Presbyopia: Signs, Diagnosis and Treatment

Presbyopia is a common vision defect that mainly occurs in old age. It refers to the gradual loss of the ability of the eyes to focus on nearby objects. The condition becomes more apparent in the early to mid-40s and deteriorates until about age 65.

According to the Community Eye Health Journal, the prevalence of presbyopia in people aged 40 and above is 62 percent, and it affects more women than men. In 2017, for example, approximately 1.04 billion people had the condition globally.

Symptoms of Presbyopia

You will become aware of presbyopia when you start holding books or your phone at a distance away from the eyes to read the content. A basic eye exam can diagnose the condition, especially if you exhibit these symptoms:

• Blurred vision at a distance you would otherwise consider the average reading distance
• Eye strain or headaches when you try reading objects close to you
• Difficulty seeing text on computer screens
• The need for brighter lighting when doing close work

These symptoms tend to become worse if you’re reading in an area with dim lighting. However, consider seeing your doctor if blurry close-up vision keeps you from reading, enjoying everyday activities, or performing close-up tasks. They will help you determine if yours is a presbyopia case and advise you on the treatment options.

Treat the case as an emergency if you:

• Experience sudden hazy or blurred vision
• Suddenly lose vision in one eye, with or without eye pain
• See light flashes, halos, or black spots
• Experience double vision

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Causes of Presbyopia

The eye relies on the cornea and the lens to focus the light reflected from objects, forming an image. The closer the object is to the eye, the more the lens flexes.

The cornea refers to the eye’s clear surface, with a shape that resembles a dome. The lens is a clear structure and sits inside the eye behind the colored iris. The cornea and lens refract or bend light entering the eye, making it possible to focus the image on the retina, found at the back wall of the eye to the inside.

The lens has greater flexibility than the cornea and can change shape, aided by the circular muscles that surround it. As you look at something at a distance, this circular muscle relaxes and constricts when you look at something close nearby. The constriction allows the lens to curve, changing its focusing power.

Presbyopia happens when the lens of the eye hardens and becomes less flexible. It loses its ability to change shape to focus on close-up images. Consequently, the images appear to be out of focus.

As an age-related process, presbyopia is an inevitable condition. It happens even if you’ve never had vision problems before. People with myopia will also notice blurriness in their sight when they wear their usual eyeglasses to correct distance vision.

Risk Factors for Presbyopia

Some factors increase the likelihood of developing presbyopia. They include:

• Age: It’s the most significant risk factor for presbyopia, with almost everyone experiencing it to some degree after 40.
• Underlying medical conditions: Diabetes, cardiovascular diseases, multiple sclerosis, and being farsighted can increase the risk of presbyopia before the age of 40.
• Medications: Some antidepressants, diuretics, and antihistamines cause premature presbyopia symptoms.

Diagnosis of Presbyopia

Diagnosing presbyopia entails a basic eye exam, including an eye health assessment and refraction. The refraction assessment test checks if you have nearsightedness, presbyopia, astigmatism, or farsightedness. The doctor will use various equipment to look at your eyes through several lenses to test close-up vision and distance.

The eye care provider may put eye drops in your eyes to dilate the pupils allowing the doctor to have a better view of the inside of your eyes. You may have eye or light  sensitivity for some time after the exam.

According to the American Academy of Ophthalmology, adults should have a complete eye exam:

• 5-10 years under the age of 40
• 2-4 years between the ages 40 and 54
• 1-3 years between ages 55 and 64
• 1-2 years beginning the age of 65

Treatments for Presbyopia

Treatment for presbyopia aims at compensating for the inability of the eyes to focus on nearby objects. Some standard treatment options include:

• Eyeglasses: Eyeglasses are a safe and effective treatment to correct problems caused by presbyopia. Your doctor may prescribe reading glasses, bifocals, trifocals, progressive multifocal or office progressives.
• Contact lenses: If you don’t want to wear eyeglasses you can try contact lenses to improve presbyopia. Lens types include monovision contact lenses, bifocal contact lenses and modified monovision.
• Refractive surgery: It changes the shape of your cornea to improve close-up vision in the non-dominant eye. Surgical procedures include conductive keratoplasty, photorefractive keratectomy (PKR), Laser-assisted subepithelial keratectomy (LASEK) and Laser-assisted in situ keratomileusis (LASIK).
• Lens implants: Some ophthalmologists use a procedure to remove the natural lens and replace them with a synthetic lens. 
• Corneal inlays: The process involves inserting a small plastic ring with an opening in the center into the cornea. The opening acts as a pinhole camera to let in focused light for better vision of close objects.
• Lifestyle changes and home remedies: Have your eyes checked regularly, prevent eye injuries, protect the eyes from sunlight, eat healthy foods and control chronic health conditions.

Prevention

You can’t prevent presbyopia as it is a normal part of aging. However, you can take good care of your eyes to reduce the symptoms. Make sure you have adequate lighting when reading. Also, remember to keep up with the recommended doctor’s appointments for early diagnosis and treatment.

FAQs

Can presbyopia lead to blindness?

Presbyopia progresses until the age of 55, causing vision to change over many years. However, the condition does plateau at some point but will not wholly cause you to lose your up-close vision. You won’t go blind because of presbyopia.

Can you reverse presbyopia?

There is no natural or medical way of reversing presbyopia at the current time, but scientists suggest that it may be possible in the future. However, you can correct the condition through various treatment options.

References

1. Presbyopia. (January 2020). American Academy of Ophthalmology.

2. Presbyopia: prevalence, impact, and interventions. (September 2007).  National Center for Biotechnology Information.

3. All about presbyopia. (June 2018). Read Loop.

4. Presbyopia: What causes it and how to treat it. (November 2021). All About Vision.

5. Presbyopia (farsightedness) causes, symptoms and natural remedies. (October 2015). Bel Marra Health.

6. Presbyopia. (November 2021). Mayo Clinic.

7. Presbyopia. (January 2020). American Academy of Ophthalmology

8. Presbyopia. (June 2020). Cleveland Clinic.

9. How can presbyopia be corrected? (June 2020). National Center for Biotechnology Information.

10. What Would It Take to Reverse Presbyopia? (2016). Maple Eye and Laser Center.

11. Everything you need to know about Presbyopia. (July 2018). Grace & Vision Optometrist.