Presbyopia is the inability to see clearly up close due to a natural aging process inside of the eye. The lens sits just behind the colored part of the eye (the iris) and changes shape to help us focus both far and near. This happens easily when we are younger because the lens is soft and flexible. However, once we are around age 40, the lens begins to become more rigid and less flexible, making it harder to focus on items up close.
Presbyopia is often confused with hyperopia, which is the inability to see clearly up close due to the length of the eye. Although they both make it difficult to see near objects clearly, they are entirely different vision disorders.
Near object is clear
Lens hardens with age
Image behind the retina
Near object is blurry
Correction with a plus lens
Presbyopia typically begins to develop around age 40 and will continually worsen from about age 45-65. Everyone will develop presbyopia eventually, as this natural aging process cannot be stopped or cured.
One of the first tell-tale signs of presbyopia is having to hold items such as your phone or a book further away to read it clearly. You may also experience headaches or eye strain, especially after reading or doing other close tasks such as sewing or reading a medicine bottle.
As presbyopia progresses, it will become more and more difficult to see at an intermediate range as well (such as reading the car dashboard or using a computer). Many times this is what brings patients into our office, as they’ve discovered their “arms aren’t long enough anymore!”
Presbyopic patients will also notice that it is substantially easier to read with more light. Low-light environments, such as dim restaurants, will make reading more difficult. (That’s why you may notice people in restaurants using their cell phone flashlights to read the menu!)
Presbyopia will progress naturally over time, making near and intermediate vision increasingly difficult. This natural process is unavoidable and irreversible, but thankfully presbyopia is easily corrected with one of the following methods.
Reading-only glasses: Either drug-store reading glasses or prescription glasses designed to only be worn for near tasks. Distance vision will be blurry with this type of prescription so these glasses are for part-time wear only.
Bifocal, trifocal, or progressive glasses: These glasses have two or three different prescriptions in one lens to correct for multiple distances. A lined bifocal will correct for both distance and near while a lined trifocal or a progressive lens will correct for distance, intermediate (such as computer or dashboard range), and near. These glasses can all be worn full-time, which most patients find to be more convenient than having to search for their reading-only glasses.
Computer or workspace lenses: A secondary pair of computer or workspace lenses may be ideal for certain work environments. These lenses are designed to focus at an intermediate range (such as computer distance) and can be further specialized to help with near vision as well.
Multifocal contacts: Multifocal contacts are specially designed lenses that have reading powers aligned in concentric rings to automatically improve your near vision when focusing up close. They allow you to see clearly at all ranges without relying on reading glasses.
Monovision contacts: An excellent alternative if you are not a candidate for or not interested in multifocal contacts. This involves correcting your dominant eye for distance and the other eye for near.
Surgery: There are a few surgical options available for presbyopes including implants or cataract surgery.
Medicated eye drops: In the fall of 2021, Allergan released an FDA-approved eye drop called Vuity (pilocarpine HCl 1.25%) that is dosed once daily to treat mild to moderate presbyopia. It works by contracting the muscles of the iris which constricts pupil size in order to help presbyopes focus more clearly on near or intermediate tasks without impacting their distance vision. Vuity works as quickly as 15 minutes and for as long as 6 hours.
Keep in mind that although everyone will develop presbyopia, treatment is not the same for everyone due to underlying prescriptions (whether they are also nearsighted or farsighted). For instance, it is possible to sit down at a table with three presbyopic friends who all have a different approach to clearly reading the menu. One person may be able to see it clearly by simply taking off their glasses, another may need to just temporarily use a pair of reading glasses, and the third may require their prescription glasses or contact lenses to read it.
If this sounds all too familiar and you think you might be suffering from the strains of presbyopia you are not alone! Contact us today to schedule an appointment so you can talk with our doctors about the best treatment strategy for you!