Presbyopia causes blurry vision up close due to changes in the eyes’ lenses that occur naturally as we age (typically starting around age 40). Some people refer to presbyopia as “age-related farsightedness,” but this isn’t an accurate term for presbyopia because it’s not the same as typical farsightedness.
Presbyopia is the main reason so many middle-aged folks start wearing reading glasses. In fact, many people first become aware of presbyopic vision changes when they have to hold reading material at arm’s length in order to read more clearly.
In this guide, we’ll discuss what causes presbyopia, how it differs from farsightedness, its symptoms, and its treatment options.
Presbyopia Causes
The leading cause of presbyopia is reduced flexibility in the lens of your eye. The muscles that move the lens still work properly. It’s the lens that changes and becomes more hardened.
The lens of your eye is a clear structure shaped like a lentil or an M&M candy—that is, convex on both sides. Your lens is positioned just behind your iris. When light enters the eye, the lens focuses so the light hits the retina at the back of your eye and produces an image, which is then sent to the brain for interpretation.
When you’re looking at something far away, the ciliary muscles around the lens are relaxed. But when you look at something close-up, the muscles contract to adjust the shape of the lens, allowing it to flex and focus the light properly.
As you get older, your lens becomes thicker and less able to change its shape. As a result, it can’t focus light as well when you’re looking at nearby objects. Your ciliary muscles may also be less effective at manipulating the lens.
Because your lens is no longer focusing light onto the retina properly, close-up tasks such as reading a book, doing a crossword puzzle, or sewing becomes more challenging.
Does Everyone Get Presbyopia?
Yes—research suggests that presbyopia affects almost everyone as they age and is “nearly universal” in people over 65. It develops regardless of gender, location, and habits. (However, the extent to which you experience presbyopia can vary based on your daily visual demands and whether you are already nearsighted or farsighted.)
Presbyopia vs. Hyperopia vs. Myopia: What’s the Difference?
Presbyopia causes trouble with your near vision, and hyperopia can too (but not always). However, they aren’t the same condition.
Presbyopia occurs when the lens of your eye can’t focus light as well because of its thickness and inelasticity. Hyperopia, on the other hand, is caused by a short eyeball shape or a cornea that lacks the right curvature for focusing light on the retina.
As for presbyopia vs. myopia, the same kind of differentiation applies. Myopia (or nearsightedness) happens when your eyeball is too long, or your cornea is too steeply curved. It’s also different from presbyopia because it impairs your distance vision, not your near vision.
Can You Have Presbyopia and Nearsightedness at the Same Time?
Yes. Presbyopia can coexist with other vision problems, such as nearsightedness, farsightedness, and astigmatism.
Like nearsightedness, presbyopia is a kind of refractive error: A condition caused by light refracting improperly within the eye and missing its mark on the retina. Refractive errors can have different causes rooted in the structure of the eye—including the shape of the eyeball, cornea, or lens—and more than one refractive error can be present in a given eyeball.
As you can imagine, having multiple vision problems calls for increasingly precise and complex eye prescriptions.
Presbyopia Symptoms
The most common symptoms of presbyopia are:
Having blurry vision while trying to read or conduct close-up work
Lacking consistency in vision and compensating by holding reading material farther away or squinting to see text or close-up work more clearly
Experiencing eye strain, headaches, or fatigue after viewing anything up-close
Requiring more light for close-up tasks
If you’re experiencing any of these symptoms, schedule an eye exam with an eye doctor.
How Is Presbyopia Diagnosed?
An eye doctor can diagnose presbyopia by conducting an eye exam. They’ll test your visual acuity, see how your eyes refract light, and complete a refraction test to determine your eye prescription.
Even if you aren’t experiencing any of the common symptoms listed above, it’s still a good idea to get regular eye exams. That way, your doctor can track the development of any vision problems or eye conditions from their early stages.
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When presbyopia sets in, multiple treatment options are available to help you see close-up text and objects more clearly.
Reading Glasses
Reading glasses have lenses with slight magnification built-in, so you can comfortably scan page after page without holding your book (or phone) far from your face. They’re meant for close-up work or reading only, so you can’t wear them all the time. Store them safely in a glasses case when you’re not using them.
