Presbyopia

Diagnosis

Presbyopia is commonly diagnosed during a comprehensive eye examination, which includes both a refraction assessment and an evaluation of eye health.

During the refraction assessment, your optometrist identifies any refractive errors such as nearsightedness, farsightedness, astigmatism, or presbyopia. This process may involve testing both distance and close-up vision by looking through various lenses.

For the eye health examination, your eye doctor may use drops to dilate your pupils. This can temporarily increase light sensitivity for a few hours after the exam. The pupil dilation enables a clearer view of the inside of your eyes.

According to the American Academy of Ophthalmology, adults should have a comprehensive eye examination:

• Every 5 to 10 years if they are under the age of 40.
• Every 2 to 4 years between the ages of 40 and 54.
• Every 1 to 3 years between the ages of 55 and 64.
• Every 1 to 2 years starting at the age of 65.

If you require glasses or contact lenses, have risk factors for eye illness, or both, you could require more frequent exams.

Treatment

The objective of treatment is to address the difficulty of your eyes in focusing on nearby objects. Treatment options encompass wearing corrective eyeglasses (spectacle lenses) or contact lenses, opting for refractive surgery, or receiving lens implants specifically for presbyopia.

Eyeglasses

Eyeglasses present a straightforward and safe solution for addressing vision issues arising from presbyopia. If your vision was previously good and uncorrected before the onset of presbyopia, you might find over-the-counter (nonprescription) reading glasses suitable. It’s advisable to consult your eye doctor to confirm if nonprescription glasses are appropriate for your needs. Nonprescription reading glasses typically vary in power from +1.00 diopter (D) to +3.00 D.

When choosing reading glasses:

• Start with lower powers and experiment with different magnifications until you discover one that makes reading comfortable for you.
• Use reading materials held at a reasonable distance to test each pair.

If over-the-counter glasses prove insufficient for addressing presbyopia, or if you already require prescription corrective lenses for nearsightedness, farsightedness, or astigmatism, then prescription lenses are necessary. Your available options comprise:

• Prescription eyewear for reading. You can use reading-only glasses with prescription lenses if you don’t have any other vision issues. When you’re not reading, these must be removed.
• Bifocals. A visible horizontal line on these lenses distinguishes between your reading prescription, which is below the line, and your distance prescription, which is above the line.
• Trifocals. These glasses contain adjustments for afar vision, intermediate distance vision (such as what’s shown on computer screens), and close-up work. There are two discernible horizontal lines in the lenses.
• Progressive multifocals. Although this kind of lens lacks apparent horizontal lines, it can be corrected for distance, middle distance, and close-up with numerous powers. The focusing power of the lens’s various sections vary. The lens has varying focusing strengths across different areas.
• Office progressives. These glasses are adjusted for near work and computer distance. Usually, you use these when using a computer or reading, taking them off when driving or going for a stroll.

Contact lenses

Individuals who prefer not to wear eyeglasses frequently explore contact lenses as an alternative to address vision issues associated with presbyopia. However, this choice may not be suitable for individuals with specific conditions related to their eyelids, tear ducts, or the surfaces of their eyes, such as dry eye.

Various types of lenses are accessible:

• Bifocal contact lenses. Bifocal contact lenses offer both distance and close-up correction in each lens. In one design, the reading portion of the lens is weighted at the bottom to maintain proper positioning on the eye. Alternatively, newer bifocal contact lens designs provide one type of correction through the periphery of each lens and the other type of correction through the center.
• Monovision contact lenses. This involves wearing a lens for distance vision in one eye (typically the dominant eye) and a lens for close-up vision in the other eye.
• Modified monovision. This employs a bifocal or multifocal lens in one eye and a distance lens in the other (often the dominant eye), allowing both eyes to focus on distance while using one eye for reading.

Refractive surgery

Refractive surgery alters the curvature of your cornea. In addressing presbyopia, this procedure can enhance close-up vision in your non-dominant eye, akin to the effect of wearing monovision contact lenses. Despite surgery, you may still require glasses for close-up tasks. Consult your doctor regarding potential side effects, as refractive surgery is irreversible. It may be prudent to experiment with monovision contact lenses before opting for surgery.

Refractive surgical procedures encompass:

• Conductive keratoplasty. Heat is applied to small areas surrounding the cornea using radiofrequency energy during this technique. The cornea’s edge shrinks slightly as a result of the heat, making it more curved and capable of focusing. Conductive keratoplasty can have unpredictable and short-lived effects.
• Laser-Assisted in Situ Keratomileusis (LASIK). Your eye surgeon will remove a small, hinged flap from the front of your eye during this treatment. He or she then utilizes a laser to steepen the domed form of your cornea by removing its inner layers.
  When compared to other corneal procedures, recovery from LASIK surgery is typically quicker and less painful.
• Laser-assisted Subepithelial Keratectomy (LASEK). The surgeon forms an ultra-thin flap solely in the cornea’s epithelium, or outermost layer of protection. After steepening the curve of the cornea’s outer layers with a laser, he or she replaces the epithelium.
• Photorefractive Keratectomy (PRK). This process is comparable to LASEK, with the exception that the cornea is reshaped using a laser after the surgeon removes all epithelium. The epithelium regenerates spontaneously and takes on the new form of your cornea instead of being replaced.

Lens implants

Certain ophthalmologists perform a procedure where they extract the lens in each eye and substitute it with a synthetic lens, known as an Intraocular Lens (IOL).

Various types of lens implants are accessible for addressing presbyopia. Some enable both near and distance vision, while others adjust position or shape within the eye (accommodative lens). However, lens implants may result in diminished near vision quality, necessitating the continued use of reading glasses.

Potential side effects include glare and blurring. Moreover, this surgery entails risks akin to those associated with cataract surgery, including inflammation, infection, bleeding, and glaucoma.

Corneal inlays

Certain individuals have found relief from presbyopia through a treatment method involving the insertion of a small plastic ring with a central opening into the cornea of one eye. This opening functions akin to a pinhole camera, allowing focused light to enter and facilitating clear vision of nearby objects.

Should you find the outcomes of your corneal inlay procedure unsatisfactory, your eye surgeon retains the ability to remove the rings, providing you with the opportunity to explore alternative treatment avenues.