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If you’re older than 45 and things are looking a little blurry, there’s one very common cause. Here’s everything you need to know.
Maybe this sounds familiar, or you’ve seen it happening with someone you know: You’re holding restaurant menus a little farther away in order to see them clearly. Or you find yourself picking up your phone to read a text and then extending your arm until the words on the screen become clear. Or maybe you suddenly feel the need to turn on extra lights when you settle down to read a book.
These could all be signs of presbyopia, which is the age-related blurring of your close-up vision. In fact, here’s an amazing statistic: By age 45 to 55, almost 80% of Americans have presbyopia, and even though this common problem makes everything from working to checking social media to reading a recipe more challenging, an estimated 16% of people with presbyopia aren’t getting help for it. Here’s what you should know about the condition.
What is presbyopia?
Presbyopia is the gradual loss of clear, close-up vision caused by natural, age-related changes in your eye’s lens, according to the American Optometric Association. The lens plays an important role in sharp vision by precisely focusing light on the retina at the back of the eye.
In childhood and young adulthood, the lens is soft and changes shape easily as the ring of muscle that surrounds it contracts to bring nearby objects into focus. But after about age 45, the lens thickens, stiffens, and is less able to make those small adjustments that keep your close-up vision sharp, explains optometrist Rebecca Passa, O.D., who sees patients at America’s Best Contacts & Eyeglasses in Scottsdale, Arizona.
“Imagine squeezing a rubber ball,” Dr. Passa explains. “If it’s soft, it’s easy to squeeze. If it’s thick and hard, it’s more difficult to squeeze.”
Is presbyopia the same as being farsighted?
Both conditions make it difficult to see things clearly up close, but farsightedness (also called hyperopia) is different from presbyopia.
Hyperopia either happens when your eyes are shorter than normal (measured from back to front) or your lens or cornea (the clear layer at the front of your eyes) isn’t shaped optimally. In both cases, that means the light shining through your lens focuses on the wrong place inside your eyes — behind your retina instead of directly on it.
Presbyopia, on the other hand, isn’t about where light focuses inside your eyes. It’s due to physical changes (the stiffening and thickening mentioned above) in the lens itself.
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Does presbyopia happen only when you’re middle-aged and older?
“Presbyopia is a Greek word that literally means ‘old eye,’” Dr. Passa says. “There are other vision problems that can affect near vision in children and younger adults, but presbyopia always refers to near vision problems caused by changes to the lens with age.”
But for some people, this “old eye” problem arrives a little sooner. Diabetes, cardiovascular disease, multiple sclerosis, a head injury, and being farsighted can all increase your risk of developing presbyopia before age 40, according to the American Optometric Association. Taking antidepressants, diuretics, or antihistamines may also increase the odds of premature presbyopia.
What are the symptoms of presbyopia?
“You may notice your vision isn’t as clear as it used to be when you try to read a book or menu or something on your computer,” Dr. Passa says. “You may hold things farther and farther away to see clearly. You may also have headaches and eyestrain.”
Presbyopia can develop slowly, she adds, and you may be able to adjust for quite a while — and then you simply can’t anymore. “I often hear people say they woke up this morning and their phone is too blurry to read,” Dr. Passa says.
You may also notice the problem more when you’re feeling tired or the lights are dim.
How will my eye doctor diagnose presbyopia?
During an eye exam, your eye doctor will measure your vision at different distances. This involves reading an eye chart while you look through a device called a phoropter. Your doctor can measure your vision with different-strength lenses in front of your eyes, and they may also use a retinoscope to see how well your eyes can bend light.
What treatments are available for presbyopia?
You’ll be happy to hear that presbyopia is easily corrected with glasses or contact lenses. These simple devices restore sharp vision safely and relatively inexpensively. There are also some more drastic measures, such as surgery, that some people may want to consider.
Your eye doctor can help you sort through the pros and cons of each of these presbyopia treatments, help you figure out which will work best for you.
Let’s run through the options:
Prescription reading glasses
If you’ve never needed vision correction up until now, glasses are a very easy way to correct blurry up-close vision. Your eye doctor will give you a prescription specifically tailored to presbyopia.
Depending on the reading power that you need, you could choose to wear prescription reading glasses over distance-vision contact lenses. Or you could choose to have multiple pairs of glasses: one pair with lenses for distance and another pair with lenses for close-up vision, Dr. Passa says.
“Even people who wear bifocals or progressives sometimes get an extra pair of glasses specifically for reading and working on the computer once they develop presbyopia,” she adds.
