As we reach middle age, particularly after age 40, it is common to start to experience difficulty with reading and performing other tasks that require near vision. This is because with age, the lens of our eye becomes increasingly inflexible, making it harder to focus on close objects. This condition is called presbyopia and eventually it happens to everyone who reaches old age to some extent.

To avoid eyestrain, people with untreated presbyopia tend to hold books, magazines, newspapers, and menus at arm’s length in order to focus properly. Trying to performing tasks at close range can sometimes cause headaches, eye strain or fatigue in individuals who have developed this condition.

Causes of Presbyopia

During our youth, the lens of our eye and the muscles that control it are flexible and soft, allowing us to focus on close objects and shift focus from close to distant objects without difficulty. As the eye ages however, both the lens and the muscle fibers begin to harden, making near vision a greater challenge.

Presbyopia is a natural result of the aging process and not much can be done to prevent it. Its onset has nothing to do with whether you already have another vision impairment such as nearsightedness, farsightedness or astigmatism. Everyone will notice some degree of loss of near vision focusing power as they age, although for some it will be more significant than others.

Symptoms and Signs of Presbyopia

Presbyopia is characterized by:

• Difficulty focusing on small print
• Blurred near vision
• Experiencing eyestrain, fatigue or headaches when doing close work or reading
• Needing to hold reading material or small objects at a distance to focus properly
• Requiring brighter lighting when focusing on near objects

Presbyopia can be diagnosed in a comprehensive eye exam.

Treatment for Presbyopia

There are a number of options available for treating presbyopia including corrective eyewear, contact lenses or surgery.

Eyeglasses

Reading glasses or “readers” are basically magnifying glasses that are worn when reading or doing close work that allow you focus on close objects.

Eyeglasses with bifocal or multifocal lenses such as progressive addition lenses or PALs are a common solution for those with presbyopia that also have refractive error (nearsightedness, farsightedness or astigmatism). Bifocals have lenses with two lens prescriptions; one area (usually the upper portion) for distance vision and the second area for near vision. Progressive addition lenses or PALs similarly provide lens power for both near and distance vision but rather than being divided into two hemispheres, they are made with a gradual transition of lens powers for viewing at different distances. Many individuals prefer PALs because unlike bifocals, they do not have a visible division line on the lens.

Bifocal and Multifocal Contact Lenses

People who would rather wear contact lenses instead of glasses can get bifocal and multifocal lenses in both soft and Rigid Gas Permeable (RGP) types.

Multifocal contact lenses give you more freedom than glasses because you can see clearly in any direction, including up, down, and to the sides. People who wear glasses with progressive lenses, on the other hand, have to look over their glasses in order to see up or far away.

Monovision is another choice for people who like contact lenses. Monovision uses your dominant eye for faraway vision and your other eye for near vision. Most of the time, you will use single vision lenses in each eye. However, sometimes you will use a single vision lens in your primary eye and a multifocal lens in your other eye to help you see far away and up close. The term for this is “modified monovision.” Your eye doctor will do a test to see what kind of lens works best for each eye and gives you the best vision.

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Surgery

Presbyopia can also be treated with surgery, such as monovision LASIK eye surgery, conductive keratoplasty (CK), corneal inlays or onlays, or a refractive lens exchange (RLE), which is similar to cataract surgery but replaces the hardened lens in the eye with an intraocular lens (IOL).

Since it affects so many older people, there is a lot of study and development going on to give presbyopes more and better options. Talk to your eye doctor about what your best choices are.