Understanding Presbyopia

What is Presbyopia?

Presbyopia is an age-related eye condition that gradually affects the ability to see clearly and focus at near distances. Presbyopia is a natural part of aging – it will affect everyone at some point of their life but usually starts around the age of 40. But what does it mean for our eyes and how can it be treated?

The natural lens in your eyes is flexible and soft to begin with, meaning it can easily adapt its shape to focus light into the retina. This flexibility is important when using your eyes at near distances, as the lens changes shape to adjust its focusing power. With age, the lens gets stiffer and thicker, whilst the circular muscle fibres surrounding it also begin to deteriorate, making this process more difficult.

Gradually, presbyopia can cause objects in near distances, such as the small print on labels or a text on your mobile phone, to appear out of focus.

It’s common for those suffering from untreated presbyopia to hold objects at an arm’s length in order to help them to focus; however this is only a short-term solution. This is because the lens continues to lose its elasticity until around the age of 65 and seeing at near distances grows considerably more difficult and ‘fuzzier’.

Presbyopia Symptoms

The only direct symptom of presbyopia is the gradual inability to focus on objects at near distances, yet our eyes naturally work harder to compensate, causing further complications. Though the condition eventually affects everyone, the signs of presbyopia are so gradual that you might not notice at first. This is why regular eye check-ups above the age of 40 are especially important, to avoid picking up common, yet harmful habits to ease eyesight.

These can include:

  • Having to hold objects at an arm’s length to read
  • Having to use bright lights to read
  • Squinting more than usual

These habits can cause eye strain and headaches that grow more unmanageable as time goes on.

Presbyopia can also be onset earlier in age due to other factors. If you already suffer from long-sightedness (difficulty seeing close up), you may need new glasses or contact lens prescriptions to manage presbyopia as it develops. Some medical conditions like diabetes, multiple sclerosis or cardiovascular diseases can also prompt an early onset presbyopia, as can certain drugs (antidepressants, antihistamines and diuretics).

Fortunately, there are a variety of presbyopia correction options that can help to restore your eyesight.

Presbyopia Treatment

Presbyopia can be corrected with eye glasses or contact lenses, while some people choose to have a refractive lens exchange or other surgical procedures, which can significantly reduce reliance on glasses or contact lenses.

Non-prescription reading glasses

If your presbyopia is mild and you haven’t previously relied on corrective lenses for long or short sightedness or astigmatism, you may only need reading glasses. These can be bought without a prescription and vary in strength ( +1.00 D to +3.00 D). Discuss with your optometrist or eye doctor whether this would work for you. You would need to remove these when you’re not reading as they would feel blurred at far distances.

Prescription glasses or contact lenses

If your presbyopia cannot be corrected with over-the-counter glasses, or you already suffer from other vision issues, your eye doctor might prescribe you stronger eye glasses or contact lenses. Like over-the-counter options, these bend light rays before they enter your eye to enable you to focus more clearly.

Some options – like bifocals and trifocals – have one or two visible lines on the glasses that separate distance vision from reading vision, meaning you shouldn’t have to remove your glasses throughout the day. Progressive multifocals are an option which gradually changes the focus from distance, through intermediate to near, depending on which area of the lens you use.

Contact lenses are often an option for those with more active lifestyles, or for those who dislike wearing glasses. There are various options available, including bifocal, which corrects near and distance vision in each lens, or monovision correction, which divide the vision ranges between each lens.

As with all contact lenses, these require changing and cleaning at regular intervals. If you have any other eye issues concerning the tear ducts or surface of your eye, wearing contact lenses may cause future complications, so it’s important to discuss these risks with your optometrist or eye doctor.

Refractive surgery

There are various type of this treatment that involve using lasers, small incisions or other measures to reshape the cornea (the clear outer layer of your eye) of your non-dominant eye to help with close-up vision.

This procedure is attractive for those who dislike the monotony of glasses or contact lenses and want permanent vision correction. However, it’s important to discuss the after effects of refractive surgery, as this procedure is irreversible in many cases and you may still need to use glasses after surgery.

Refractive lens exchange

Refractive lens exchange offers presbyopia correction with an aim to reduce dependency on glasses. This treatment involves removing the natural lens inside each eye and replacing them with artificial, intraocular lenses. The procedure is relatively painless with anaesthetic and usually only takes 20-30 minutes for each eye, which are treated in separate appointments.

Having an intraocular lens implanted can help to avoid other eye health problems. For example, some opt for the implant of intraocular lenses to avoid the risk of cataracts and having to undergo other procedures later in life to remove them. This is because refractive lens exchange is essentially the same as cataract surgery – there is just no cataract to remove.

As with all surgical procedures, it’s important to discuss the potential risks of this treatment with your eye doctor, as it is irreversible and you may still need to use glasses at certain ranges.

PanOptix® IOL

There are also various lens options to choose from when undergoing refractive lens exchange. Alcon developed PanOptix® IOL trifocal lenses to improve vision at near, optimal intermediate and distance ranges. Better yet, the success rate is high;

  • 100% of patients reported spectacle independence at near and intermediate ranges after having surgery*
  • 95% of patients reported spectacle independence at far distances with the PanOptix® IOL trifocal lens*

* Based on the feedback from 20 patients 3 months after bilateral implantation of the PanOptix® IOL