Over-the-Counter Reading Glasses: You may have seen reading glasses for sale at drug and retail stores. Typically, the power of these lenses ranges from around +1.00 diopters to +2.75 diopters.
It’s tempting to simply pluck a pair off the shelf, but keep in mind they’re a one-size-fits-all option. They won’t help if one eye needs more correction than the other or if you have astigmatism. Instead, we recommend getting an eye exam and a verified prescription before you shop. You may need additional vision correction or a more precise prescription than what you can find in these non-specialized stores.
Single-Vision Reading Glasses: Otherwise known as prescription reading glasses, these readers are much more fine-tuned to a person’s visual needs.
Often, people who buy reading glasses from a store are only estimating the power their eyes need and end up getting the wrong one. They might also have different visual issues in each eye—over-the-counter readers don’t account for this.
Single-vision reading glasses can have prescriptions outside the limited range of over-the-counter readers and can simultaneously address other visual issues, such as astigmatism. Therefore, they’re the most customized and comfortable choice for easy reading.
Glasses With Multifocal Lenses
To address all of your visual needs (including presbyopia) in a single pair of glasses, try multifocal lenses.
Progressives: Progressives are the most popular type of lens used in glasses to correct for presbyopia. Unlike bifocals and trifocals, progressive lenses don’t have visibly delineated zones for each kind of vision. Instead, the different powers for distance, intermediate, and near vision blend seamlessly into one another.
For many people, progressive lenses are cosmetically ideal because they avoid the appearance of a line on your lenses. They look just like single-vision lenses but contain all the vision correction needed for seeing clearly at any distance. They’re also advantageous for busy lifestyles. There’s no need to switch between different pairs of glasses for life on the go and computer use, for example.
Bifocals: Glasses with bifocal lenses have two separate zones—one for near vision, one for distance vision—in each lens. The zones are separated by a visible line on the lens. The zone for near vision tends to be in the lower section so that you can look downwards for close objects and tasks.
Trifocals:Trifocals are like bifocals with an added feature: a zone for intermediate vision, usually placed between the zones for near and distance vision.
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If you’d rather not wear eyeglasses, you can treat your presbyopia with a few types of prescription contact lenses.
Multifocal contacts: Much like multifocal glasses lenses, multifocal contacts have different powers built right into the structure of the lens.
Because the contact lens sits directly on the surface of your eye, you don’t actually “switch” between looking through each zone—you’re looking through all of them simultaneously. However, your brain gradually adapts to the lens and will shift your focus to match the distance at which you’re trying to see something.
Monovision contacts: Wearing monovision contacts also has a bit of a learning curve. That’s because you wear a contact lens that corrects your distance vision in one eye and a contact lens that corrects your near vision in the other eye.
The hope is that your brain will eventually acclimate to the lenses, and you’ll be able to see clearly at both distances. However, judging depth and the speed at which an object is moving may be more difficult. That said, most people are good candidates for monovision contacts.
Surgery
Some people elect to get surgery on their eyes to offset the effects of presbyopia and other vision problems. These tend to be the most costly presbyopia treatments available.
Refractive surgery: Surgeries such as LASIK can reshape the eye’s cornea for sharper vision. Surgeons can also perform these surgeries to mimic the effects of monovision contact lenses. Essentially, they reshape one cornea for distance vision and the other for near vision.
Corneal inlays: A corneal inlay is a lens or aperture-like device that a surgeon implants into the cornea of your non-dominant eye. It helps light refract properly for close-up vision without compromising your distance vision.
Eye Drops
Treating presbyopia with eye drops has only recently graduated from a theory to a real possibility. There are two kinds of eye drops designed to help with near vision: miotic drops, which temporarily reduce the size of the pupil, and lens-softening drops, which restore some of the lens’s lost flexibility.
The first miotic eye drop to earn FDA approval did so in 2021. However, lens-softening drops are still being researched and tested.
What can happen if you don’t correct presbyopia? First of all, you’ll still find it difficult to read small print. But you could also get headaches and fatigue.
Presbyopia: A Part of Everyone’s Life
We’ll all have to contend with presbyopia sooner or later. Thankfully, there are multiple ways to treat this condition—and if you’re someone who likes to accessorize, then readers or progressive glasses will just be another go-to in your lineup. Our advice? Get your eyes checked regularly, make peace with presbyopia, and get back to your favorite books.
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