Presbyopia: Symptoms, Causes & Treatment

What is Presbyopia (Age-Related Farsightedness)?

Presbyopia, Greek for "old eye," is when the eye has trouble focusing on near objects. It is a natural part of aging and typically starts after age 40. 

As we age, the eye's clear lens, which helps the eye focus, becomes less flexible and more rigid. This makes it harder to focus light onto the retina (the light-sensitive tissue at the back of the eye), leaving close-up vision blurry and unfocused. 

Presbyopia is a type of refractive error that affects about 150 million Americans. Refractive errors are vision problems that make it difficult to see clearly. Luckily, presbyopia can be effectively managed and corrected.²

Presbyopia is often confused with farsightedness (hyperopia), but the two conditions differ. Presbyopia results from a hardening lens, while farsightedness occurs because the eye shape is too short, allowing light to focus behind the retina instead of on it. 

What are the Symptoms of Presbyopia?

Symptoms typically start after age 40 and gradually worsen until age 65. They can include:⁴

• Difficulty focusing on close objects
• Eye strain when reading 
• Blurry vision when reading small print
• Need for more light
• Headaches when working on near objects
• Need to hold reading material at arm's length 

What Causes Presbyopia?

Presbyopia is caused when the eye's lenses gradually change shape and lose flexibility, reducing its ability to focus light. The leading cause of presbyopia is the natural aging process. 

Risk Factors for Premature Presbyopia 

People can get presbyopia before age 40. This is usually due to risk factors stemming from chronic medical conditions, eye trauma, and medications. This is called premature presbyopia, and risk factors include:

• Anemia 
• Smoking cigarettes daily for over a year
• Diabetes
• Poor nutrition
• Hyperopia
• Extended sun exposure
• Frequent alcohol consumption 
• Multiple sclerosis 
• Eye injury or disease
• Antidepressants
• Diuretics 

When to See an Eye Doctor

Visit an eye doctor when vision changes disrupt your quality of life and interfere with your ability to read and engage in near-vision tasks. 

Noticeable vision changes might include:

• Blurred vision
• Eyestrain
• Frequent headaches
• Inability to focus on close-up objects

Seek immediate medical attention if you experience sudden vision loss in one or both eyes or have severe eye pain. 

How is Presbyopia Diagnosed?

Presbyopia is diagnosed during a comprehensive, dilated eye exam administered by a licensed ophthalmologist. 

Because presbyopia is age-related, the American Academy of Ophthalmology (AAO) recommends people over 40 start getting routine eye exams.

Vision tests that are typically performed include:

• Refraction (tests distance and close-up vision)
• Near and distant visual acuity tests (how clear you see)
• Visual field test (looks at your side or peripheral vision)
• Eye muscle function test
• Tonometry exam (measures eye pressure)
• Pupil response test (how well your eyes respond to light)

Treatment Options for Presbyopia

Here are some treatment options for presbyopia:

1. Eyeglasses

Reading glasses correct presbyopia for people who do not have other refractive errors (nearsightedness, astigmatism). Eyeglasses correct vision by bending light before it enters the eye. 

People can purchase eyeglasses over-the-counter (OTC) for mild presbyopia cases. Or, an eye doctor might prescribe reading glasses if more substantial vision correction is needed. 

Different lenses are available for eyeglasses, such as:

• Bifocals. Bifocal lenses are eyeglasses that correct both near and distance vision. They have a visible line towards the bottom that separates the lenses.
• Trifocals. Trifocals are similar to bifocals, except three lens areas correct distance vision, mid-range vision, and near vision.
• Progressive Lenses. Progressive lenses correct near, mid-range, and distance vision, but no visible line separates each section.

2. Contact Lenses

Contact lenses are a good option for people who don't always want to wear glasses. They are thin, clear disks that sit on top of your cornea (transparent protective outer layer), correcting refractive errors.

Two types of contact lenses correct presbyopia: 

• Multifocal contacts. These are designed to allow you to use both near and far vision simultaneously.
• Monovision contacts. One lens corrects near vision, and the other corrects distant vision.

3. Eye Surgeries

Monovision and refractive error correction are achieved through eye surgery. Many people decide surgery is an excellent alternative to wearing glasses and/or contact lenses. 

Eye surgery options include:

• LASIK. Laser-assisted in situ keratomileusis (LASIK) eye surgery corrects refractive errors using a laser to change the cornea's (transparent protective outer layer) shape.
• PRK. Photorefractive keratectomy (PRK) surgery is similar to LASIK. It also uses a laser to change the shape of the cornea.
• LASEK. Laser epithelial keratomileusis (LASEK) is laser eye surgery that only creates a flap in the cornea's delicate outer layer (epithelium) to correct refractive errors.
• Conductive keratoplasty. Conductive keratoplasty (CK), also called NearVision CK, uses radio waves to change cornea shape to correct presbyopia and other refractive errors.
• Lens implants. Intraocular lens (IOL) implants are artificial lenses that correct refractive errors and replace natural lenses during cataract surgery.
• Corneal inlays. A corneal inlay is a small device implanted into the cornea using laser surgery. The device increases the depth of focus to correct close-up vision.

Presbyopia Complications

Presbyopia is a normal part of aging and will affect everyone. If left untreated, presbyopia will gradually worsen and significantly affect quality of life. 

The condition can also result in uncomfortable symptoms, including:

• Difficulty reading
• Trouble driving, especially at night
• Frequent headaches
• Eyestrain
• Difficulty working at a computer 
• Trouble completing tasks that require close-up vision and focus

Fortunately, eyeglasses, contact lenses, or surgery can easily treat and correct presbyopia. 

Can You Prevent Presbyopia?

While developing presbyopia can't be prevented, there are ways to reduce symptoms and maintain good eye health. These include:

• Get an annual comprehensive eye exam
• Maintain a healthy diet
• Stop smoking
• Wear sunglasses when outside in the sun
• Control blood pressure and blood sugar 
• Use good light when reading
• Limit time in front of a computer and smartphone
• Wear contact lenses and eyeglasses

Summary

Presbyopia is when the cornea becomes rigid, and its elasticity gradually changes over time. This results in a loss of near vision and the ability to focus on close-up objects. It is part of the aging process and typically starts after 40.

Presbyopia symptoms include blurred vision, difficulty reading small print, frequent headaches, and eye strain. 

Reading glasses, contact lenses, or surgery can easily treat presbyopia. If left untreated, it will gradually worsen, affecting the quality of life and the ability to do everyday activities.