Presbyopia is an eye condition that impacts foreground vision, making nearby objects and text more challenging to see. It’s also known as age-related farsightedness and comes from the Greek words for elderly person (presbys) and eye (ṓps).
You don’t have to be elderly to experience it, though: Presbyopia typically becomes apparent around age 40 and is the main reason so many middle-aged folks start wearing reading glasses.
What Causes Presbyopia?
Scientists think that presbyopia has two leading causes: reduced flexibility in the lens of your eye and reduced functionality in the muscles that move the lens. (There’s still some debate over which cause contributes to the condition the most.)
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 it 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 bendy. 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 become more challenging.
Does everyone get presbyopia?
Yes—research suggests that presbyopia affects 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 is a normal and natural age-related change in the function of the eye, not a disease.
Presbyopia vs. hyperopia vs. myopia: what’s the difference?
Both presbyopia and hyperopia cause trouble with your near vision, but they aren’t the same condition.
Presbyopia occurs when the lens of your eye can’t focus light as well due to 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 can certainly be present in a given eyeball.
As you can imagine, having multiple vision problems calls for increasingly precise and complex eye prescriptions.
What is premature presbyopia?
Premature presbyopia is a condition that can affect people under age 40 before age-related presbyopia would typically develop. Certain diseases, medications, and injuries seem to increase the risk of premature presbyopia.
For example, people with diabetes, multiple sclerosis, or a history of head injuries might be more prone to premature presbyopia than others. Antidepressants and anti-anxiety drugs, among other medications, can also cause presbyopia to develop earlier in life.
If you think that your near vision is getting worse, it’s important to see an eye doctor—no matter how old you are.
Presbyopia Symptoms
The most common symptoms of presbyopia are:
- Blurry vision while trying to read or conduct close-up work
- Compensating by holding reading material farther away from your face to see text more clearly
- Eye strain, headaches, or fatigue after viewing anything up-close
- Requiring more light for close-up tasks
- Squinting to see things close up
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 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 visual problems or eye conditions from their early stages.
Presbyopia Treatment
When presbyopia sets in, you’ll have multiple treatment options that will 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 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 at 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 on the go—and computer use.
For more on progressives, see: What Are Progressive Lenses?
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, and the zone for near vision tends to be in the lower section so that you can look downwards for close-up 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.
If you’d rather not wear glasses, 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 requires 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 become acclimated 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, and not everyone is a good candidate 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 cornea of the eye 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.
Intraocular lens implant: One way to combat an inelastic lens is to replace the lens completely. During an intraocular lens implant procedure, a surgeon will remove the lens from your eye and put an artificial lens in its place.
This surgery is most commonly associated with cataracts, but people with presbyopia can also have it performed if they meet certain criteria (e.g., they also have hyperopia and are not good candidates for LASIK). In this case, the procedure is also known as a refractive lens exchange or a clear lens extraction.
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.
For more information on applying eye drops, check out our step-by-step guide on how to put in eye drops.
Additional Presbyopia FAQs
Want to know more about presbyopia? We’ve addressed some frequently asked questions below.
Can presbyopia be prevented?
No. Presbyopia happens to us all and is an unavoidable part of getting older. Unfortunately, as of right now, there’s no known way to stop, slow, or reverse its development without surgery. (Lens-softening eye drops may change this in the near future!)
Is presbyopia permanent?
If it’s not treated with surgery, then presbyopia can be considered a permanent condition. Glasses and contact lenses help treat its effects but do not change any underlying causes.
Does presbyopia get worse over time?
Presbyopia can worsen over time as the lens of your eye continues to thicken and lose its flexibility. It typically progresses from the time you turn 40 until around age 65, the point at which the lens has become as inflexible as it’ll get.
Monitor your presbyopia with regular eye exams, as your visual needs can change over time.
Can presbyopia lead to blindness?
No, presbyopia does not lead to blindness. It only blurs your near vision and makes close-up tasks more difficult (but can easily be treated!).
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 reading 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.
