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Both of these eye conditions impact your ability to see well at a close distance, but they don’t happen for the same reason.
If you have trouble scanning the menu in a dimly lit restaurant, reading your text messages, or threading a needle for craft projects, it’s clear that your close-up vision is … well, not very clear.
There are two vision-related conditions that can cause this up-close problem: presbyopia and hyperopia. Both are refractive errors — which means the shape of the eye doesn’t bend light correctly — but they are caused by very different things, explains Richard G’Sell, O.D., an optometrist with America’s Best Contacts & Eyeglasses in St. Louis, Missouri.
To clear up any confusion, we asked Dr. G’Sell to break down the differences and share how each is managed.
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Hyperopia and Presbyopia, Explained
Hyperopia is an eye-focusing disorder also known as farsightedness. You can see objects at a distance clearly, such as road signs and scenic vistas, but nearby objects appear blurry. Hyperopia affects both children and adults, and the National Eye Institute says it affects up to 10% of all Americans.
Presbyopia, like hyperopia, also means you have trouble focusing on objects that are up close. It is not a disease, and it can’t be prevented. It’s a normal part of aging. Everyone will get presbyopia as they get older, usually after age 40, says Dr. G’Sell.
Hyperopia Starts in Childhood
Farsightedness usually appears in childhood. Some people are born with an eye shape that causes hyperopia. Normally, light focuses directly on your retina, delivering signals to the optic nerve to create a clear picture of what you see.
But if you have hyperopia, light will focus behind your retina and create a blurry image, says Dr. G’Sell. This can happen if your eyes are shorter from front to back than normal or if your lens or cornea are misshapen.
Hyperopia can cause headaches, eyestrain, and reading problems in children. But it often goes undetected. “You may find that children with hyperopia shy away from close-up tasks in favorite of those that are distance-oriented,” Dr. G’Sell says.
Only Adults Develop Presbyopia
Presbyopia isn’t an issue you’re born with. As we get older, our eyes undergo physical changes, much like the rest of our bodies do.
“As we age, the lens of our eye that needs to bend to focus up close becomes thicker and less flexible,” Dr. G’Sell explains. “People start to notice they have to hold an object farther away from them or use brighter lights for up-close tasks.”
Certain chronic conditions, such as diabetes and heart disease, can cause presbyopia to develop earlier than normal. Antihistamines, antidepressants, and diuretics are also associated with the premature onset of presbyopia, according to the American Optometric Association.
For many people who had a lifetime of great vision, this is not easy to accept. “It can be emotionally traumatizing when your ability to see things close up is gone,” says Dr. G’Sell. “Patients worry about how bad it’s going to get.”
How Hyperopia and Presbyopia Are Managed
Whether you have presbyopia or hyperopia, there are simple and effective options to help you see clearly:
Sometimes you won’t have to do anything to correct the problem. The eye can compensate by generating the power it needs to bring the close-up object into focus, says Dr. G’Sell.
However, if you or your child avoid near tasks, such as reading, or experience headaches or eyestrain, your optometrist will recommend prescription eyeglasses or contacts. For adults, refractive surgery (or surgery to replace your natural lenses with artificial ones) can also correct hyperopia.
One of the most popular treatment options is getting a pair of reading glasses. These can be worn on an as-needed basis. Reading glasses can be purchased over the counter. You can also get a prescription from an optometrist.
Dr. G’Sell says prescription readers often offer more comfortable vision, since “most patients’ eyes are not identical.” An optometrist can correct for your refractive error and factor in other eye problems, such as astigmatism. That’s a condition in which your cornea or lens has an irregular curvature. An eye doctor can also account for how far apart your pupils are for proper measurement of the readers.
Learn more about the differences between prescription and OTC reading glasses here.
If you already wear glasses for distance vision, bifocal or progressive lenses may also be an option for you. Bifocals have a faintly visible line in the center of the lens to separate near and far vision. Progressives (also called multifocals) have no visible lines but separate the lens into near, far, and in-between vision fields. There are also multifocal contact lenses.
Monovision is another treatment option often prescribed for people with presbyopia. The patient wears a contact lens for near or intermediate vision in one eye, and if needed, a lens for distance vision in the other eye.
One of the newest options for the early stages of presbyopia is a once daily prescription eye drop. Monovision LASIK surgery is another treatment option. Similar to monovision contact lenses, this type of LASIK corrects one eye for distance and one eye for near vision.
There’s even a surgical option called refractive lens exchange that can reduce or eliminate the need for reading glasses, according to the American Optometric Association. Here, each eye’s natural lens is replaced with an intraocular lens that corrects for the refractive error.
Dr. G’Sell says it’s important to talk to your eye doctor about the pros and cons of each, so you can determine the best treatment for you.
Medically reviewed by Richard G’Sell, O.D.
Recommended reading: Monovision vs. Multifocal Contact Lenses: What’s the Difference, and Which One Is Right for You?
Seeing Well After 45: Presbyopia, Contact Lenses, and You
How to Decide if Your Next Eyeglasses Should Be Multifocal
See our sources:
Frequency of hyperopia: National Eye Institute
Hyperopia definition: American Optometric Association
Presbyopia frequency: National Eye Institute
Medication, treatment options, and presbyopia: American Optometric Association
Presbyopia and monovision: American Optometric Association