For more on presbyopia solutions for contact lens wearers, read “Wearing Contact Lenses and Reading Glasses? You Have Other Options” here.
Bifocals, trifocals, and progressive multifocal lenses
If you already wear glasses for distance vision but are finding it increasingly hard to see up close, you may be a candidate for bifocals, trifocals, or progressive multifocal lenses that accommodate both distance and close vision.
Bifocal lenses provide correction for distance in the upper part of the lens and for close-up vision in the lower part. Trifocals are like bifocals, with the addition of an area in the middle of the lens for middle-distance vision (such as working at a computer).
Progressive multifocal lenses have corrections for distance, middle, and near vision but without visible lines on the lenses. Another type of glasses, called “office progressives,” are similar, but the lenses have areas that correct close-up and middle-distance vision only.
Contact lenses can also help you see better up close. Bifocal contact lenses work like bifocal glasses, with areas on each lens for distance and near vision correction. Monovision contact lenses give you corrected distance vision in one eye and corrected close-up vision in the other.
Nonprescription reading glasses, or “readers”
If you don’t need glasses or contact lenses for any other vision problem, your eye doctor may give you the go-ahead to use nonprescription reading glasses. The corrective power they provide ranges from +1.0 diopter (D) to +4.0 D.
For the most comfortable vision, be sure to buy the corrective power your doctor recommends. It’s also important to know that over-the-counter readers aren’t a good option if you need different corrective powers in each eye, which does happen sometimes. In fact, it’s one of the reasons it’s important to get your eyes examined when you first notice signs of presbyopia.
“Having one eye with the wrong correction will make the other eye work harder, contributing to eyestrain,” Dr. Passa says.
Surgery to reshape your cornea can also help with presbyopia, but it has drawbacks that should be considered carefully. Generally, the procedure is performed on one eye for close-up vision. Some experts recommend trying monovision contact lenses first to make sure this approach will work for you. That’s because the surgical procedure cannot be reversed. And you may still need reading glasses afterward.
Surgical options include LASIK (laser-assisted in situ keratomileusis), LASEK (laser-assisted subepithelial keratectomy), and PRK (photorefractive keratectomy), all of which use a laser to reshape the cornea. There’s also conductive keratoplasty, which, like the other procedures, involves reshaping the cornea, but it uses heat provided by radiofrequency energy to do the job.
Another fix involves replacing the lens in your eye with a new, synthetic one that’s multifocal. Research shows that there are potential drawbacks to this procedure, including vision problems like hazy vision and compromised night vision, as well as a small risk of infection.
“Most people wait and have this done as cataract surgery, when health insurance covers at least some of the cost,” Dr. Passa says.
You can choose from a variety of replacement lenses based on your vision needs and budget. Some of these lenses correct near vision, so you won’t need reading glasses.
Another type of implant, approved by the U.S. Food and Drug Administration (FDA) in 2015, is a corneal inlay. In this procedure, which is performed on your nondominant eye, a small disk is implanted into your cornea to increase its depth of field and to focus the light more precisely on the retina.
This eye then becomes the one that you use as the “near” eye for reading and other up-close activities. The procedure has risks and potential side effects (as does any surgery, no matter how minimally invasive). These include infections, scarring of the cornea, dry eyes, and poorer vision at night.
Prescription eye drops
One of the big health headlines in 2021 was the introduction of the first FDA-approved eye drops to treat presbyopia. The drops, called Vuity (pilocarpine hydrochloride ophthalmic solution) 1.25%, are a potential game-changer for people in their 40s and 50s who are in the early stages of presbyopia, Dr. Passa says.
“The drops seem to work better in that group of people,” she says.
The drops sharpen near vision for about six hours by reducing the size of your pupil to change the way your eyes focus light. “And they may affect your ability to drive at night,” she adds.
Possible side effects include eye redness and headache.
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Are new presbyopia treatments being explored?
Definitely. In addition to the new FDA-approved eye drops mentioned above, a 2021 review of emerging presbyopia treatments and therapies highlighted a number of topical prescription eye drops currently being studied. The report, which was published in the journal Clinical Ophthalmology, noted that therapies being explored fall into one of two categories:
- Drops to manage the symptoms of presbyopia
- Drops to address the underlying cause of presbyopia
There’s lots to be excited about in terms of presbyopia care, says Dr. Passa, who adds: “We have many more solutions and options to share with presbyopia patients today.”