Presbyopia: Symptoms, Causes & Treatment
Have you noticed your eyesight changing as you age? You’re not alone. Presbyopia is an unavoidable, natural condition. You may start experiencing its effects in your 40s, when you have trouble seeing small print. It’s not a disease, but there are ways to get relief. Here’s our guide to understanding and treating presbyopia.
What is presbyopia?
Presbyopia is the inability to focus on objects near your eyes.
What causes presbyopia? As we grow older, proteins in the lens at the front of the eye begin to change. This makes the lens lose flexibility. Muscle fibres around the lens also weaken. As a result, the lens can’t change shape to focus like it used to.
Find out more in our video with Mr Tariq Ayoub, Consultant Ophthalmologist at Oculase:
The onset of presbyopia is very gradual. You may notice the following signs and symptoms:
- Eye strain or headaches after close-up work or reading
- Needing brighter lighting for reading vision
- Blurred text at normal reading distances
- You squint or hold reading material further away to make letters more legible.
Without correction, presbyopia will only make your eyesight worse. As your ability to focus continues to decrease, small text becomes impossible to read.
Because everyone develops presbyopia eventually, it’s possible to have it alongside pre-existing eye conditions. These include myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.
Cardiovascular disease, diabetes and multiple sclerosis increase risks of developing presbyopia before the age of 40. Certain medicines – such as antidepressants, antihistamines and diuretics – may bring on premature presbyopia.
There are many presbyopia treatment options. The first line of treatment is to prescribe glasses or contact lenses.
Because eyes change as you age, the prescription for your glasses or contacts also needs adjusting from time to time. This usually settles around the age of 65.
At any stage, if none of those options is suitable, we can treat presbyopia with surgery.
Prescription lenses use eye examination measurements to meet your needs:
- Prescription reading glasses: These are only for reading and close work. They’re suitable if you have no other vision problems.
- Bifocals and trifocals: These have two or three corrections for reading and distance vision, but there’s a visible line separating the focusing strengths.
- Progressive lenses: These lenses blend the different focusing strengths. They help you change focus more naturally as you shift your gaze.
Lenses can also have:
- Anti-reflective coating to reduce eye strain
- Photochromic coating, which darkens in bright light.
What if you use contact lenses and develop presbyopia? You could have prescription glasses for reading without needing to remove your contacts.
Different types of contact lenses include:
- Soft lenses: Thinner and less rigid than hard lenses, they’re designed to be comfortable for long periods of time.
- Hard lenses: Thicker and more rigid, they’re designed for superior visual acuity.
- Bifocal and multifocal: These contact lenses (soft or hard versions) contain different focal strengths for near and distant vision.
- Monovision and modified monovision: These contact lenses provide different focussing strengths to each eye.
When glasses or contact lenses aren’t ideal, surgery may be an option for presbyopia. What are the benefits of having surgery? It can make wearing glasses unnecessary. And everyday activities like reading, watching television, driving, or using a computer are much easier.
In broad terms, there are two main kinds of presbyopia surgery: laser eye surgery and refractive lens exchange.
Laser eye surgery
There are different types of laser eye surgery (or laser vision correction) for presbyopia. But they all involve a laser beam to reshape the transparent front part of the eye known as the cornea:
LASIK (laser-assisted in-situ keratomileusis). Surgeons create a thin flap in the cornea. The laser reshapes the cornea’s inner layers to correct your vision, and the flap is re-positioned at the end of the procedure.
LASEK (laser-assisted subepithelial keratectomy). Laser is used to reshape the cornea to correct your vision after the surface layer of the cornea, called the epithelium, is removed.
Trans-PRK (photorefractive keratectomy) is similar to LASEK. However, unlike LASEK, laser is used to remove the outer layer of the cornea called the epithelium and then laser is used to reshape the cornea to correct your vision.
Blended monovision LASIK or Trans-PRK can be used to correct your dominant eye for distance and non-dominant eye for near correcting your presbyopia and giving you greater glasses independence .
Refractive lens exchange (RLE)
If laser surgery cannot correct your presbyopia, we can replace the natural lens with an advanced artificial intraocular lens implant.
Refractive lens exchange is more invasive than laser surgery and identical to the procedure used to treat cataracts. One of its benefits is that if you have RLE, you won’t develop a cataract later in life. It will also correct your short-sightedness, long-sightedness, astigmatism and your presbyopia.
Listen to the experience of our patients who have had presbyopia surgery.
Book an appointment
If you experience blurred vision that prevents you from enjoying day-to-day activities, book an appointment to find out how we can help.
At your first visit, we will carry out a complete eye exam, including eye scans and an eye health check. The consultation will determine whether laser eye surgery or another procedure is the right choice for you.