Presbyopia

Diagnosis

Presbyopia is diagnosed during a routine eye examination that includes a refraction assessment and an overall eye health evaluation.

A refraction assessment helps determine whether you have nearsightedness, farsightedness, astigmatism, or presbyopia. During this part of the exam, your eye doctor uses different instruments and asks you to look through multiple lenses to test both distance and close-up vision.

For the eye health exam, drops are usually placed in your eyes to widen, or dilate, your pupils. Dilation allows the eye doctor to see the internal structures of the eye more clearly. Your eyes may feel more sensitive to light for a few hours after this part of the exam.

The American Academy of Ophthalmology recommends regular comprehensive eye exams for adults based on age:

• Every five to ten years if you are under 40

• Every two to four years between ages 40 and 54

• Every one to three years between ages 55 and 64

• Every one to two years starting at age 65

More frequent exams may be needed if you have risk factors for eye disease, existing vision problems, or if you wear glasses or contact lenses.

Treatment

The main goal of presbyopia treatment is to make up for the reduced ability of the eyes to focus on nearby objects. Treatment options include eyeglasses, contact lenses, refractive surgery, or lens implants. The right choice depends on your vision needs, lifestyle, and overall eye health.

Eyeglasses
Eyeglasses are a simple and safe option for correcting vision changes caused by presbyopia. If you previously had good vision without correction, nonprescription reading glasses may be helpful. Your eye doctor can advise whether these are suitable for you.

Most over-the-counter reading glasses range in strength from +1.00 to +3.00 diopters. When choosing reading glasses:

• Start with the lowest strength and work upward

• Check whether you can read comfortably at a natural distance

• Test the glasses using typical reading material

If nonprescription glasses do not provide enough correction, or if you already wear corrective lenses for other vision issues, prescription eyeglasses may be recommended. Options include:

• Prescription reading glasses, used only for close work

• Bifocals, which have a visible line separating distance and reading vision

• Trifocals, which correct near, intermediate, and distance vision with two visible lines

• Progressive multifocal lenses, which provide multiple vision zones without visible lines

• Office progressives, designed mainly for computer work and reading rather than driving

Contact lenses
Some people prefer contact lenses instead of eyeglasses to manage presbyopia. Contact lenses may not be suitable if you have certain eye surface conditions, eyelid problems, or dry eyes.

Available options include:

• Bifocal contact lenses that correct near and distance vision within the same lens

• Monovision contact lenses, where one eye is corrected for distance and the other for near vision

• Modified monovision, combining a multifocal or bifocal lens in one eye with a distance lens in the other

Refractive surgery
Refractive surgery reshapes the cornea to improve focusing ability. For presbyopia, these procedures typically improve close-up vision in the nondominant eye, similar to monovision contact lenses. Even after surgery, reading glasses may still be needed.

Because these procedures are not reversible, doctors often recommend trying monovision contact lenses before considering surgery.

Refractive surgery options include:

• Conductive keratoplasty, which applies heat to the cornea using radiofrequency energy

• Laser-assisted in situ keratomileusis, where a laser reshapes inner layers of the cornea

• Laser-assisted subepithelial keratectomy, which reshapes the cornea after lifting a thin outer layer

• Photorefractive keratectomy, where the outer corneal layer is removed and naturally regrows after reshaping

Lens implants
Lens implant surgery involves removing the eye’s natural lens and replacing it with a synthetic one, called an intraocular lens. Some lenses allow both near and distance vision, while others adjust position or shape inside the eye.

Although lens implants can improve vision, you may still need reading glasses afterward. Possible side effects include glare, blurred vision, and reduced vision quality. This procedure carries similar risks to cataract surgery, such as infection, inflammation, bleeding, or glaucoma.

Corneal inlays
Corneal inlays involve placing a small plastic ring with a central opening into the cornea of one eye. This opening helps incoming light focus properly for near vision.

If the results are unsatisfactory, the inlay can usually be removed, allowing you to consider other treatment approaches.