What is Presbyopia?

What is Presbyopia?

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.

During middle age, usually beginning in the 40s, people experience blurred vision at near points, such as when reading, sewing or working at the computer. There’s no getting around it — this happens to everyone at some point in life, even those who have never had a vision problem before.

Presbyopia Symptoms and Signs

When people develop presbyopia, they find they need to hold books, magazines, newspapers, menus and other reading materials at arm’s length in order to focus properly. When they perform near work, such as embroidery or handwriting, they may have headaches or eyestrain, or feel fatigued. You may notice these symptoms are worse if you are tired or are in an area with dim lighting.

What Causes Presbyopia?

Presbyopia is caused by an age-related process. This is different from astigmatism, nearsightedness and farsightedness, which are related to the shape of the eyeball and caused by genetic factors, disease, or trauma. Presbyopia is generally believed to stem from a gradual loss of flexibility in the natural lens inside your eye.

The eye’s lens stiffens with age, so it is less able to focus when you view something up close. The result is blurred near vision.

(Illustration: Varilux)

These age-related changes occur within the proteins in the lens, making the lens harder and less elastic with the years. Age-related changes also take place in the muscle fibers surrounding the lens. With less elasticity, the eye has a harder time focusing up close. Other, less popular theories exist as well.

When to see a doctor

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.

 

 Presbyopia Treatment:

 Eyewear

Eyeglasses with bifocal or progressive addition lenses (PALs) are the most common correction for presbyopia. Bifocal means two points of focus: the main part of the spectacle lens contains a prescription for nearsightedness or farsightedness, while the lower portion of the lens holds the stronger near prescription for close work.

Progressive addition lenses are similar to bifocal lenses, but they offer a more gradual visual transition between the two prescriptions, with no visible lines between them.

Reading glasses are another choice. Unlike bifocals and PALs, which most people wear all day, reading glasses are typically worn just during close work. If you wear contact lenses, your eye doctor can prescribe reading glasses that you wear while your contacts are in. You may purchase readers over-the-counter at a retail store, or you can get higher-quality versions prescribed by your eye care practitioner.

Contact Lenses

People with presbyopia also can opt for multifocal contact lenses, available in gas permeable or soft lens materials.

Another type of contact lens correction for presbyopia is monovision, in which one eye wears a distance prescription, and the other wears a prescription for near vision. The brain learns to favor one eye or the other for different tasks.

While some people are delighted with this solution, others complain of reduced visual acuity and some loss of depth perception. Because the human eye change as you grow older, your presbyopia glasses or contacts prescription will need to be increased over time as well. You can expect your eye doctor to prescribe a stronger correction for near work as you need it.

Lasers for Presbyopia-PresbyLASIK: LASIK for presbyopia correction

Multifocal LASIK — sometimes called presbyLASIK — is an advanced type of laser vision correction surgery that changes the shape of the eye’s cornea to create different power zones for seeing at varying distances.

Like progressive lenses and other multifocal eyeglasses and contact lenses, multifocal LASIK corrects presbyopia, which causes near vision to blur as the eye’s natural lens begins to lose its focusing flexibility later in life (generally, soon after age 40).

 

Surgery for Presbyopia

1. Corneal Inlays

Corneal inlays are an exciting new option for the correction of presbyopia. These tiny lenses are implanted in the cornea of one eye to improve near vision without causing any significant loss in distance vision.

Kamra Corneal Inlay

Developed by AcuFocus, the Kamra corneal inlay received FDA approval for use in the U.S. in April 2015. It also is commercially available in nearly 50 countries worldwide.

Corneal inlays for presbyopia correction generally are placed in the anterior portion of the corneal stroma of the non-dominant eye.

2. Near Vision CK

NearVision CK is a minimally invasive surgical procedure that uses radio-frequency (RF) energy to change the shape of the cornea and provide sharper near vision without glasses.

NearVision CK is a monovision technique — meaning one eye is made nearsighted by the procedure (for improved close-up vision) while the other eye remains untouched.

The limitation of monovision is that the eye that sees clearly up close will be blurry in the distance. But with both eyes open, most people can adapt to this and feel their vision is acceptably clear at all distances.

Still, it’s a good idea to first try monovision with contact lenses or a trial lens in the doctor’s office before proceeding with NearVision CK, to make sure you’ll adapt.

Another limitation of NearVision CK is that the vision improvement from the procedure tends to diminish after several months and the procedure may need to be repeated.

3. Refractive Lens Exchange

Refractive lens exchange (RLE) is a more invasive procedure that can be used for presbyopia correction. In this procedure, the eye’s natural lens is removed and replaced with an intraocular lens (IOL) that’s identical to the type of IOL used in cataract surgery

RLE can correct presbyopia by replacing the eye’s natural lens with a multifocal IOL or an accommodative IOL. In addition to providing clear distance vision, these premium intraocular lenses help restore near vision as well.

Consult with Your Eye Doctor First

The first step in finding the best solution to presbyopia for your needs — including surgery for presbyopia — is to have a consultation with your eye doctor following a comprehensive eye exam.

Your doctor can help you choose what makes the most sense for you based on important factors including your age, eye health and your daily visual needs.

FOR FURTHER READING

• https://www.mayoclinic.org/diseases-conditions/presbyopia/symptoms-causes/syc-20363328
• https://www.allaboutvision.com/en-in/conditions/presbyopia/
• https://www.healthline.com/health/presbyopia
• https://www.allaboutvision.com/over40/presbyopia_surgery.htm