Can Presbyopia Be Prevented?
No. After age 40 or so, farsightedness is inevitable — but correctable — for most people. Here’s what else you should know when your near vision starts to falter.
It happens to the best of us. We find ourselves holding a cereal box at arm’s length to decipher the nutrition label or asking a dining companion to read the specials out loud because we can’t make out the fine print on the menu. These are the early signs of presbyopia, also known as age-related farsightedness, and it’s nearly inevitable.
Statistics bear this out: Nearly 90 percent of adults will experience gradual worsening of their close-up vision after age 45 or so, according to research presented in May 2020 at an annual meeting for the American Society of Cataract and Refractive Surgery.
Can presbyopia be prevented? In a word, no. Reversed? Also no, although it can be corrected with reading glasses and other measures. “If there is a way to postpone or reduce presbyopia, we haven’t found it yet,” says Craig See, MD, an ophthalmologist and eye surgeon at Cleveland Clinic in Ohio.
Eye experts do know a lot about age-related farsightedness, however. Here are some basic facts you should know as well.
It’s the result of natural aging of the eye, explains Laura Di Meglio, OD, an instructor of ophthalmology and primary care optometrist at the Wilmer Eye Institute at Johns Hopkins Medicine in Baltimore.
“The lens of the eye is positioned just behind the iris and is attached to little muscles that help it change shape in order to focus,” she says. These muscles, called ciliary muscles, contract automatically when you focus on a close-up object, increasing the curvature of the lens. When you look away, the muscles relax.
“Beginning at about age 40, these muscles begin to not work as well, and the lens gets harder and less flexible,” says Dr. Di Meglio. The combination of these factors means the lens loses its ability to change shape, making it harder to focus on objects that are close.
One group who may get away with not needing reading glasses are people with myopia (nearsightedness) who are able to focus perfectly (or nearly so) on things that are up close but have trouble making out objects in the distance without corrective lenses. When they wear glasses or put in contacts to see far away, they lose their natural ability to focus close up. “That’s why you’ll sometimes see people who are nearsighted take their glasses off to read something up close as they get older,” she explains.
There are habits that can help you preserve the overall health of your eyes, though. For example, eating a varied diet rich in specific nutrients — vitamins A, C, and E, the mineral zinc, and the antioxidants lutein and zeaxanthin — may help reduce the risk of certain eye diseases that can cause vision loss, including macular degeneration, according to the American Academy of Ophthalmology. And in general, exercising and being in good physical shape overall can help support the health of the retina and blood vessels in the back of the eye, says Di Meglio.
As for bad health habits, a small study published in the Journal of Eye and Ophthalmology found an association between smoking and early onset of presbyopia, but the research is limited.
Smoking marijuana or drinking too much might cause short-lived problems with your close-up vision. “THC may have muscle relaxant properties that temporarily make your up-close vision a little worse,” says Di Meglio. (THC, or tetrahydrocannabinol, is the major psychoactive component in marijuana; it’s what causes a high). And being around any smoke can dry out your eyes, which can affect vision.
The same is true of drinking alcohol. If you overindulge, you may experience blurred or double vision, according to an article published in April 2021 in the Journal of Ophthalmic & Vision Research. These side effects will go away as the effects of the alcohol wear off.
As you age, the risk of dry eye increases, in part because our eyes naturally produce fewer quality tears, which are made of water, oil, and mucus and help keep the eyes lubricated, according to the National Eye Institute.
Taking steps to manage dry eyes won’t correct presbyopia, but it may help prevent the condition from making it harder to see close up. Things you can do to counter dry eyes include blinking often, running a humidifier in rooms where you spend a lot of time, getting plenty of sleep, and taking regular breaks from staring at a computer or other screen for long periods.
Di Meglio suggests following the 20:20:20 rule: Every 20 minutes, look at something 20 feet away for 20 seconds. “Be sure to blink during the 20-second break,” she says. Artificial tears may also help with dry eye symptoms, she adds.
There are contact lenses that can correct close-up and far away vision, and some people can benefit from laser surgery, corneal inlays, or refractive lens exchange. In this procedure, which is performed as part of cataract surgery, the lens of one eye is removed and replaced with an implant that corrects the near-vision in that eye — an approach to correcting presbyopia known as monovision.
See your eye doctor as soon as you realize you’re struggling to read or do close-up tasks, such as threading a needle, to find out which options might be right for you. Your ophthalmologist can help you find the best way to bring your newly fuzzy world back into focus.
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