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Presbyopia

 

Presbyopia is a condition in which the lens of the eye loses its ability to focus. This makes it hard to see objects up close.

Causes

The lens of the eye needs to change shape to focus on objects that are close. The ability of the lens to change shape is because of the elasticity of the lens. This elasticity decreases slowly as people age. The result is a slow loss in the ability of the eye to focus on nearby objects.

People most often begin to notice the condition at around age 45, when they realize that they need to hold reading materials farther away in order to focus on them. Presbyopia is a natural part of the aging process and it affects everyone.

Symptoms

 

Symptoms include:

  • Decreased focusing ability for near objects
  • Eyestrain
  • Headache

 

Exams and Tests

 

The health care provider will perform a general eye exam. This will include measurements to determine a prescription for glasses or contact lenses.

Tests may include:

  • Exam of the retina
  • Muscle integrity test
  • Refraction test
  • Slit-lamp test
  • Visual acuity

 

Treatment

 

There is no cure for presbyopia. In early presbyopia, you may find that holding reading materials farther away or using larger print or more light for reading may be enough. As presbyopia worsens, you will need glasses or contact lenses to read. In some cases, adding bifocals to an existing lens prescription is the best solution. The reading glasses or bifocal prescription will need to be strengthened as you get older and lose more ability to focus up close.

By the age of 65, most of the lens elasticity is lost so that the reading glasses prescription won't continue to get stronger.

People who do not need glasses for distance vision may only need half glasses or reading glasses.

People who are nearsighted may be able to take off their distance glasses to read.

With the use of contact lenses, some people choose to correct one eye for near vision and one eye for far vision. This is called "monovision." The technique eliminates the need for bifocals or reading glasses, but it can affect depth perception.

Sometimes, monovision can be produced through laser vision correction. There are also bifocal contact lenses that can correct for both near and far vision in both eyes.

New surgical procedures are being evaluated that can also provide solutions for people who do not want to wear glasses or contacts. Two promising procedures involve implanting a lens or a pinhole membrane in the cornea. These very often can be reversed, if necessary.

People who are having cataract surgery can chose to have a special type of lens implant that allows them to see clearly in the distance and up close.

 

Outlook (Prognosis)

 

Vision can be corrected with glasses or contact lenses.

 

Possible Complications

 

Vision difficulty that gets worse over time and is not corrected can cause problems with driving, lifestyle, or work.

 

When to Contact a Medical Professional

 

Call your provider or ophthalmologist if you have eye strain or have trouble focusing on close objects.

 

Prevention

 

There is no proven prevention for presbyopia.

 

 

References

Alio JL, Azar DT, Stasi K, Soria FA. Surgical correction of presbyopia. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 3.10

Crouch ER, Crouch ER, Grant TR. Ophthalmology. In: Rakel RE, Rakel D, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 17.

Doane JF. Accommodating intraocular lenses. In: Tansman W, Jaeger EA, eds. Duane's Clinical Ophthalmology. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol. 6, chap 14.

Donahue SP. Presbyopia and loss of accommodation. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 9.21

Sheedy JE, Andre BJ. Prescribing multifocal lenses. In: Tansman W, Jaeger EA, eds. Duane's Clinical Ophthalmology. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol. 1, chap 44.

 
  • Farsighted

    Farsighted - illustration

    A person who is farsighted has the ability to see objects clearly far away but not see as clearly close-up. Farsightedness usually occurs naturally with the aging process.

    Farsighted

    illustration

    • Farsighted

      Farsighted - illustration

      A person who is farsighted has the ability to see objects clearly far away but not see as clearly close-up. Farsightedness usually occurs naturally with the aging process.

      Farsighted

      illustration

    Tests for Presbyopia

     

       

      Review Date: 3/15/2016

      Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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