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Presbyopia

Presbyopia is a slow loss of ability to see close objects or small print. It is normal to have this as you get older. People with presbyopia often have headaches or strained, tired eyes. Reading glasses usually fix the problem.

PubMed Health Glossary
(Source: NIH - National Institute for Aging)

About Presbyopia

Presbyopia is a common type of vision disorder that occurs as you age. It is often referred to as the aging eye condition. Presbyopia results in the inability to focus up close, a problem associated with refraction in the eye.

Can I have presbyopia and another refractive error at the same time?

Yes. It is common to have presbyopia and another type of refractive error at the same time. There are several other types of refractive errors: myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

What is refraction?

Refraction is the bending of light as it passes through one object to another. Vision occurs when light rays are bent (refracted) by the cornea and lens. The light is then focused directly on the retina, which is a light-sensitive tissue at the back of the eye. The retina converts the light-rays into messages that are sent through the optic nerve to the brain. The brain interprets these messages into the images we see.

How does presbyopia occur?

Presbyopia happens naturally in people as they age. The eye is not able to focus light directly on to the retina due to the hardening of the natural lens. Aging also affects muscle fibers around the lens making it harder for the eye to focus on up close objects. The ineffective lens causes light to focus behind the retina, causing poor vision for objects that are up close.

When you are younger, the lens of the eye is soft and flexible, allowing the tiny muscles inside the eye to easily reshape the lens to focus on close and distant objects.

Who is at risk for presbyopia?

Anyone over the age of 35 is at risk for developing presbyopia. Everyone experiences some loss of focusing power for near objects as they age, but some will notice this more than others. NIH - National Eye Institute

What works? Research summarized

Evidence reviews

Laser Eye Surgery for Vision Correction: A Review of Clinical Effectiveness and Guidelines [Internet]

Refractive error (ametropia) is a common condition resulting in decreased visual acuity. Patients are treated and symptoms can be corrected with eyeglasses, contact lenses, or surgery. Eyeglasses are the simplest and safest means of refractive error correction. Laser eye surgeries are a subset of surgical procedures used to correct most common refractive errors and are the most frequently performed procedures for low to moderate near-sightedness (myopia). Photorefractive keratectomy (PRK), was developed over 20 years ago, and subsequently wavefront-guided laser in situ keratomileusis (LASIK) has become the most commonly performed keratorefractive procedure. Other procedures are variations of PRK and include laser epithelial keratomileusis (LASEK) and epi-LASIK. Long term studies demonstrate excellent safety, efficacy, and stability of these procedures with long term refractive stability for far-sighted (hyperopic) patients less certain than for myopic patients.

Accommodative intraocular lenses compared with monofocal intraocular lenses in cataract surgery

Accommodation is the ability of the eye to focus on both distant and near objects.

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

This study found large variability in the use of some common procedures that cannot be explained by differences in local need and may reflect uncertainty about appropriate use. This may help identify procedures that could be reassessed for disinvestment.

See all (6)

Summaries for consumers

Presbyopia: Overview

Seeing nearby objects less clearly is a normal part of aging. Known as presbyopia, this typically becomes noticeable in your mid-forties: you have to start holding newspapers or books further away in order to be able to read them. Although there are no effective treatments for the causes of presbyopia, its effects can be corrected.

How can presbyopia be corrected?

Our ability to see nearby objects gets worse with age. This is known as presbyopia. Although it can’t be reversed, it is easy to correct. The simplest way is to wear reading glasses. Laser treatment and other kinds of eye surgery have hardly any advantages, but are associated with a lot of risks. Presbyopia usually becomes noticeable in your mid-forties, and at first is often only a problem when reading. Wearing reading glasses is then a simple and effective solution for people who don’t already have other problems with their eyesight. Those who already had to wear glasses or contact lenses beforehand can use varifocal or multifocal glasses to avoid having to switch between different pairs. Multifocal contact lenses are an alternative to multifocal glasses. They also allow you to see both nearby and distant objects clearly. Laser treatment and other kinds of eye surgery are called refractive surgery. The aim of these procedures is to change the refractive power (focusing power) of the eye in order to correct your vision. They can’t yet effectively reverse presbyopia. What’s more, most of the procedures are still being tested. The advantages of not having to wear glasses or contact lenses have to be weighed against the possible risks associated with the procedure. For instance, your spatial vision may be worse afterwards, or you may suddenly have trouble seeing things that are further away. The costs of these procedures aren’t covered by statutory health insurers in Germany. People have to pay for them themselves.

Accommodative intraocular lenses compared with monofocal intraocular lenses in cataract surgery

Accommodation is the ability of the eye to focus on both distant and near objects.

Terms to know

Cornea
The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside.
Lens in the Eye
A clear disk that focuses light, as in a camera or microscope. In the eye, the lens is a clear, curved structure at the front of the eye behind the pupil. It focuses light rays that enter the eye through the pupil, making an image on the retina (light-sensitive layers of nerve tissue at the back of the eye).
Refractive Error
A defect in the focusing of light on the retina.
Retina
The light-sensitive tissue lining at the back of the eye. The retina converts light into electrical impulses that are sent to the brain through the optic nerve.

More about Presbyopia

Photo of an adult

Other terms to know: See all 4
Cornea, Lens in the Eye, Refractive Error

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