Presbyopia

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is presbyopia?

As people age, their ability to see close-up objects diminishes, a condition called presbyopia. The definition of presbyopia is age-related farsightedness—when the eye’s lens begins to harden and becomes less flexible—beginning around age 40. It’s not the same as farsightedness, also known as hyperopia, which is a problem with the length of the eyeball. Hyperopia is usually present at birth and it affects near and distant vision. With presbyopia, the aging lens at the front of the eye cannot focus light on the retina in order to sharpen close-up objects. People can have presbyopia and also any other vision condition, including farsightedness, nearsightedness or astigmatism. Presbyopia may worsen preexisting vision problems.

To focus light on the retina, the muscle around the eye’s lens contracts and relaxes in order to change the shape of the lens. When the muscle contracts, it allows your eye to focus on close-up objects, sharpening your vision while reading or doing close-up work. But as we get older, the lens becomes less flexible and the muscles degenerate, decreasing the muscle’s ability to change its shape. When this happens, the eye can’t bring close-up objects into focus, and things right in front of you become blurry.

This hardening of the lens usually begins as people enter their fourth decade of life. Presbyopia may continue to get worse until about age 65. Some people may be at risk of premature presbyopia, which occurs when they are younger than 40. Factors that increase the risk of premature presbyopia include some other health conditions, such as multiple sclerosis and diabetes, or taking certain medications.

Presbyopia symptoms tend to get worse between the ages of 40 and 65. You may notice you have to hold a book at arm’s length to read, and your close-up vision may be even worse in dim lighting. You may also get eye fatigue or eye strain after reading or working on close-up projects.

The simplest treatment for presbyopia is reading glasses or prescription eyeglasses. Some people may prefer contact lenses. Surgical presbyopia treatment is also an option, but it may not be right for everyone.

Presbyopia is an unavoidable and often annoying condition, but it is not serious. However, if you are experiencing eye pain or sudden vision changes, it is important to see a doctor right away. You may have a serious eye condition, such as glaucoma or a detached retina, or other medical problem that needs a prompt diagnosis.

What are the symptoms of presbyopia?

Because the condition is age-related, people typically start noticing presbyopia symptoms around age 40, and they may worsen until about age 65. Presbyopia develops gradually. If you start having difficulty seeing things up close, or find yourself squinting to read, talk with an eye doctor about your symptoms.

Common symptoms of presbyopia

You may develop headaches or eye strain or eye fatigue when you read or work on something up close, such as needlepoint.

Words may be blurry at a normal reading distance. In order to see words clearly, you may need to hold your book farther from your eyes, usually at arm’s length.

If your eyes must work even harder to see up-close things, these symptoms might be even worse. Reading or working in well-lit areas may reduce presbyopia symptoms.

While these presbyopia symptoms are common as people age, not all vision problems are benign. Sudden vision problems, such as vision loss, hazy or double vision, flashes of light, or seeing black spots or halos around lights are symptoms of glaucoma or cataracts. These should be evaluated by a doctor right away. Eye pain along with these symptoms could indicate retinal detachment, which is an emergency and needs immediate medical attention.

What causes presbyopia?

As we age, the lens inside the eye, which helps bring the things we see into focus, gets harder and less flexible. In normal vision, the lens bends, or refracts, the light coming into the eyes to make the object you see, whether near or far, come into focus. As the lens hardens, however, it is not able to change shape as easily, reducing your ability to focus on close objects. This makes the objects appear blurry.

What are the risk factors for presbyopia?

Plain and simple—presbyopia is just part of getting older for many people. But in addition to age, other factors can contribute to presbyopia in people younger than 40. This is premature presbyopia.

Risk factors for presbyopia include:

  • Being between the ages of 40 and 65

  • Being farsighted

  • Having certain medical conditions, such as diabetes, multiple sclerosis, dysautonomia, or cardiovascular diseases

  • Taking certain medications, including antidepressants and antianxiety medications, antihistamines and allergy medications, antipsychotics, antispasmodics, and diuretics

  • Having had a previous head trauma

Reducing your risk of presbyopia

While you cannot stop the aging process, you may be able to delay the onset of presbyopia and other vision problems. It is important to get an eye exam every year to help take care of your eyes and to discuss any symptoms with your eye doctor. Other steps you can take include:

  • Read in good lighting to reduce eye strain.

  • Wear sunglasses to protect your eyes against UV rays.

