What Is Presbyopia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Nearly everyone develops presbyopia, and it typically begins around age 40.

Presbyopia is a common age-related vision disorder that makes it difficult for you to see or focus on objects up close.

Presbyopia stems from an issue with the lens of the eye, which sits behind the iris (colored part) and pupil.

When a person is younger, the lens is soft and flexible. Tiny muscles in the eye can easily change the shape — and, as a result, the focus — of the lens, a process called accommodation.

With age, the elasticity of the lens and of the muscles around it starts to diminish. This makes it so the lens isn’t able to focus on up-close objects, making them appear blurry.

• Poor nutrition
• Anemia
• Smoking
• Alcohol abuse
• Work that requires a lot of near vision (such as staring at a computer screen all day)
• Substantial sunlight exposure
• Premature menopause

Presbyopia is diagnosed during routine, comprehensive eye exams that test your ability to see both near and distant objects.

During the exam, your ophthalmologist (eye doctor) may also dilate your pupils to make it easier to see the insides of your eyes. Your eyes may stay a bit sensitive to light for several hours after the exam.

The AAO’s eye exam recommendations vary you get older, depending on your age:

• Ages 40 to 54 Every two to three years
• Ages 55 to 64 Every one to three years
• Ages 65 and over Every one to two years

Prognosis of Presbyopia

Once you have presbyopia, you’ll have it for life. The good news is, there are many treatments that may help you to see better.

Your doctor may recommend corrective glasses or contact lenses. In some cases, you might be able to consider refractive (or laser) surgery, lens implants, or corneal inlays.

Refractive surgery is irreversible, and these surgeries may cause side effects or not completely restore your vision to the way it was before you started to experience vision problems.

Eyeglasses

• Reading glasses These are worn only when reading or doing close-up work.
• Office progressives You’ll also generally only wear these for reading or using a computer and remove them when you’re out and about.
• Bifocals These glasses correct your distance vision when you look through them at eye level, and they correct your near vision when looking through the lower part of the lens.
• Trifocals These glasses have corrections for near, middle, and far vision.
• Progressive multifocals These lenses are similar to trifocals but don’t have horizontal lines.

Contact Lenses

• Bifocal or multifocal contact lenses Like bifocal glasses, these contacts help you see both far away and up close
• Monovision contact lenses You’ll wear two different types of lenses: one corrects for distance vision and the other for near vision. This helps you see better at all distances.
• Modified monovision This involves wearing a multifocal lens in one eye, and one lens in the other for near or far vision

Surgical Procedures

If you don't want to wear glasses or contact lenses, talk to your doctor about a surgical procedure for presbyopia.

There are several types of refractive surgery:

• Conductive keratoplasty Heat from radiofrequency energy shrinks the edge of the cornea to change its curve. The effectiveness of the surgery varies, and it may not last.
• LASIK surgery A small flap is cut in the cornea and a laser is used to remove part of the cornea to increase its curve. This procedure usually causes fewer side effects and is faster than other surgeries.
• Photorefractive keratectomy (PRK) As with LASIK, a laser (but no incision) is used to reshape the cornea.

• Lens implants The lenses in each eye are replaced with artificial (intraocular) lenses. It may not entirely correct vision and can lead to vision blurriness and glare, infection, bleeding, and glaucoma.
• Corneal inlays A small plastic ring is placed into the cornea of one eye, refocusing light to improve up-close vision.

Prevention of Presbyopia

Presbyopia isn’t considered a disease — it’s a natural part of aging that affects the eye. That means there’s no way to prevent presbyopia.

• Reduce eyestrain by keeping your home and workplace well-lit.
• Get regular eye exams to make sure your prescription is up-to-date and to look for signs of other eye conditions.
• Use corrective glasses or contacts if you need them to optimize your vision.
• Wear sunglasses to protect your eyes from damaging ultraviolet (UV) rays.
• Support your overall health by eating a balanced diet that’s rich in vitamins A, C, E, and lutein.
• Limit alcohol.
• Exercise regularly.
• Drink plenty of water.
• Don’t smoke.
• Control chronic conditions like diabetes and high blood pressure. Left untreated, they can impact your vision.
• See your doctor right away if you have double vision, see flashes of light or black spots, have suddenly blurry vision, or suddenly lose vision in one eye, as these symptoms may indicate a serious condition.

Presbyopia complications are generally linked to problems caused by surgery to correct your vision.

Talk to your doctor about the potential risks and complications of your surgical options to determine if a procedure is right for you.

The eye’s lens changes shape to allow you to focus on nearby objects. Presbyopia is a normal part of aging caused by the hardening of the lens in the eye, which makes close objects look blurry.

Presbyopia Unlocked

If you geek out on science, you might enjoy this podcast, which is produced by a group of ophthalmologists. Topics include presbyopia-correcting technologies and trifocal intraocular lenses.

American Academy of Ophthalmology (AAO)

The AAO is the professional organization that sets guidelines for the eye physicians and surgeons. The group’s presbyopia page features insightful videos showing how the eye works, what presbyopia is, and how monovision corrects presbyopia.

Additional reporting by Joseph Bennington-Castro.