Presbyopia is the gradual loss of your eyes’ ability to focus on nearby objects. It’s a natural, often annoying part of aging. Presbyopia usually becomes noticeable in your early to mid-40s and continues to worsen until around age 65.
You may become aware of presbyopia when you start holding books and newspapers at arm’s length to be able to read them. A basic eye exam can confirm presbyopia. You can correct the condition with eyeglasses or contact lenses. You might also consider surgery.
Presbyopia develops gradually. You may first notice these signs and symptoms after age 40:
You may notice these symptoms are worse if you are tired or are in an area with dim lighting.
See an eye doctor if blurry close-up vision is keeping you from reading, doing close-up work or enjoying other normal activities. He or she can determine whether you have presbyopia and advise you of your options.
Seek immediate medical care if you:
To form an image, your eye relies on the cornea and the lens to focus the light reflected from objects. The closer the object, the more the lens flexes.
The lens, unlike the cornea, is somewhat flexible and can change shape with the help of a circular muscle that surrounds it. When you look at something at a distance, the circular muscle relaxes. When you look at something nearby, the muscle constricts, allowing the relatively elastic lens to curve and change its focusing power.
Presbyopia is caused by a hardening of the lens of your eye, which occurs with aging. As your lens becomes less flexible, it can no longer change shape to focus on close-up images. As a result, these images appear out of focus.
Certain factors can make you more likely to develop presbyopia, including:
Presbyopia is diagnosed by a basic eye exam, which includes a refraction assessment and an eye health exam.
A refraction assessment determines if you have nearsightedness or farsightedness, astigmatism, or presbyopia. Your doctor may use various instruments and ask you to look through several lenses to test your distance and close-up vision.
Your eye doctor likely will put drops in your eyes to dilate your pupils for the eye health exam. This may make your eyes more light sensitive for a few hours after the exam. Dilation enables your doctor to more easily view the inside of your eyes.
The American Academy of Ophthalmology recommends that adults have a complete eye exam every:
You may need more-frequent exams if you have risk factors for eye disease or you need glasses or contact lenses.
The goal of treatment is to compensate for the inability of your eyes to focus on nearby objects. Treatment options include wearing corrective eyeglasses (spectacle lenses) or contact lenses, undergoing refractive surgery, or getting lens implants for presbyopia.
Eyeglasses are a simple, safe way to correct vision problems caused by presbyopia. You may be able to use over-the-counter (nonprescription) reading glasses if you had good, uncorrected vision before developing presbyopia. Ask your eye doctor if nonprescription glasses are OK for you.
Most nonprescription reading glasses range in power from +1.00 diopter (D) to +3.00 D. When selecting reading glasses:
You’ll need prescription lenses for presbyopia if over-the-counter glasses are inadequate or if you already require prescription corrective lenses for nearsightedness, farsightedness or astigmatism. Your choices include:
People who don’t want to wear eyeglasses often try contact lenses to improve their vision problems caused by presbyopia. This option may not work for you if you have certain conditions related to your eyelids, tear ducts or the surfaces of your eyes such as dry eye.
Several lens types are available:
Refractive surgery changes the shape of your cornea. For presbyopia, this treatment can be used to improve close-up vision in your nondominant eye. It’s like wearing monovision contact lenses. Even after surgery, you may need to use eyeglasses for close-up work.
Talk with your doctor about the possible side effects, as this procedure is not reversible. You might want to try monovision contact lenses for a while before you commit to surgery.
Refractive surgical procedures include:
Some ophthalmologists use a procedure in which they remove the lens in each eye and replace it with a synthetic lens. This is called an intraocular lens.
Several types of lens implants are available for correcting presbyopia. Some allow your eye to see things both near and at a distance. Some change position or shape within the eye (accommodative lens). But lens implants can cause a decrease in the quality of your near vision, and you may still need reading glasses.
Possible side effects include glare and blurring. In addition, this surgery carries with it the same risks as those associated with cataract surgery, such as inflammation, infection, bleeding and glaucoma.
Some people have had success with a presbyopia treatment that involves inserting a small plastic ring with a central opening, into the cornea of one eye. The opening acts like a pinhole camera and allows in focused light so that you can see close objects.
If you don’t like the results of your corneal inlay procedure, your eye surgeon can remove the rings, leaving you free to consider other treatment options.
You can’t prevent presbyopia. You can help protect your eyes and your vision by following these tips:
If you’re having difficulty with your vision, start by seeing an eye specialist (optometrist or ophthalmologist). To make the most of your time with your doctor, it’s a good idea to prepare for your appointment. Here’s some information to help you prepare.
Preparing a list of questions can help you make the most of your time with your doctor. List your questions from most important to least important. For presbyopia, some basic questions to ask your doctor include:
In addition to the questions that you’ve prepared, don’t hesitate to ask additional questions that may occur to you during your appointment.
