What is presbyopia?
Presbyopia is a universal natural age-related change in close vision, where your eyes gradually lose the ability to see things clearly up close. Presbyopia is a normal part of aging that affects everyone. Symptoms of presbyopia generally first become noticeable in your mid-40s. It makes near tasks such as reading, phone use, and detailed close work such as threading a needle, more difficult. Initially when you first become aware of presbyopia you will probably find that you hold reading materials farther away in order to see them clearly.
What causes presbyopia?
Inside the eye, beyond the pupil, sits the crystalline lens. The lens in our eye is responsible for adjusting our focus from distance to near. When we are looking into the distance the lens is flat and relaxed. When we look at something up close the lens changes shape becoming more steeply curved enabling things at close range to come into sharp focus. When we are young this process happens instantaneously inside the eye without us being aware. This process is called accommodation. Throughout our lives the lens inside our eye becomes more rigid and less elastic, this leads to the gradual reduction in the ability of the lens to change shape, to focus at near, resulting in a reduced ability to see things clearly at close range.
For many, presbyopia can seem like the sudden need for reading glasses which can feel frustrating or inconvenient, especially if you have always enjoyed good vision up until your mid 40’s.
Treatment options for presbyopia
While presbyopia cannot be prevented, a range of effective treatment options can restore functional near vision. These include:
1. Glasses
- Reading glasses: Used only for near tasks
- Multifocal or progressive glasses: Provide a blend of distance, intermediate, and near vision
- Bifocals: Distance correction on top with near correction below
2. Contact Lenses
- Multifocal contact lenses
- Monovision lenses, where one eye is set for distance and the other for near
3. Laser Vision Correction
Procedures such as LASIK or SMILEpro can be customised to create:
- Monovision
- Mini-monovision – providing improved vision at arm’s length (computer screen) while maintaining good distance clarity. Spectacles would still be required for reading tasks.
4. Lens Surgery (Intraocular Lens Options)
During cataract surgery or refractive lens exchange, the natural lens is replaced with an artificial intraocular lens (IOL). Options include:
- Full range of vision IOLs: Provide good near, intermediate, and distance vision.
- Extended depth-of-focus (EDOF) IOLs: Offer a smooth range of vision, especially for intermediate tasks.
- Monovision with IOLs: One eye set for distance, the other for near.
These solutions can significantly reduce or eliminate the need for reading glasses.
Choosing the right visual solution when you have presbyopia
A discussion with the eye surgeon and consideration of the following will help determine the best option for you:
- Lifestyle and visual priorities
- Eye health and prescription
- Desire to reduce reliance on glasses
- Occupation and hobbies