What is Presbyopia?
Past the age of 40, we all have loss of near vision like death and taxes. This process is called presbyopia. For doctor and patient alike, presbyopia can be a very frustrating condition as there are no complete fixes or cures. Although both effect near vision, presbyopia and farsightedness are different.
Signs and Symptoms of Presbyopia
The first symptom of presbyopia is usually a slowing of focusing from distance to near. As the process progresses, the near vision declines to a point where all near tasks are blurry. Eyestrain, tired eyes, and headaches with reading and computer work are also common symptoms.
What Causes Presbyopia?
Tucked in behind your pupil is a lens about the size of a plain M&M. Small muscles within the eye bend this lens to change its shape and this allows us to focus from distance to near objects. This unconscious processes is called accommodation. Past the age of 18, the lens begins to lose flexibility and our focusing ability decreases by 50% every six or seven years which results in near vision blur anywhere from 35 to 45 years old and complete loss of focusing ability by age 55.
How is Presbyopia Diagnosed?
Presbyopia can only be diagnosed during a comprehensive eye examination. Your doctor will perform a refraction which involves testing multiple lens combinations to determine the prescription that is best for you.
How is Presbyopia Treated?
Treatment for presbyopia for some patients can be as simple as buying over-the-counter reading glasses at your local drugstore. These simple glasses are effective only if your distance vision is good and your eyes are fairly equal. Reading glasses can be effective in the early stage of presbyopia. However, as the process continues, many patients feel that the constant “on and off” of the readers, cheaters, granny glasses, etc. to be annoying and switch to a multifocal lens which can be worn all the time. Progressive invisible multifocal lenses are the most common and functional options but some patients still choose lined bifocals or trifocals.
There are also contact lens options for presbyopia. Here are the three options that are available.
- Distance vision only contact lenses with reading glasses for near vision.
- Monovision contact lenses involve one eye focused for near and the other eye focused for distance. For many patients, monovision is an acceptable solution for their presbyopia problems. For others, the loss of binocular (both eyes together for all distances) vision and subsequent loss of depth perception are not tolerable.
- Multifocal contact lenses: recent advancements in contact lens technology have produced multifocal contacts which can work well for presbyopic patients who have minimal astigmatism. These lenses work by alternating rings of distance vision and near vision areas within the lens so essentially patients are looking through distance and near at the same time. This can result in mild blurring of the distance vision which for most patients is insignificant. Multifocal contact lenses will dramatically reduce the need for reading glasses but probably not eliminate them completely.
LASIK surgery is very limited in its use for presbyopia. Currently, the only option is to treat one or both eyes to achieve a monovision outcome. It is highly recommended that patients try monovision with contact lenses first, before being surgically altered into vision they might not like.
Advancements in custom cataract surgery now allow surgeons to remove the non-bending lens and replace it with a flexible lens that can significantly reduce the need for reading glasses after cataract surgery. This is a fairly expensive procedure in most insurances do not cover the flexible lens.
What Steps Should I Take If I Think I Have Presbyopia?
We recommend making an appointment to see Dr. Reinders as quickly as possible to make sure that a simple case of presbyopia is all that is causing your vision problem. He has 22 of years of experience treating patients with presbyopia and other related conditions. The sooner he can check your eyes, the better. All doctors agree that waiting and hoping it will get better is not a prescription for success.