Presbyopia Surgery

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What Is Presbyopia?

Presbyopia is an eye condition, in which individuals cannot see objects clearly at a close distance. This condition normally begins after the age of 40 and progresses until about 65 years of age.

When people have presbyopia, they may need to hold books or magazines farther away to see the text or image. 

Some symptoms of presbyopia include:

  • Difficulty in seeing items up close
  • Eye strain (when the eyes become tired or sore)
  • Headaches 
  • Dry eyes
  • Need to keep reading materials at a farther distance than normal for better sight

What Causes Presbyopia?

Presbyopia occurs because of the rigid lens sitting inside the eye. In younger people, the clear lens is soft and flexible, changing shape to refract (bend) light onto the retina. The retina is  sensory tissue that transmits visual signals via the optic nerve to the brain. Your brain interprets these signals as the visual images you see.

graphic showing normal eye and presbyopia

However, there comes a moment after the age of 40 when the natural lens loses its flexibility. The shape does not change as much as before. This means that light entering into the lens of the eye does not bend as well and eyesight gets worse. Reading, threading a needle, or performing other close-up activities become more challenging and for some, frustrating.  

Certain risk factors may increase an individual’s likelihood of developing presbyopia. These factors include:

  • Age. This is one of the primary causes of presbyopia. Most individuals will experience presbyopia to a certain extent after turning 40 years old.  
  • Other health conditions. Farsightedness or other medical conditions like diabetes, multiple sclerosis, or cardiovascular disease can increase an individual’s likelihood of premature presbyopia. Premature presbyopia describes individuals younger than 40 who begin developing presbyopia. 
  • Drugs. Antidepressants, antihistamines, and diuretics are associated with premature presbyopic symptoms. 

It is important to remember that presbyopia forms part of the normal aging process. When it occurs, individuals cannot stop the eye condition from deteriorating. 


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However, early detection of presbyopia can help individuals consider treatment options to avoid more severe symptoms. Visiting an eye care professional regularly and undergoing a comprehensive eye exam could determine whether the age-related condition is present. 

If an eye doctor makes a presbyopia diagnosis, treatment options (both invasive and non-invasive) are available.

Best Surgeries for Presbyopia 

Individuals may choose to undergo refractive surgery to correct presbyopia. Some of these eye surgeries include:

  • Conductive keratoplasty. Eye surgeons use radiofrequency energy to direct heat to small areas around the cornea. The edge of the cornea diminishes in size due to the heat, enhancing its curve and ability to focus. Results from this type of surgery will vary from one individual to the next, and may not last for extended periods. 
  • Laser-assisted in situ keratomileusis (LASIK). The surgical procedure includes a thin, hinged flap incision deeper into the cornea. Using a laser, the ophthalmologist then takes away inner layers of the cornea to create an even more domed shape. In comparison to other corneal surgeries, LASIK has faster and less painful recovery results. 
  • Laser-assisted subepithelial keratectomy (LASEK). This surgery includes an ultra-thin flap incision in the cornea’s epithelium (the outer protective barrier). Using a laser, the eye surgeon then reshapes the cornea’s outer layers, enhances the curve, and replaces the epithelial flap. 
  • Photorefractive keratectomy (PRK). This surgical procedure uses a laser to reshape the cornea. However, it is different from LASEK, because the eye surgeon removes the epithelium completely. This outer protective barrier will grow back naturally to fit the cornea’s reshaped contour. 
  • Lens implants. Eye surgeons remove the natural lens to replace it with an artificial lens called an intraocular lens (IOL). Lens implants will vary for presbyopia correction. Reading glasses may still be necessary after this type of surgical procedure. Also, lens implant surgery may pose some risks similar to those found in cataract surgery, such as inflammation, infection, bleeding, and glaucoma (a gradual decrease in vision due to optic nerve damage). 
  • Corneal inlays.  A possible surgical option is the insertion of a small plastic ring with a central opening into the cornea of the eye. Like a tiny camera, the pinhole opening lets focused light pass through for clearer vision of items up close. 

Other Presbyopia Treatments

Individuals living with presbyopia alone may only need glasses. Reading glasses can help bend light before it comes into the eye to correct close-up vision issues. To determine the specific power of reading glasses, it is best to undergo an eye exam at the nearest eye clinic.

For those with early-stage presbyopia, there are additional tricks for vision correction. For example, using bright reading lights, selecting large-print texts, or enlarging font size on the computer can all help. 

However, if other eye vision problems are present (hyperopia, myopia, or astigmatism), individuals may need to consider wearing other types of lenses. These lenses include:

  • Bifocals. These eyeglass lenses are suitable for close-up and far vision errors. Bifocals have a line segment which divides the distance prescription (at the top) from the reading prescription (below the line).
  • Trifocals. These eyeglasses lenses provide three different fields of vision, including close-up, mid-range, and far. 
  • Progressive lenses. These eyeglass lenses are similar to both bifocals and trifocals. However, changes from one field of vision to another are much more gradual, and there is no visible line of demarcation on the lens. 

Similarly, for those looking for more comfort, two types of contact lenses are available to help treat presbyopia. The two kinds of  contact lenses include:

  • Monovision contact lenses. With these contacts, one eye corrects distance vision errors while the other eye corrects near vision errors. Individuals using these contacts will require the brain to adapt to this new way of viewing objects. Some individuals may also find that judging speed and distance is not as accurate with this type of contact lens. 
  • Multifocal contact lenses. These lenses offer different focal areas at various powers. Individuals use both close-up and far vision simultaneously. Like monovision contacts, the brain will need some time to learn how to determine the right focus for viewing objects clearly. However, this type of contact lens may decrease sharpness in vision. 

It is always recommended to visit an ophthalmology clinic and consult an eye health professional regarding any presbyopia concern. Performing regular eye exams can help determine to what extent the eye condition has developed. An eye health professional can then provide the best treatment plan.

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Author: Anthony Armenta | UPDATED October 19, 2020
Medical reviewer: MELODY HUANG, O.D. 
Resources

Boyd, Kierstan. “What Is Presbyopia?” American Academy of Ophthalmology, 27 June 2020, www.aao.org/eye-health/diseases/what-is-presbyopia.

“Presbyopia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 30 Sept. 2020, www.mayoclinic.org/diseases-conditions/presbyopia/symptoms-causes/syc-20363328.

“Presbyopia.” National Eye Institute, U.S. Department of Health and Human Services, 8 Sept. 2020, www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/presbyopia.

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