Presbyopia is an age-related and progressive refractive error where patients have difficulty reading up close.
“Presbyopia” by EyeSmart – American Academy of Ophthalmology
Presbyopia is diagnosed by one’s age and manifest refraction. “Add” powers can be determined by age, but it’s always best to have this checked by an eye doctor to ensure you’re happy with this power. An “add” power is amount of magnification provided in a pair of glasses for reading. Manifest refraction is a subjective measure of determining a patient’s prescription by giving a patient choices between different lenses, whereas the patient chooses based on clarity.
Presbyopia is caused by decreased accommodation (focusing ability) of the lens inside the eye, which usually changes shape when we focus up close. The lens inside the eye changes shape based on what we are looking at. If we look at an object far away, the lens relaxes. If we focus on an object up close, the lens contracts. As we get older, the lens becomes less flexible and does not contract as adequately as when we are younger.1 Presbyopia usually begins at 40 years old and worsens overtime until stabilization at around 65-70 years old.
Often, patients find themselves holding reading material further away from their eyes or increasing font size to see more clearly up close. Reading is also easier with more light on your materials.
It is important to have eye exams as recommended by one’s eye care provider to assess ocular health and progression of presbyopia.
Reading glasses : only used for seeing up close
Bifocals: glasses for far away and up close (line or round edge separating the different distances).
Trifocals: glasses for far away, intermediate, and up close distances (two lines separating the different distances).
Progressive addition lenses (PALs): no line multifocal, glasses gradually transition from distance vision to up close (provides clarity at multiple distances).
Multifocal contact lenses: add power for reading integrated into the lens.
Monovision contact lenses: single vision lenses (no multifocal), one corrected for far away, the other for near.
Modified monovision contact lenses: one eye corrected for distance, the other eye corrected with a multifocal lens.2
Refractive surgery: usually LASIK or PRK, surgeon corrects one eye for distance and the other corrected for near (monovision).
Cataract surgery: multifocal (add power included) or monovision (one eye corrected for far away, the other for near) intra-ocular implants (IOLs).
Corneal inlays: implant into the cornea (clear portion of the front of the eye) to improve up close vision in patients with presbyopia. 3