I have presbyopia. What are my treatment options?

Presbyopia usually begins to make its presence known around about the time you turn 40.  You may find that you are struggling to focus on close-up images and that your vision is blurry.   Reading can become difficult, especially in poor light, and you find yourself holding your book further and further away from your eyes.

As the rest of your body ages, so does your eyes.  Normally the lens in your eyes is flexible and changes shape allowing you to see both close and distant objects.  As you get older, your lens loses that flexibility and hardens so that it can no longer change shape, losing its ability to focus on close-up objects.

Although there is no cure for presbyopia, there are several treatment methods available that will help to correct your vision.

Non-prescription glasses

If you don’t have any other vision problems, you may find over-the-counter reading glasses will suit you.  These are available through your local pharmacy.  It is important to test the different degrees of magnification until you find the one that suits you.  It is recommended that you choose the lowest magnification that allows you to read comfortably.

Prescription glasses

You may choose to ask your optometrist for prescription glasses for use while reading.  If you have other vision problems that require corrective lenses, there are options available that will rectify both your distance and close-up vision:

  • Prescription reading glasses. Your optometrist will be able to provide you with prescription reading glasses, should you have no other vision problems and prefer this to over-the-counter reading glasses.
  • Bifocals. These lenses have two different types of focus with your distance prescription at the top and your reading prescription at the bottom.  A visible horizontal line divides the two.
  • Trifocals. These lenses have corrections for distance, middle distance and close-up and come with two horizontal lines dividing the prescriptions.
  • Progressive multifocal lenses. Without any noticeable divisions between distance, middle distance and close-up vision, these types of lenses provide excellent vision at all distances and are the most popular solution.

Contact lenses

If you don’t wish to wear glasses, then there are contact lenses that are able to improve vision problems caused by presbyopia.

  • Bifocal contact lenses. These contact lenses provide distance and close-up correction on each contact, similar to bifocal glasses with distance at the top and reading at the bottom.  The bottom reading portion of the lens is weighted to keep it correctly position on your eye.
  • Monovision contact lenses. One contact lens is set to your distance vision, while the lens for your other eye is set for close-up vision.  Your brain learns to favour one eye or the other depending on the task.
  • Modified monovision contact lenses. In this instance you would wear a bifocal lens in one eye, set for reading and distance vision, and the other eye set to distance vision only.  You would then use both eyes for distance and one eye for reading.  Your brain will learn to adjust to process the image.

Refractive Surgery

There are several refractive surgeries available that involve the reshaping of the cornea.

  • Conductive keratoplasty. Radiofrequency energy is used to head tiny spots around the cornea causing a change to its curvature.  Whilst effective, sometimes the results are variable and may diminish over time.
  • Laser-assisted in situ keratomileusis (LASIK), Laserassisted subepithelial keratectomy (LASEK) and Photorefractive keratectomy. Using several different methods, a laser is used to reshape your cornea.  This can be used to create monovision, with one eye corrected for close-up vision and the other for distance.

Lens Implants

There is also the option of replacing the lens in your eye with a synthetic lens, known as an intraocular lens implant.  While some allow your eye to see things close-up and at a distance, others (called accommodative lens) change position or shape in your eye.  However, lens implants can reduce your close-up vision, so you may still need to wear reading glasses.

Corneal inlays

A small plastic ring with a central opening is placed into the cornea of one eye focusing light so you can see close-up objects.  Unlike other procedures where the results are not reversable, these rings can be removed if you find the results are not effective for you.

Whilst we can’t reverse the aging of our eye that causes presbyopia, we can ensure it has as little impact on our day-to-day lives as possible.  The good news is that the vision lost to presbyopia can be corrected whatever method of treatment you choose.

If you are having symptoms of presbyopia, it is recommended that you consult your optometrist and have a full eye examination.  It is wise as we get older to also have our eyes examined for the presence of any eye disease or vision disorders that may also begin to develop around this time.

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