Your Guide to Presbyopia: Symptoms, Causes, and Surgery

As you age, your eyes change, sometimes leading to vision problems. Presbyopia is an age-related vision problem many people face starting in their 40s. Changes to the structure of the eye can make it harder to read, see in low light, and look at objects without eye strain. It’s a frustrating problem, but it’s manageable.

If you’re experiencing symptoms of presbyopia, Pair is here to help you determine the best course of action. While you should contact an eye doctor for formal diagnosis and treatment, you can start your journey to presbyopia management with this article.

What Is Presbyopia?

Presbyopia develops when the flexible lens inside your eye turns rigid with age. This change in the structure of your eye can make it harder to focus without glasses or contact lenses, especially on small print and other close-up objects.

Unlike nearsightedness and farsightedness, which usually start to develop in childhood, presbyopia most likely will not present symptoms until 40-45 years old.

The natural aging process makes the eye lens less adaptable to light and changes in focus, leading to blurred vision, eye strain, and the need for extra light.

Sometimes, reading glasses are enough to fix these issues, but you might need more intensive treatment as the condition progresses. It all depends on how much presbyopia interferes with your day-to-day life.

What Are the Causes of Presbyopia?

The cornea is a fixed part of your eye that helps you focus the light that reflects off objects. It works with the flexible intraocular lens, which means you’ll ideally see clearly when looking near and far away.

Changes in the lens's elasticity and the cornea's structure can cause refractive errors, which are issues with how light is refracted by your eye.

Other types of refractive errors, like myopia and hyperopia, can also get worse over time, but these aren’t aging-related conditions in the same way presbyopia is. Overall, getting older is the main reason you may experience presbyopia symptoms, and developing this condition might mean you need eyeglasses to see close objects for the first time in your life.

How Is Presbyopia Diagnosed?

Correcting presbyopia starts with an accurate diagnosis from an optometrist or ophthalmologist. These eye care professionals know how to spot the telltale symptoms of presbyopia and other refractive errors, and they’ll use evidence-based measures and tests to make sure they diagnose and treat you correctly.

There are four main diagnostic measures for presbyopia and other eye health conditions: a standard eye exam includes a visual acuity test, a refraction test, a general eye health exam, and pupil dilation. Testing for presbyopia might include all of these measures in person at an eye clinic.

Visual Acuity Testing

Your eye doctor uses a visual acuity test to compare your near vision to your far vision, which helps them measure refractive errors like nearsightedness and hyperopia.

Depending on the results of this test, your eye doctor will tell you whether you need progressive lenses, single-vision lenses, bifocals, or trifocals to correct your vision problems. All of these lenses, as well as over-the-counter reading glasses, can correct presbyopia at different levels.

Refraction Testing

Refraction tests help your eye doctor determine your prescription for effective presbyopia treatment. This test measures how light bends as it passes through the cornea, the lens, and other parts of your eye affected by presbyopia.

Depending on the results, your eye doctor can write a prescription that adjusts how light enters your eyes and helps you with close-up vision.

Pupil Dilation

It can be difficult to get a good look at your eyes without some help. Dilating your pupils enlarges them so your eye doctor can see exactly what’s happening. To do this, they’ll administer special eye drops, which widen your pupils and can make any issues more visible.

General Eye Health Exam

Sometimes, the symptoms of presbyopia can look deceptively similar to other medical conditions. For example, hyperopia (farsightedness) can make it hard to see near objects, but it’s a different condition with its own unique causes that set it apart from presbyopia.

That’s why your eye doctor will thoroughly check for other eye diseases and refractive issues that might coexist with presbyopia or be the sole cause of your trouble seeing clearly.

Other aging-related eye issues, such as glaucoma and cataracts, sometimes develop alongside presbyopia, and a thorough eye health exam will help your eye doctor catch early signs of these common diseases.

By focusing on the correction of presbyopia and overall preventative eye health care, your opthalmologist will help you manage your vision to the best of your ability and see as clearly as possible.

What Are the Treatment Options for Presbyopia?

Presbyopia is usually treated with glasses initially, and over-the-counter reading glasses may do the trick for a while. However, other lenses can provide more significant improvements, which you may need as the condition progresses.

Eye doctors sometimes prescribe bifocal glasses for presbyopia, especially in its early stages of development. These glasses' lenses have two levels of magnification, one for seeing up close and one for distance vision.

Similarly, trifocals have three distinct magnification levels, with extra support added for intermediate vision. Progressive lenses, sometimes called no-line bifocals, support your eyes at different focal lengths without sharp transitions between magnification levels.

All of these lenses can correct presbyopia, but the right choice for you depends on how much the condition has progressed.

Contacts can also help with presbyopia. Monovision contact lenses are one of the most unique forms of treatment, with one eye fitted for distance vision and one for near vision. This imbalance in the prescription can make it easier for your eyes to focus on nearby objects without squinting or straining.

Should You Get Surgery for Presbyopia?

If your presbyopia is so severe that it’s making your life less enjoyable, your ophthalmologist might recommend surgery. You have a few options here, including LASIK surgery, intraocular lens implants, corneal inlays, and more.

LASIK

LASIK is used to correct refractive errors — everything from nearsightedness to astigmatism —and it changes the shape of your cornea to normalize how light enters your eye.

After this surgery, you most likely won’t have to wear glasses or contact lenses; the results can last for decades. Sometimes, this refractive surgery is as close to a permanent solution as possible.

LASIK has a quicker recovery time than other procedures, and you’ll notice the difference in your vision right away. However, you might need extra magnification from reading glasses to help you see clearly over time. Additionally, not everyone can go through LASIK, as some eye conditions make the procedure risky.

Intraocular Lens Implants (IOLs)

This intense form of presbyopia treatment replaces your eye’s natural lens with an artificial one. While this treatment is most often used as part of cataract surgery, it’s also a helpful way to correct refractive errors like presbyopia.

You have multiple options for lens implants, and your eye doctor can help you determine the right one for you. Monofocal IOLs correct your vision at only one distance, usually a solution for seeing far away — but that means they aren’t usually the best for presbyopia.

Multifocal lenses can correct near, intermediate, and distance vision, making them more versatile and helpful.

The best and most modern form of IOLs is accommodative lenses, which mimic your natural lens’ ability to adjust focus based on what you’re looking at. These artificial lenses adapt to your environment and can be especially helpful if you struggle to see close up and far away.

Corneal Inlays

These implants can help your eyes focus at greater depths, and they’re typically used in just one eye, leaving the other for distance vision. However, this option isn’t as helpful if you have other corneal issues, and it can have some complications. Still, it’s worth talking over with your eye doctor.

Achieve Relief From Presbyopia

Presbyopia can make it hard to do what you love, so it’s always worth it to ask about treatment. Through close work with your eye doctor and following their advice, you can find the best possible solution for your vision problems and have clearer vision than you’ve had in years.

Sources:

Refractive Errors | Johns Hopkins Medicine

IOL Implants: Lens Replacement After Cataracts | American Academy of Ophthalmology

LASIK surgery: Is it right for you? | Mayo Clinic

Farsightedness: What Is Hyperopia? | American Academy of Ophthalmology