age 40. Symptoms may seem worse if you are tired or are in an area with dim lighting.
- A tendency to hold reading material farther away to make the letters clearer
- Blurred vision at normal reading distance
- Eyestrain or headaches after reading or doing close-up work
See an eye doctor if blurry near vision or eye fatigue is keeping you from reading, doing close-up work, or enjoying other normal activities. The eye care experts at Hill Vision Services can determine whether you have presbyopia and advise you of your treatment options.
Certain factors can make you more likely to develop presbyopia, including:
- Age – Age is the greatest risk factor, with almost everyone experiencing some degree of presbyopia after age 40.
- Other medical conditions – Being farsighted or having certain diseases (such as diabetes, multiple sclerosis, or cardiovascular diseases) can increase your risk of developing presbyopia before age 40.
- Drugs – Certain drugs (such as antidepressants, antihistamines, and diuretics) are associated with premature presbyopic symptoms.
The goal of treatment is to compensate for the inability of your eyes to focus on nearby objects. Some of our recommended treatment options include:
Over-the-counter (non-prescription) reading glasses are one of the simplest and cheapest ways to treat presbyopia. They can be found at almost any drug store, pharmacy, or convenience store but the specific power of reading glasses that you need should be determined by an eye exam. Request an appointment with our eye doctors today!
If you have astigmatism (irregular shape of the eye that requires prescription correction), reading glasses may not provide a clear image for you. It is best to see your eye doctor for prescription reading glasses or bifocals that can help you see clearly. Additionally, if you have other eye conditions that are affecting your vision, reading glasses may not be effective. You should see your eye doctor for a complete eye exam.
Bifocals are prescription glasses with distance correction in the top half and near correction in the bottom half of the lenses. You can think of these as prescription glasses with a pair of reading glasses “built-in” to the bottom. As you look straight ahead, you see through the distance prescription at the top of the lenses. When you look down you are viewing your reading material through the near prescription.
Presbyopia Contact Lenses
- Monovision contact lenses – Where one contact lens helps you see well at a distance and a different contact lens in the other eye helps you see near objects. It takes some time for monovision lens-wearers to get used to this arrangement. It is important that the dominant eye (similar to being right-handed or left-handed) is corrected for distance, while the non-dominant eye is corrected for near vision.
- Multifocal contacts lenses – These have several rings or zones with different focusing power built into each lens. Similar to bifocals, these special contacts allow you to see both distance and near with each eye. However, it can be difficult to get the right fit and centration on the surface of the eye. Since contact lenses move slightly with every eye movement and blink, too much movement of the lens (and the concentric rings) relative to the eye causes the vision to come in and out of focus.
Recently, a prominent ophthalmic drug manufacturer announced the FDA approval of Vuity (pilocarpine HCl ophthalmic solution 1.25%) eye drops for the treatment of presbyopia. This medication is not new, but the specific formulation for presbyopia is new to the market. At Hill Vision Services, we have samples of these eye drops that can be used once daily to improve near vision and depth of focus for individuals with presbyopia. After an eye exam, our doctors can recommend a trial with sample drops or write a prescription for patients, if desired.
Eyeglasses and contact lenses are temporary solutions for presbyopia that require ongoing maintenance. Now, more and more people are opting for a permanent treatment through corrective surgery.
Refractive surgery changes the shape of your cornea. For presbyopia, this treatment can be used to improve close-up vision in your non-dominant eye. It’s like wearing monovision contact lenses. Even after surgery, you may need to use eyeglasses for close-up work. Refractive surgical procedures include:
- LASIK for presbyopia – This is where a thin, hinged flap is cut away from the front of your eye, then a laser is used to remove inner layers of your cornea to steepen its domed shape. Although LASIK cannot treat the root cause of presbyopia, there are LASIK variations that can help reduce your need for reading glasses or bifocals.
- Photorefractive keratectomy (PRK) – This procedure is similar to LASIK, except the epithelium is completely removed, then the laser is used to reshape the cornea, but the epithelium is not replaced (it will grow back naturally, conforming to your cornea’s new shape).
Presbyopia Cataract Surgery and Lens Implants
Sometimes, presbyopia can be surgically treated in combination with cataract surgery. Cataract surgery involves removing a cataract (the natural lens that has become cloudy with age) from inside the eye and replacing it with a clear synthetic lens, called an intraocular lens. Several types of lens implants are available for correcting presbyopia. For example:
- Multifocal IOLs – Similar to multifocal contact lenses, they have concentric rings of increasing power, splitting the light that enters the eye to provide improved clarity of vision at both distance and near.
- Accommodating lens implants – They are designed to have a moving hinge to simulate the natural changes to the lens.
- Monovision – Just as monovision can be achieved with soft contact lenses, it can also be achieved by placing appropriately chosen intraocular lenses.
With lens implants, you may have some functional intermediate and near vision but may need reading glasses to read fine print.
Corneal Inlays for Presbyopia
Corneal inlays are tiny implantable lenses that are placed in the cornea during a minimally invasive surgical procedure. While some of these products showed initial promise for presbyopia treatment, they are not widely used. One prominent product of this type was recently taken off the market by the manufacturer. It still remains to be seen whether new technology in this area will be useful for widespread treatment of presbyopia.