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Presbyopia

Medically reviewed by Drugs.com. Last updated on Nov 10, 2023.

Overview

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.

Symptoms

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.

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.

Seek immediate medical care if you:

Causes

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.

Anatomy of the eye

Your eye is a complex and compact structure measuring about 1 inch (2.5 centimeters) in diameter. It receives millions of pieces of information about the outside world, which are quickly processed by your brain.

Presbyopia

With normal vision, an image is sharply focused onto the retina (top image). If you have presbyopia, your inflexible lens doesn't adjust to focus light properly, so the point of focus falls behind the retina (bottom image). This makes close-up objects appear blurry.

Risk factors

Certain factors can make you more likely to develop presbyopia, including:

Diagnosis

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.

Treatment

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

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:

Contact lenses

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

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:

Lens implants

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.

Corneal inlays

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.

Lifestyle and home remedies

You can't prevent presbyopia. You can help protect your eyes and your vision by following these tips:

Preparing for an appointment

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.

What you can do

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.

What to expect from your doctor

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:

What you can do in the meantime

Make sure you have adequate lighting. If you don't currently wear prescription eyeglasses, try a pair of over-the-counter (nonprescription) reading glasses.

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