What Is Presbyopia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Everyone develops presbyopia, and it typically begins around age 40.

Presbyopia is a common age-related vision disorder that makes it difficult for you to see or focus on objects up close. Presbyopia isn’t considered a disease — it’s a natural part of aging. (1)

While similar to simple farsightedness, presbyopia is a separate condition that’s related to natural aging. (2)

If you have to hold reading materials at arm’s length to properly focus on the words, you may be experiencing one of the most common first signs of presbyopia.

Other symptoms include:

• Difficulty reading small print
• Headaches from doing work up close
• Eyestrain
• Requiring more light to read

The symptoms of presbyopia are similar to those of farsightedness (hyperopia), but the two conditions have different causes.

Farsightedness is caused by an eyeball that’s shorter than usual, or a cornea that’s too flat. Presbyopia is caused by a hardening of the lens with aging. (3)

Presbyopia stems from an issue with the lens of the eye, which sits behind the iris (colored part) and pupil.

The lens of the eye bends (or refracts) light to focus it directly onto the retina, which is the light-sensitive tissue at the back of the eye. (4)

The retina converts light into signals that are sent to the brain, which then interprets the signals as images. (5)

When a person is younger, the lens is soft and flexible. Tiny muscles in the eye can easily change the shape — and, as a result, the focus — of the lens, a process called accommodation.

With age, the elasticity of the lens and of the muscles around it starts to diminish. This makes it so the lens isn’t able to focus on up-close objects, making them appear blurry.

When you get presbyopia before the age of 40, it’s known as premature presbyopia. A study published in the International Journal of Contemporary Medical Research concluded that risk factors for early loss of near vision vary by sex and include: (6)

• Poor nutrition
• Anemia
• Smoking
• Alcohol abuse
• Work that requires a lot of near vision (such as staring at a computer screen all day)
• Substantial sunlight exposure
• Premature menopause

The study authors also found that reading on a smartphone for at least one hour at one sitting, or for two hours throughout the day, for six months, also elevated a person’s risk for developing premature presbyopia. (6)

Presbyopia is diagnosed during routine, comprehensive eye exams that test your ability to see both near and distant objects.

During the exam, your ophthalmologist (eye doctor) may also dilate your pupils to make it easier to see the insides of your eyes. Your eyes may stay a bit sensitive to light for several hours after the exam.

Because presbyopia is so common, the American Academy of Ophthalmology (AAO) recommends all adults get a complete eye exam at age 40. You may need to see your doctor sooner if you have a history of diabetes or high blood pressure or a family history of eye disease. (7)

The AAO’s eye exam recommendations vary you get older, depending on your age:

• Ages 40 to 54 Every two to three years
• Ages 55 to 64 Every one to three years
• Ages 65 and Older Every one to two years

If you wear glasses or contacts or are at greater risk for certain eye conditions, you may need to see your eye doctor more often. (8)

Prognosis of Presbyopia

Once you have presbyopia, you’ll have it for life. The good news is, there are many treatments that may help you to see better.

Your doctor may recommend corrective glasses or contact lenses. In some cases, you might be able to consider refractive (or laser) surgery, lens implants, or corneal inlays.

Refractive surgery is irreversible, and these surgeries may cause side effects or not completely restore your vision to the way it was before you started to experience vision problems.

There’s no way to get rid of presbyopia. The condition tends to get worse until the age of 65, at which point the eye’s lenses have lost most of their elasticity. But there’s a little bit of good news here, in that you won’t need to continue to change your reading glasses prescription. (1)

There’s no cure for presbyopia. Treatment consists of wearing eyeglasses or contact lenses, or possibly getting a corrective surgery that may help improve your near vision. (10)

Eyeglasses

Several types of eyeglasses are available for presbyopia, including: (10)

• Reading Glasses These are worn only when reading or doing close-up work.
• Office Progressives You’ll also generally only wear these for reading or using a computer and remove them when you’re out and about.
• Bifocals These glasses correct your distance vision when you look through them at eye level, and they correct your near vision when looking through the lower part of the lens.
• Trifocals These glasses have corrections for near, middle, and far vision.
• Progressive Multifocals These lenses are similar to trifocals but don’t have horizontal lines.