Your doctor is likely to ask you a number of questions, including some that relate to your general health, your medical history, your eye health history, your family medical history and your history of eye problems. Your doctor may ask:
Make sure you have adequate lighting. If you don’t currently wear prescription eyeglasses, try a pair of over-the-counter (nonprescription) reading glasses.
In Presbyopia, a person’s eye progressively diminishes in its ability to focus on near objects with age. The exact mechanism that causes this “loss” in focusing ability is not completely proven. However, most researchers believe that the crystalline lens inside the eye loses its flexibility with age as an early cataract begins to form.
Presbyopia occurs as a patient begins to enter their late 30s or early 40s. It is characterized by an inability to use the muscles inside the eye to move the image from behind the retina onto the retina. This is often corrected with lenses that have a bifocal in them.
This loss in flexibility directly causes a loss in a person’s ability to focus. Similar to grey hair, presbyopia is a symptom that everyone experiences as they age.
The first symptoms most people notice are difficulty reading the fine print, particularly in low light conditions, eyestrain when reading for long periods, blur at near or momentarily blurred vision when transitioning between viewing distances. Many extreme presbyopes complain that their arms have become “too short” to hold reading material at a comfortable distance.
Presbyopia symptoms, like other focus defects, become much less noticeable in bright sunlight due to the action of the iris closing to a smaller diameter. This is a similar effect that occurs with a camera. A small pupil increases the depth of field for the observer and offers some help for the observer.
A delayed onset of seeking correction for presbyopia has been found among those with certain professions. For instance, homemakers and farmers work in broad lighting conditions and are not stuck on a computer all day, so they tend to seek out help a few years later than engineers and computer programmers who are looking at small print much more frequently.
Treatment for presbyopia has advanced significantly in recent years with many options now available to our patients. Some of the following options you may find helpful:
1. Reading Glasses – Over the counter reading glasses are sold to may people in drug stores and in dollar stores. They are an effective form of treatment for people who see well in the distance. Of course, these do not work for nearsighted individuals and only work well for far-sighted individuals who have small degrees of farsightedness.
2. Contact Lenses – Have you ever seen the president of the United States wearing glasses? The reason why you never see this occurring is that every president of the United States has monovision contact lenses and or bifocal contact lenses. This is a very effective form of treatment that can be tried during a contact lens examination.
3. Bifocal Glasses – This works very well for most people. The top portion of the glasses are for seeing in the distance and the bottom portion of the lenses are for seeing up close. The two main types of bifocal glasses are glasses with and without a line. A progressive addition lens does not have a line. Lots of people prefer the “no line” or progressive lens because it is cosmetically pleasing. However, we prefer the lined bifocal because it is easier for a patient to adapt too. During the routine eye examination, a prescription is always given to the patient, and bifocal glasses are an excellent option for glasses.
Cataracts are hard to see through because they cause clouding of the lens within the eye. Cataracts most often affect both eyes and cause glare sensitivity and blurred vision.
A cataract is a normal part of ageing. As we age, the normally clear crystalline lens within our eye can become yellow or opaque. Clinically significant cataracts occur when the patient is bothered by glare or blurred vision.
Most cataracts are caused by age and progress slowly. The following risk factors can increase the chance or progression of cataract:
1. Accumulated exposure to ultraviolet radiation
3. Some diseases of the eye
4. Some medications
5. Systemic diseases such as diabetes
6. Poor nutrition
In the early stages, your optometrist will monitor your cataract(s). Often your vision can be improved by making a change in your eyeglass prescription. However, if the cataract progresses and causes your vision to become too blurry a referral to an Ophthalmologist for cataract surgery will be arranged by your Optometrist. To Slow down the formation of cataracts we recommend protection from the sun and a balanced diet.
Regular eye examinations by the optometrist to check the health of your eyes
Glaucoma is a disease of the optic nerve, which causes loss of peripheral vision initially, and can lead to tunnel vision and then blindness.
In most types of glaucoma, the nerve damage occurs slowly and creates blind spots in peripheral vision, but as the disease progresses, these blind spots enlarge and grow together. It is common for a person not to notice they are afflicted until the later stages of the disease when the central vision becomes affected. At this point, severe and irreversible vision loss has occurred.
In a less common form of glaucoma, called acute angle-closure glaucoma, patients may experience a sudden onset of a red, painful eye with blurred, steamy vision and seeing haloes or rainbows around lights. This is a Medical Emergency and requires immediate urgent treatment to lower the eye pressure and prevent blindness.
1. Age (More Common after 50)
3. Increased Pressure in the eye
4. High Hyperopia ( for Acute Glaucoma)
6. Some Medications
7. Family History
8. Trauma to the Eye
9. Infections and Inflammation
Most cases of glaucoma, if detected early, can be successfully controlled, provided the patient is compliant with using their medication and returning for regular monitoring and follow-up care.
1. Eye Drops Used Daily to lower the Pressure in the Eye
2. Laser Surgery
3. Oral Medicine (for acute cases of Glaucoma)
4. Ocular Microsurgery
NOTE: Glaucoma patients require to be monitored life-long