Presbyopia is a problem that affects a great many people, and many would certainly like to be free of it. For a large part of the population, presbyopia is the first condition that makes them wear glasses, while for others, mainly those with high myopia, it creates the need for a second pair of glasses, which has a real impact on daily life. Contact lens wearers also face difficulties, and things become considerably more complicated if hyperopia (long-sightedness) is present as well.
Page contents
- What is presbyopia?
- What are the possible causes of presbyopia?
- How is presbyopia diagnosed?
- What are the symptoms of presbyopia? At what age does it appear?
- Presbyopia or hyperopia? The differences
- How can presbyopia be treated? Is there a permanent cure?
- How much does treatment cost? Are the prices affordable?
- Presbyopia and myopia: why short-sighted people “take their glasses off” to read
- Glasses options in detail
- Contact lenses for presbyopia
- Surgical options for presbyopia
- Eye drops for presbyopia
- Living with presbyopia: practical tips
- When difficulty with near vision is not just presbyopia
- How presbyopia progresses over the years
- Presbyopia and dry eye
- Myths about presbyopia
- Why you need a full eye examination, not just a glasses test
- Frequently Asked Questions about Presbyopia
What is presbyopia?
Presbyopia is the natural ageing of the eye’s lens, which makes it harder to shift focus from distance to near vision. It is caused by age-related changes that make the lens less soft and therefore less able to change shape. It is this change in the shape of the lens, and so in its focusing power, that allows the eye to adjust from far to near. In other words, presbyopia is not really a disease but an age-related condition, which means it is something all of us will face at some point in our lives. What varies is when a person will need to start wearing glasses, and this depends both on the condition of the lens and on their refractive error, that is, whether they have myopia or hyperopia and to what degree.
The condition of the lens is influenced by several factors, the most important being heredity, diet and the use of certain medicines, mainly cortisone. Some conditions, such as diabetes mellitus, can also speed up the natural wear of the eye’s lens.
What are the possible causes of presbyopia?
The causes are not fixed and can vary from case to case. The lens of the eye may harden, which usually happens at an older age and not in children. Essentially, the lens becomes less flexible and cannot change shape to focus at a close distance. As a result, patients may often see blurred.
How is presbyopia diagnosed?
Diagnosing presbyopia is relatively easy, as it only requires a simple examination by an ophthalmologist. The ophthalmologist may need to put drops in your eyes to dilate the pupils.
What are the symptoms of presbyopia? At what age does it appear?
Presbyopia develops gradually. Essentially, after your 40s the first symptoms are likely to start appearing:
- Headaches or eye pain when working for many hours at a computer
- Blurred vision at a normal reading distance when reading a book
- Holding the book further away than usual
The symptoms may become more noticeable in dim light or when you are tired after a long working day.
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An examination and clear advice on your case at our practice in Neo Psychiko.
Presbyopia or hyperopia? The differences
Both conditions make near vision difficult, which is why they are often confused. However, they have different causes and follow a different course.
| Presbyopia | Hyperopia | |
|---|---|---|
| Cause | The natural lens loses its flexibility with age | The eye is “shorter” or the cornea flatter than normal |
| When it appears | Usually after 40 to 45 | Present from birth and can be noticed at any age |
| Who it affects | Everyone, as the years go by | Part of the population |
| Distance affected | Mainly near vision | Near vision and, at higher degrees, distance vision too |
| Progression | Increases until around 60 | Fairly stable in adults, but becomes more noticeable with age |
The two conditions can coexist. A long-sighted person who did not need glasses, because the eye compensated for the error by accommodating, often needs reading glasses earlier than people of the same age, and later needs glasses for distance as well. You can find out more about diagnosis and correction on our page about hyperopia (long-sightedness). When both are present after the age of 45 to 50, presbyopia-correcting intraocular lenses can correct vision at several distances at the same time.
How can presbyopia be treated? Is there a permanent cure?
The easiest and safest way is with glasses. Presbyopia tends to increase gradually until the age of 65. In people who also have latent hyperopia, this is added to the presbyopia.
Unfortunately, presbyopia is a condition for which there is no perfect surgical solution. In other words, there is no operation that will give perfect near and distance vision forever. However, for people who do not want to wear glasses, there are certain cases in which we can help significantly.
Presbyopia with hyperopia
When someone has latent hyperopia, it usually starts to show after the age of 40. At first it affects near vision, but very soon it begins to affect distance vision as well. The benefit in such a case is very great, as distance vision can become excellent and near vision can also improve considerably, to the point where in some cases glasses are no longer needed. This can be enhanced with a technique called monovision, in which we make distance vision excellent in the dominant eye and improve near vision in the non-dominant eye. In this way we reduce the need for glasses, for both distance and near, even further.
Book an appointment with the doctor
An examination and clear advice on your case at our practice in Neo Psychiko.
Presbyopia without the need for distance glasses
Presbyopia without the need for distance glasses. In this case, the monovision technique can be used to improve near vision and to correct any small errors in distance vision, but above all to reduce the chances of needing glasses for distance in the future.
