Presbyopia

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Presbyopia

Topic Overview

What is presbyopia?

Presbyopia is the normal worsening of vision with age, especially near vision. As you approach middle age, the lenses in your eyes begin to thicken and lose their flexibility. The ability of the lens to bend allows our eyes to focus on objects at varying distances (accommodation). The loss of this ability means that vision gets worse and objects cannot be brought into focus. This typically becomes noticeable some time around age 40 when you realize that you have to hold a book or newspaper farther from your face to focus on it.

Normally, a muscle surrounding the lens in your eye expands or contracts, depending on the distance to the object you're focusing on. With presbyopia, the muscle still works, but it may not work as well. Also, the lens loses much of its flexibility and won't bend enough to bring close objects into focus. Images are then focused behind the retina instead of directly on it, leaving close vision blurred. Putting greater distance between the object and your eye brings the object into focus. For example, holding a newspaper farther from your face helps you see the words. For this reason, presbyopia is sometimes called "long-arm syndrome."

What causes presbyopia?

Presbyopia is a natural part of aging. As you grow older, the lenses in your eyes thicken. They lose their elasticity, and the muscles surrounding the lenses weaken. Both these changes decrease your ability to focus, especially on near objects. The changes take place gradually, though it may seem that this loss of accommodation occurs quickly.

What are the symptoms?

The main symptom of presbyopia is blurred vision, especially when you do close work or try to focus on near objects. This is worse in dim light or when you are fatigued. Presbyopia can also cause headaches or eye strain.

How is presbyopia diagnosed?

Presbyopia can usually be diagnosed with a general eye examination. Your doctor will probably test your visual acuity (sharpness of vision), your refractive power (the ability of your eyes to change focus from near to far), the condition of the muscles in your eye, and the condition of your retina. He or she will probably also take measurements for glasses or contact lenses at the time of the examination.

How is it treated?

Presbyopia can usually be corrected with glasses or contact lenses. If you didn't need glasses or contacts before presbyopia appeared, you can probably correct your eyesight by using reading glasses for close work. Glasses you buy without a prescription may be sufficient. But check with your eye doctor to find out the right glasses for you. If you do buy glasses without a prescription, try out a few different pairs of varying strength (magnification) to make sure you get glasses that will help you read without straining.

If you already use glasses or contacts to correct nearsightedness, farsightedness, or astigmatism, you'll need a new prescription that will also correct presbyopia. You may wish to use bifocals, in which distant vision is corrected at eye level and close vision is corrected at the bottom. Other options include trifocal glasses, which can correct for distant, near, and middle vision; progressive lenses, which give a smooth transition between distant, middle, and near vision; bifocal contact lenses; or monovision contact lenses, which correct distant vision in your dominant eye and close vision in your weaker eye. Your prescription may have to be changed over time as presbyopia gets worse.

If you don't want to wear glasses or contacts, surgery may be an option to correct presbyopia. Procedures being used to treat presbyopia include laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Both of these surgeries use lasers to reshape the cornea of your eye. Laser surgery cannot give you both distance and near vision in the same eye. But your doctor can correct one eye for distance vision and the other eye for near vision.

Another option is clear lens extraction with an intraocular lens implant, in which the natural lens is removed and an artificial one is implanted to replace it. Some lens implants correct either distance or near vision. Others (called multifocal implants) correct both near and distance vision.

None of these surgeries will restore perfect vision—you will have to compromise. For example, you may have surgery to correct distance vision and then use reading glasses for near vision. Or you may have one eye adjusted for near vision and one for distance vision, which would reduce your depth perception. New procedures that reverse presbyopia are being developed and tested.

Will your vision continue to get worse?

Near vision begins to decline due to presbyopia at around age 40. Your eyes continue to lose the ability to accommodate—requiring changes to prescriptions for glasses or contacts—until you reach your early 60s. Then accommodation stabilizes and your vision should stop getting worse.

Other Places To Get Help

Organizations

American Optometric Association (AOA)
243 North Lindbergh Boulevard
St. Louis, MO  63141-7881
Phone: 1-800-365-2219
Web Address: www.aoanet.org
 

The American Optometric Association (AOA), which is a national organization of optometrists, can provide information on eye health and eye problems.


Canadian Association of Optometrists
234 Argyle Avenue
Ottawa, ON  K2P 1B9
Phone: 1-888-263-4676
Fax: (613) 235-2025
Email: info@opto.ca
Web Address: http://www.opto.ca
 

The Canadian Association of Optometrists represents the profession of optometry and works to enhance the quality, availability, and accessibility of eye, vision, and related health care. Its Web site provides information on optometry as well as eye health information.


Canadian Ophthalmological Society
610-1525 Carling Avenue
Ottawa, ON  K1Z 8R9
Email: cos@eyesite.ca
Web Address: www.eyesite.ca/english/index.htm
 

The Canadian Ophthalmological Society is an association of eye doctors dedicated to helping the public take good care of their eyes and vision. This group provides educational information on eye conditions and diseases and eye safety.


EyeCare America
P.O. Box 429098
San Francisco, CA  94142-9098
USA
Phone: 1-877-887-6327 toll-free
Fax: (415) 561-8567
Email: pubserv@aao.org
Web Address: www.eyecareamerica.org
 

EyeCare America is a public service program of the Foundation of the American Academy of Ophthalmology that raises awareness about eye diseases and eye care. This site provides educational materials and information about how to get medical eye care.


National Eye Institute, National Institutes of Health
Information Office
31 Center Drive MSC 2510
Bethesda, MD  20892-2510
Phone: (301) 496-5248
Email: 2020@nei.nih.gov
Web Address: www.nei.nih.gov
 

As part of the U.S. National Institutes of Health, the National Eye Institute provides information on eye diseases and vision research. Publications are available to the public at no charge. The Web site includes links to various information resources.


References

Other Works Consulted

  • American Academy of Ophthalmology (2007). Refractive Errors and Refractive Surgery (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.
  • Donahue SP (2009). Presbyopia and loss of accommodation. In M Yanoff, JS Duker, eds., Ophthalmology, 3rd ed., pp. 1059–1060. Edinburgh: Mosby Elsevier.
  • Riordan-Eva P (2008). Presbyopia section of Optics and refraction. In P Riordan-Eva, JP Whitcher, eds., Vaughan and Asbury's General Ophthalmology, 17th ed., pp. 387–388. New York: McGraw-Hill.
  • Trobe JD (2006). Refractive disorders section of Principal ophthalmic conditions. In Physician's Guide to Eye Care, 3rd ed, pp. 121–124. San Francisco: American Academy of Ophthalmology.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
Last Revised July 19, 2011

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