What Is Presbyopia? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Presbyopia is a common, age-related vision disorder that makes it difficult for you to see or focus on objects up close.
It's not considered a disease. While similar to simple farsightedness (hyperopia), presbyopia is a separate condition that's related to natural aging, typically beginning around age 40.
Signs and Symptoms of Presbyopia
If you have to hold reading materials at arm's length to focus on the words, you may be experiencing one of the most common first signs of presbyopia.
Other symptoms include:
Headaches from doing work up close
Eyestrain
Requiring more light to read
Blurred vision
The symptoms of presbyopia are similar to those of farsightedness, but the two conditions have different causes.
Farsightedness is caused by an eyeball that's shorter than usual or a cornea that's too flat. Presbyopia is caused by a hardening of the lens of the eye with aging.
Causes and Risk Factors of Presbyopia
Presbyopia stems from an issue with the lens of the eye, which sits behind the iris (colored part) and pupil.
The lens of the eye bends or refracts light to focus it directly onto the retina, which is the light-sensitive tissue at the back of the eye. The retina converts light into signals that are sent to the brain, which then interprets the signals as images.
When a person is younger, the lens is soft and flexible. Tiny muscles in the eye can easily change the shape — and, as a result, the focus — of the lens, a process called accommodation.
With age, the elasticity of the lens and of the muscles around it starts to diminish. This makes it so the lens cannot focus on up-close objects, making them appear blurry.
In addition to age, risk factors of presbyopia include:
Cardiovascular disease
Diabetes
Farsightedness
Medications such as antihistamines or antidepressants
Multiple sclerosis (MS)
Certain medications and medical conditions can cause presbyopia to appear before age 40, known as premature presbyopia. Research also shows that genetic factors, excessive screen time, and ultraviolet radiation may contribute to premature presbyopia.
How Is Presbyopia Diagnosed?
Presbyopia is diagnosed during routine, comprehensive eye exams that test your ability to see objects nearby and far away.
During the exam, your eye doctor may also dilate your pupils to make it easier to see the insides of your eyes. Your eyes may stay a bit sensitive to light for several hours after the exam.
Because presbyopia is so common, affecting 1.8 billion people, the American Academy of Ophthalmology (AAO) recommends that all adults get a complete eye exam at age 40. You may need to see your doctor sooner if you have a history of diabetes or high blood pressure or a family history of eye disease.
The AAO's eye exam recommendations vary as you get older, depending on your age:
Age 20 to 29: At least once
Age 30 to 39: At least twice
Age 40 to 54: Every two to three years
Age 55 to 64: Every one to three years
Age 65 and older: Every one to two years
If you wear glasses or contacts or have an eye infection or pain, you may need to see your eye doctor more often.
Treatment for Presbyopia
There's no cure for presbyopia. Treatment consists of eyeglasses, contact lenses, corrective surgery, or eye drops.
Eyeglasses
Several types of eyeglasses are available for presbyopia, including:
Reading Glasses These are worn only when reading or doing close-up work.
Bifocals These glasses correct your distance vision when you look through them at eye level, and they correct your near vision when looking through the lower part of the lens.
Trifocals These glasses have corrections for near, middle, and far vision.
Progressive Lenses These lenses are similar to trifocals but don't have horizontal lines.
Contact Lenses
Several types of contact lenses can correct presbyopia and other vision problems:
Bifocal or Multifocal Like bifocal glasses, these contacts help you see far away and up close.
Monovision You'll wear two different types of lenses: One corrects for distance vision and the other for near vision. These help you see better at all distances.
Modified Monovision These involve wearing a multifocal lens in one eye and one lens in the other for near or far vision.
Medications
The U.S. Food and Drug Administration has approved two types of eye drops to treat presbyopia.
Pilocarpine hydrochloride ophthalmic solution (Vuity, Qlosi) eye drops allow some people with presbyopia to see up close without glasses or contacts for several hours a day. Pilocarpine contracts the ciliary muscles, reducing pupil size. This results in an increased depth of focus and improved vision while looking at close objects. Eye drops under the brand name Vuity are once-daily and work in 15 minutes or less, lasting as long as six hours. Eye drops under the brand name Qlosi can be used once or twice daily and work within 20 minutes, lasting as long as eight hours.
Aceclidine ophthalmic solution (Vizz) is a once-daily eye drop that helps people with presbyopia see up close without glasses or contacts. It uses aceclidine to shrink the pupil and create a “pinhole effect” that extends depth of focus. Eye drops under the brand name Vizz may start working within 30 minutes and last as long as 10 hours.
Surgical Procedures
Ask your doctor if surgery is the right option to treat your presbyopia, as there may be risks based on your health conditions. Options may include:
LASIK Surgery A surgeon cuts a small flap in the cornea and removes part of it to increase its curve. This procedure usually causes fewer side effects and is faster than other surgeries.
Photorefractive Keratectomy (PRK) As with LASIK, a laser reshapes the cornea without making an incision.
SMILE Surgery With a small-incision lenticule extraction (SMILE) procedure, a laser creates a disc-shaped piece of tissue inside the cornea through a small incision.
Corneal Inlays A surgeon places a small plastic ring in the cornea at the front of the eye, refocusing light to improve up-close vision.
Prevention of Presbyopia
Presbyopia is considered a normal part of aging, and there is no way to prevent it altogether.
You can preserve overall eye health by wearing sunglasses, eating a healthy diet, and taking steps to avoid eye strain.
Complications of Presbyopia
Presbyopia itself isn't harmful, but problems can happen if it's not managed well or if treatments don't fit your needs. Some issues can affect how clearly you see, your comfort, and your overall satisfaction.
Getting the Wrong Correction Glasses or contacts that aren't quite right can leave you with blurry vision, eye strain, or trouble adapting. Certain lens types may cause “ghosting,” distortion, or dizziness, especially when you're new to them.
Dry Eye This can be common, especially if you wear contact lenses. Age, long hours on screens, and changes in tear production can make dryness worse, causing burning, irritation, or blurry spots. Choosing the right lenses, using lubricating drops, or switching to daily disposables can help.
Surgery These procedures can improve vision but also bring side effects, such as glare, halos, or reduced night vision.
Emotional Challenges Some people see reading glasses or bifocals as a sign of aging, which can make them resist treatment. Adjusting to new vision aids can also feel frustrating. But it also can lower quality of life if you cannot read fine print, use screens, or otherwise meet your vision demands.
If your vision suddenly gets blurry, or you notice eye pain, double vision, black spots, flashes of light, or other changes, get it checked out by an eye health professional. It may be the result of eye or health problems, such as cataracts, diabetes, multiple sclerosis, or vascular disease.
Research and Statistics: How Many People Have Presbyopia?
An estimated 128 million people in the United States have presbyopia, nearly 90 percent of adults ages 45 and older. Worldwide, an estimated 1.8 billion people have presbyopia.
The Takeaway
Presbyopia is an age-related change in vision that makes it harder to focus on close objects, usually starting around age 40.
Treatment options include glasses, contact lenses, eye drops, and surgery.
Although it isn't harmful on its own, untreated or poorly managed presbyopia can cause eye strain, headaches, or frustration with daily tasks.
If you notice sudden vision changes, eye pain, double vision, or flashes of light, see a doctor right away to rule out more serious conditions.