Contact Lenses

Several types of contact lenses can correct presbyopia and other vision problems: (2)

• Bifocal or Multifocal Like bifocal glasses, these contacts help you see both far away and up close.
• Monovision You’ll wear two different types of lenses: one corrects for distance vision and the other for near vision. This helps you see better at all distances.
• Modified Monovision This involves wearing a multifocal lens in one eye, and one lens in the other for near or far vision.

Medication

The prescription eye drop Vuity (pilocarpine ophthalmic) allows some people with presbyopia to see up close without glasses or contacts for several hours a day.

Pilocarpine, the active ingredient in Vuity, contracts the ciliary muscles, reducing pupil size. This results in an increased depth of focus and improved vision while looking at close objects. 

The once-daily drops work in 15 minutes or less, and can last up to six hours for near vision and 10 hours for intermediate vision (such as reading on a computer screen).

However, having a smaller pupil may also make it more difficult to see in low light, so the drops are not recommended before activities such as driving at night.

Surgical Procedures

If you don’t want to wear glasses or contact lenses, talk to your doctor about a surgical procedure for presbyopia.

Refractive surgery corrects your vision in both eyes so that it’s like having permanent monovision contact lenses. It’s nonreversible, and it may not entirely fix your vision. (2)

There are several types of refractive surgery:

• Conductive Keratoplasty Heat from radiofrequency energy shrinks the edge of the cornea to change its curve. The effectiveness of the surgery varies, and it may not last.
• LASIK Surgery A small flap is cut in the cornea and a laser is used to remove part of the cornea to increase its curve. This procedure usually causes fewer side effects and is faster than other surgeries.
• Photorefractive Keratectomy (PRK) As with LASIK, a laser (but no incision) is used to reshape the cornea.

There are two other types of surgeries for presbyopia: (10)

• Lens Implants The lenses in each eye are replaced with artificial (intraocular) lenses. It may not entirely correct vision and can lead to vision blurriness and glare, infection, bleeding, and glaucoma.
• Corneal Inlays A small plastic ring is placed into the cornea of one eye, refocusing light to improve up-close vision.

Prevention of Presbyopia

Because presbyopia happens naturally through the aging process, there’s no way to prevent it.

But there are steps you can take to keep your eyes healthy and prevent other more serious eye problems, like macular degeneration: (2)

• Reduce eyestrain by keeping your home and workplace well-lit.
• Get regular eye exams to make sure your prescription is up-to-date and to look for signs of other eye conditions.
• Use corrective glasses or contacts if you need them to optimize your vision.
• Wear sunglasses to protect your eyes from damaging ultraviolet (UV) rays.
• Support your overall health by eating a balanced diet that’s rich in vitamins A, C, E, and lutein.
• Limit alcohol.
• Exercise regularly.
• Drink plenty of water.
• Don’t smoke.
• Control chronic conditions like diabetes and high blood pressure. Left untreated, they can impact your vision.
• See your doctor right away if you have double vision, see flashes of light or black spots, have suddenly blurry vision, or suddenly lose vision in one eye, as these symptoms may indicate a serious condition.

Presbyopia complications are generally linked to problems caused by surgery to correct your vision.

Talk to your doctor about the potential risks and complications of your surgical options to determine if a procedure is right for you.

Everyone develops presbyopia, which typically begins after the age of 40, according to the AAO. (4)

A study published in the journal Ophthalmology estimated that there were 1.8 billion people worldwide with presbyopia as of 2015, 45 percent of whom didn’t have glasses, contacts, or other vision correction. (13)

Other research estimates that about 80 percent of adults in North America have presbyopia by ages 45 to 55, and 16 percent haven’t received correction. (14)

The eye’s lens changes shape to allow you to focus on nearby objects. Presbyopia is a normal part of aging caused by the hardening of the lens in the eye, which makes close objects look blurry.

Most people begin to notice the signs of presbyopia in their early to mid-forties. But anyone over the age of 35 is at risk for presbyopia, the National Eye Institute notes. (15)

As mentioned above, risk factors for premature presbyopia before the age of 40 include poor nutrition, smoking, alcohol abuse, anemia, work that involves near vision, increased sunlight exposure, and premature menopause. (6)

Additional reporting by Joseph Bennington-Castro.