Presbyopia Symptoms, Causes and Treatment

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What is presbyopia?

As we age we lose our ability to focus on objects closer to us. This change is called presbyopia and typically requires magnifying reading glasses in most people by the age of 50. This can be treated through surgical presbyopia treatments such as presby-laser blended vision and refractive lens exchange.

This condition affects everyone as they get older. It is caused by changes in the crystalline lens, which is located inside the eye. When we are young we have a crystalline lens that is very flexible and the muscles within the eye can manipulate it so that it changes its shape, and therefore its power, so we can focus over a range of distances. This is a reflex and is done automatically without thought or effort. It is called accommodation. As we age, the lens becomes a stiffer, more rigid structure and it becomes harder for the muscles to get the lens to increase in thickness to become more powerful. As such, focusing up close becomes more problematic.

What are the symptoms?

The decrease in accommodating capability starts very early on in life but presbyopia symptoms are not noticed until patients can no longer read without holding items further away. Presbyopia symptoms include:

Needing to hold reading material further away in order to be able to read
Eye strain or headaches when reading over long periods of time
Things keep going in and out of focus and you can often have a headache which gets worse as the day goes on

Patients often first notice the deterioration in the winter months when lighting is worse. There is no cure for presbyopia, and no way of slowing its progression. Without intervention it results in blurred near vision.

What are the causes?

Presbyopia is caused through changes in the natural lens that occur over time. It is a different condition to hypermetropia or long sightedness, which it is often confused with. Long sightedness is a refractive error that when corrected will allow clear vision at all distances, whilst presbyopia is a “near vision” only eye condition and any correction given will result in clear near vision but will blur the distance vision.

Presbyopia happens because the natural lens stiffens and loses flexibility with age. Your eye see by allowing light to pass through the cornea and lens and focus on the retina at the back of the eye. In younger people with normal eyesight, the lens flexes so that the light is focused accurately on the retina no matter what the reading distance is.

Reading glasses which come in plus + powers simply magnify the reading image allowing text or closer images to be seen clearly.

Someone who is shortsighted will continue to be able to see at near even with age, but will notice that they lose this ability as soon as they correct their vision with glasses or contact lenses.

One of our OCL Vision surgeons explaining the treatment options with laser eye surgery for reading vision correction.

What are the treatment options?

We spend much of our life reading on our phones, tablets and computer screens. A large number of daily visual tasks are in the near to intermediate distance. If you’re reading this page, you already understand the inconvenience of wearing reading glasses.

Surgical options for correction of presbyopia have been available for nearly 2 decades and have become increasingly sophisticated. The appropriate type of surgery will be determined by your eyes and visual needs and will be discussed by your surgeon who will explain which presbyopia treatment option may be best for you. This will depend on a number of factors including the severity of your presbyopia and any other eye conditions you may have.

Laser eye surgery: Monovision or laser blended vision (Presbymax): This presbyopia treatment works very well using the dominant eye for distance and the non-dominant eye for nearer vision. This spread of focus give people a very good range of day to day functional vision without the need for reading glasses. Presbymax is a more sophisticated version of monovision which further enhances depth of focus through precise adjustment of the optics of the eye.
Clear Lens Extraction or Refractive Lens Exchange: Also called permanent lens replacement. This is the same as cataract surgery in technique and involves removing the stiff natural lens and implanting a trifocal or extended depth of focus lens implant into both eyes. Most people will not require any glasses for distance or near following Refractive Lens Exchange.