40+ reading vision (Presbyopia)

An introduction to Presbyopia

YOU’LL GET PRESBYOPIA EVENTUALLY – IT’S INEVITABLE

Presbyopia happens to everyone and typically starts when you reach 40. By 50, 100% of people have presbyopia.

You’ll get presbyopia whether you have previously worn glasses or not. And it doesn’t matter if you’ve had LASIK, you’ll also get presbyopia.

As you age, the lens inside your eye loses its ability to change shape and shift the focus of the eye from the distance to the near.

The lens we’re talking about when it comes to presbyopia is different from the cornea (which is the lens at the front of your eye).

Presbyopia symptoms and lifestyle impact

FOR MANY ACTIVE PEOPLE, PRESBYOPIA IS THE FIRST SIGN THEY’RE AGEING

Eventually, the ‘zoom’ system in the eye becomes weaker. That means your ability to read small print (e.g. small text on your mobile phone, your computer screen, or on labels) diminishes and you require different lenses for focusing on close and distant objects. You’ll first notice the effects of presbyopia at night when the light is dim.

Symptoms include:

• Difficulty focusing on small print

• Blurred near vision

• Eyestrain, fatigue or headaches

• Needing to hold reading material further than normal and eventually at arm’s length

• Needing brighter light to focus on near objects (like taking off your sunglasses when reading the text on your mobile

For healthy and active people, the effects of presbyopia are the first signs of ageing and this can cause some anxiety.

Underlying causes of Presbyopia

THE EYE’S LENS IS RESPONSIBLE FOR REFRACTING (OR BENDING) LIGHT RAYS THAT ENTER THE EYE

The lens focuses the light on the retina, which converts the light into messages that are sent to the brain to interpret.

A youthful, healthy lens is soft and elastic, so it can shift easily to focus on objects that are close and distant. With age, the lens hardens and becomes more rigid, affecting the eye’s ability to focus light on the retina. The aging process also changes the muscle fibers around the lens that helps it to shift and focus on objects close by. These changes are what lead to presbyopia. Individuals with presbyopia tend to have problems with tasks like reading, sewing and sending a text message. They usually must hold reading material at an arm’s distance.

Examination protocol for Presbyopia

It’s unlikely you’ll need someone to officially diagnose your presbyopia, but if you’re unsure, you can see your optician who’ll perform a simple reading test to find out.

Treatment options for Presbyopia

THERE ARE A LOT OF GREAT OPTIONS FOR TREATING PRESBYOPIA

Reading glasses

The simplest way to correct presbyopia is with a pair of reading glasses or with bifocals.

If you have never worn glasses before, you’ll likely need reading glasses. There are relatively inexpensive glasses you can buy without a prescription at your local drug store. While cheap and easy to acquire, they can frustrate some, especially if you’ve never worn glasses before. The worst thing is having to put them on and take them off repeatedly as you switch from near to distance vision – as we commonly do throughout the day.

Bifocals and Varifocal glasses

If you’ve worn glasses or contact lenses for nearsightedness or farsightedness, you’ll then likely need to wear bifocals or varifocal lenses to correct presbyopia.  

Bifocal means the lens of the glasses provide focusing power at two distances (near and far). Usually, the lower portion of the lens has a stronger prescription for near vision and the rest of the lens has a weaker prescription for distant vision. The prescriptions are differentiated with tiny lines.

Progressive lenses

Another type of eyeglasses that can correct presbyopia feature progressive addition lenses, which have a more gradual transition between the different prescriptions.

Monovision contact lenses

People with presbyopia may choose to wear multifocal contact lenses instead of eyeglasses. These contacts are designed to restore clear vision at multiple distances.

Another name for these are monovision contact lenses, which involves using one contact lens for distance and one contact lens for near. Unfortunately, many people can’t tolerate that difference and those that do still have the problem of needing to wear contact lenses.

Conductive keratoplasty

Presbyopia can also be corrected through surgery. A procedure known as conductive keratoplasty (CK) uses radio energy to improve the curvature of the cornea and improve near vision. CK is performed on only one eye and provides temporary results.

Monovision LASIK

Laser vision correction with LASIK, which involves using laser energy to reshape the curvature of the cornea, can correct one eye for near vision, leaving the other eye untreated for distance vision.

Refractive Lens Exchange (also called RLE or Clear Lens Exchange)

Some people resort to undergoing a Refractive Lens Exchange procedure (which consists of replacing the lens inside the eye with an artificial one), much like in cataract surgery.

KAMRA Inlay

The KAMRA inlay is a small device surgically placed in the cornea to help the eye focus light. It is placed in one eye (the non-dominant eye), leaving the other untreated. The eyes work together to focus on objects at all distances.

Raindrop® Inlay

The Raindrop® Inlay is a transparent disk that we can place inside your eye in a quick, LASIK-like procedure that takes about 10 minutes. The Raindrop® Inlay improves near and intermediate vision by reshaping the front part of the eye.

Presbyopic LASIK

More recently, laser eye surgery medical device companies developed lasers that can treat presbyopia. We’re investigating this option and await the FDA to approve these devices for use in the United States.