  • Eat a healthful diet, especially with the full recommended daily amount of vitamin A, vitamin E and lutein, which is found in green leafy veggies.

  • Take care of your overall health: Get physical activity, don’t smoke, drink alcohol in moderation, and hydrate well.

What are some conditions related to presbyopia?

Farsightedness, also called hyperopia, is related to age-related farsightedness. Hyperopia and presbyopia symptoms are similar; the main differences between presbyopia vs. hyperopia are age and genetics—presbyopia develops as people get older, but hyperopia is usually present at birth and is often hereditary.

With presbyopia, the lens in the eye hardens as we age, causing it to refract light improperly. With hyperopia, the lens or the eyeball may not have developed normally, which causes the refractive error that results in farsightedness—objects farther away may appear clear but nearer objects are blurry. It is the opposite of nearsightedness (myopia).

How do doctors diagnose presbyopia?

An eye doctor, either an optometrist or ophthalmologist, can perform a comprehensive eye exam to diagnose presbyopia and other vision problems. During the exam, the doctor will do a refraction assessment, which measures how well the eyes can focus on objects at different distances. This refractive assessment can help the doctor diagnose presbyopia and other vision problems. The eye doctor may use drops to dilate your pupils in order to better see the inside of your eyes. Your eyes may be dilated for several hours after the exam.

At the exam, the doctor may ask questions such as:

  • When did you begin noticing blurry close-up vision?

  • What makes your symptoms worse?

  • What situations improve your symptoms? 

  • Are you experiencing any other symptoms, such as eye pain or double vision?

If you are experiencing problems with your close-up vision and you are younger than 40, you may have premature presbyopia. Difficulty focusing on close up objects could also be related to another eye condition—such as glaucoma, cataracts, or age-related macular degeneration—that should be diagnosed by a doctor.

What are the treatments for presbyopia?

The goal of presbyopia treatment is to help you focus clearly on up-close objects. The options for presbyopia treatment range from nonprescription reading glasses to surgery. Depending on your vision as a younger person, your current eye health, and your lifestyle needs, you may have several treatment options for presbyopia.

Reading glasses (readers) 

If you had good vision when you were younger, inexpensive over-the-counter reading glasses that magnify text and close-up work may be sufficient for your needs. You can try on different pairs of these glasses, sometimes called readers, in the store to find which power of magnification you need. Readers range in strength from +0.75 diopters to +3.00 diopters.

Practice reading something in the store, such as a label or card. Choose the lowest power necessary to be able to see the object clearly. You may need a couple of different strengths for different types of work, such as reading a computer screen vs. a book or menu.

Prescription glasses 

If over-the-counter readers are not sufficient, you may need prescription reading glasses, which are more accurate than store-bought readers. If you also need corrective lenses for distant objects (nearsightedness, or myopia), bifocals or trifocals may be your best bet. Bifocals are divided into two prescriptions, or corrections: the top half is for distant objects; the bottom half for near objects. Trifocals have three strengths, with the bottom-most strength for reading fine print or detail work. Another option is a progressive lens, which has a gradual change in correction for different distances without a visible line like a bifocal or trifocal lens.

Contact lenses 

Contacts may be a choice for people who dislike wearing glasses. If you tend to have dry eyes or other health problems related to your eyes, contacts may not be an option. As with glasses, there are several choices for how to correct your vision:

  • Bifocals, where there are two different prescriptions within each contact—either the top and bottom sections have different prescriptions, or the difference lies at the periphery vs. the center

  • Multifocals (similar in function to a progressive lens), where the contact lens has more than two points of focus 

  • Monovision, where one lens is a distance prescription and the other is a close-up prescription

  • Modified monovision, where one lens is a distance prescription and the other is a bifocal, used for both distance and close-up objects 

Corrective surgery for refractive errors, such as LASIK, is for problems with distance vision (nearsightedness), not presbyopia.

What are the potential complications of presbyopia?

Presbyopia is an unavoidable condition that everyone experiences to some degree as they age. People may begin noticing presbyopia symptoms around age 40, and they may worsen until about age 65. Besides being frustrating at times, presbyopia does not create any health complications on its own.

People who choose surgical presbyopia treatment sometimes experience complications from the procedure. Also, surgery does not stop the natural progression of presbyopia, so touch-up procedures will be necessary to maintain sharp vision at all distances.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Oct 4
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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