Treatment Options for Presbyopia

Well, it’s that time. You’re in your mid-40s and your life has been in clear focus until now. No, we’re not talking about a mid-life crisis, though you can still buy that red Ferrari if you really want to. We’re talking about presbyopia. Presby-what, you ask? Perhaps you recall the day your parents started wearing reading glasses but at the time probably didn’t realize that that would be you one day, too.


Presbyopia – It Happens to the Best of Us

Presbyopia stems from the Greek for “old eye.” Flattering, isn’t it? Unfortunately, unlike wine, our vision doesn’t improve with age. Now you’re around 45 years old, you may have started noticing that it’s a little easier and clearer to read your text messages if you hold your phone slightly farther away. Computers are probably still okay – because they’re already situated at a longer working distance. Books, newspapers, and magazines, however… If you’re reading on a digital device such as your smartphone, Kindle, or a tablet, it’s easy to just zoom in or enlarge the font. Old school printed materials are a different story.

Presbyopia is the natural, age-related decline of the eye’s focusing system, also known as the accommodative system. It happens to everyone and typically hits around the mid-40s. Presbyopia isn’t a disease or a significant cause for concern, although it can certainly be inconvenient, especially if you’re about to deliver a speech and can’t read your notes because your 2-year-old demolished your reading glasses.

It is understood that the main cause behind presbyopia is a stiffening of the crystalline lens of the eye. In a young, spritely eye, an active accommodative system is comprised of a flexible lens attached to a ring of ciliary muscle. The process of accommodation, as we focus on nearby objects, requires the lens to adjust its shape in response to the attached muscle fibers relaxing or tensing. This increased curvature of the lens brings forward our eye’s focal point, allowing us to see close detail with clarity. With age, the lens slowly but surely loses its flexibility as it grows thicker and stiffer. This process of decreasing accommodative ability begins soon after birth, but it’s only around the mid-40s that we begin to notice.

Presbyopia is a progressive condition. It might begin around 45 years of age but it certainly doesn’t stop there. While in the early stages of presbyopia you may be able to get away with holding your reading material out a little, eventually you will find your arms are simply not long enough. Your computer screen set up at an ergonomically distant length will also eventually succumb to the blur. Around 60 years old is when presbyopia is typically considered complete.


Presbyopia Treatment Options

Until we discover the cure to stopping aging, current presbyopia treatments are in the form of optical aids, surgery, or (still under research) pharmaceutical agents. You may see on the internet some suggestion of eye exercises or certain vitamins and minerals restoring your reading vision but if you dig a little deeper, these tend to be from – ahem – less credible sources. If you feel inclined to overdose yourself with vitamin A in an attempt to avoid reading glasses, run it by your (fully qualified and board registered) eye doctor first. Here’s the low-down on the more widely accepted, researched methods of presbyopia treatment.

Optical Aids
In other words, glasses and contact lenses. You could add monocle to this category too, but you’d probably be the only one wearing one. Eye glasses are the least invasive, simplest form of correction for presbyopia. You can have them made as a pair of single vision reading glasses, which are on for all near work and off for everything else. Alternatively, you can get into multifocal or bifocal lenses, which allow you the convenience of being able to see clearly at both distance and near without fiddling around with your glasses.

For many years, contact lens wearers thought that contacts were no longer an option once presbyopia began to creep in. In fact, with new developments in contact lens technology, there are actually quite a few options for those who wish to continue with the freedom that contact lens wear brings. You can ask your optometrist about:

  • Monovision contact lenses, which involve correcting one eye for long distance and the other eye for reading
  • Multifocal contact lenses, which, unlike multifocal glasses, give you near and distance vision no matter where you point your eyes

Some contact lens wearers may find the most convenient arrangement for them is to wear reading glasses over the top of their contact lenses. Different things work for different people.


Refractive Surgery
There will be some types of refractive surgery that your ophthalmologist may steer you away from, simply because they will still leave you with reading glasses. Conventional laser eye surgery procedures such as PRK and LASIK are typically used to correct for long distance vision rather than improving your reading vision. However, for the active presbyope who is not a fan of optical aids, there are still some surgical options available.

  • Refractive lens exchange, which is similar to a cataract surgery procedure but just without a cataract being present. Your crystalline lens is surgically extracted and replaced with an artificial lens implant. If you’re suitable for it and are aiming to get rid of your reading glasses, this implant can be a multifocal design or you can even have monovision implants. These arrangements will allow you clear vision at both long distance and near.
  • PresbyLASIK, Presbyond, or blended laser vision, though this is not offered by all refractive surgeons. The traditional LASIK procedure is modified to shape the cornea in such a way that it provides some degree of both distance and near vision. In essence, LASIK surgery is used to give you a multifocal cornea.
  • Intracorneal inlays are a tiny implant inserted into the cornea itself. An inlay may be designed to change the refraction of light, similar to a contact lens. Alternatively, small aperture inlays act like a pinhole to control the amount of light entering the eye. If you think about how squinting helps you focus, small aperture inlays work the same way.

Pharmacological Eye Drops
The use of certain topical drugs to reverse or reduce the effects of presbyopia is an emerging area of research. The new pharmacological agents under current investigation fall into one of two categories based on how they work.

One group of eye drops are being developed around the concept of the pinhole effect. By causing the pupil to constrict, these pharmaceutical agents have been shown to effectively improve near vision while still maintaining good long-distance sight. Adverse effects reported from these studies include headache, nausea, and eye discomfort.

The other category of presbyopia-reversing eye drops is based on softening the crystalline lens and restoring its flexibility. By chemically breaking the bonds between lens proteins, the stiffening of the eye’s lens can be reversed, allowing it to accommodate once again like the good old days. As with the anti-presbyopia eye drops built on the pinhole effect, these medications are also still in the works but so far, results have been promising.

For a lot of people, eyeglasses will be the easiest and simplest solution (and the cheapest). However, if reading glasses simply don’t fit in with your suave image or your active lifestyle, there are other options, including surgery or – hopefully in the near future – eye drops.