Presbyopia with high myopia
High myopia. People with high myopia are not well served in their near vision, since they have to bring objects very close in order to see them clearly. This is even more obvious at computer distance, for which they often have to get a second or sometimes even a third pair of glasses. In this case, we can eliminate the need for glasses for either distance or near, so that only one pair of glasses is needed, or we can use the monovision technique explained above.
How much does treatment cost? Are the prices affordable?
The cost depends on the individual case. To find out more about prices, it is best to contact the ophthalmologist.
Presbyopia and myopia: why short-sighted people “take their glasses off” to read
People with myopia experience presbyopia differently. Because the short-sighted eye naturally focuses up close, many short-sighted people over 45 find that they read better if they take their glasses off or lower them down their nose. With their distance glasses on, however, they struggle with close-up tasks. This does not mean the myopia has “gone away”. It means the eye’s lens can no longer change focus, and a solution is needed that covers both distances, such as progressive lenses.
Glasses options in detail
Reading glasses only
This is the simplest solution for people who see well in the distance. They are used for reading, mobile phones and fine work. The drawback is that you have to take them off to see into the distance. Ready-made glasses from shops may help temporarily, but they do not correct differences between the two eyes or astigmatism, and they are no substitute for an eye examination.
Progressive (varifocal) lenses
These lenses change gradually from distance correction at the top to near correction at the bottom, with no visible line. They allow clear vision at all distances with a single pair. Getting used to them usually takes a few days to two weeks, because your head and gaze need to learn which part of the lens to look through. Accurate measurement and centring are essential for comfort.
Office glasses
For those who spend many hours at a computer, there are lenses designed for intermediate and near distances. They offer a wider and more comfortable field of view on the screen than standard progressive lenses and reduce neck strain.
Contact lenses for presbyopia
There are multifocal contact lenses, which spread the distance and near correction over the same surface, as well as the monovision technique, where one eye is corrected for distance and the other for near. Both solutions suit many people, but not everyone. It is a good idea to try them for a few weeks before making any permanent decision.
Struggling with reading and your phone?
A full eye examination shows which solution suits your eyes and your daily life. Book an appointment in Neo Psychiko.
Surgical options for presbyopia
Lens replacement with a presbyopia-correcting intraocular lens
In this procedure, the natural lens of the eye is replaced with a special intraocular lens, either multifocal or extended depth of focus (EDOF), which provides vision at more than one distance. It is the same technique as cataract surgery and is particularly suitable for people over 50 to 55, those with high hyperopia or those with an early cataract. An important advantage is that a cataract will never develop in the future. You can find out more in our article on presbyopia-correcting intraocular lenses.
These lenses are not suitable for everyone. Macular disease, advanced glaucoma or severe dry eye may rule them out, and some patients see halos around lights at night, which usually lessen over time. The choice is made after a thorough pre-operative assessment and a discussion of your needs and expectations.
Laser with monovision
In some patients, mainly younger presbyopes with myopia or hyperopia, laser eye surgery can be performed on the monovision principle: the dominant eye is corrected for distance and the other for near. The brain adapts and uses the appropriate eye depending on the distance. Before the procedure, a trial with contact lenses is recommended to find out whether monovision is comfortable for you.
Eye drops for presbyopia
In some countries, eye drops are available that constrict the pupil and increase the depth of focus for a few hours, improving near vision. The effect is temporary, suits mainly early presbyopia and is not appropriate for everyone, as the drops can cause headaches, dimmed vision in low light and, rarely, more serious complications in vulnerable eyes. They should only be used after an eye examination.
Living with presbyopia: practical tips
- Lighting: good, direct light on your book makes a huge difference, because the pupil gets smaller and the depth of focus increases.
- Mobile phone and tablet: increase the font size and contrast. It is not “giving in”, it is ergonomics.
- Driving: if you find it hard to read the dashboard or sat nav, progressive lenses help you see both the road and the instruments.
- Office work: office glasses and the right screen position reduce eye strain and neck pain.
- Eye tests: presbyopia changes gradually until around 60. Prescriptions need updating every one to two years.
When difficulty with near vision is not just presbyopia
Presbyopia develops slowly and predictably. If your vision changes suddenly, if one eye sees much worse than the other, if straight lines look bent or if a shadow appears in the centre of your vision, you need an eye examination straight away. Such symptoms may be caused by cataract, diabetic changes or a disease of the macula, rather than presbyopia.
Dr. Vasileios Skouteris sees patients with presbyopia at his practice in Neo Psychiko, Athens, and recommends the right solution, from the correct glasses to modern intraocular lenses. To book an appointment, call +30 210 677 0007.
How presbyopia progresses over the years
Presbyopia usually begins around 40 to 45 and progresses gradually until 60 to 65, when the eye’s lens has lost almost all of its ability to focus. At first the difficulty appears only in dim light or when we are tired, for example in a restaurant in the evening. Later we need to hold the book or phone further and further away, until our “arms are not long enough”. At this stage reading glasses become essential.
On average, the near prescription needs a small increase every few years. After 60 the near prescription stabilises, while the first cataract changes may start to appear. That is why regular check-ups after 40 are not only about glasses but also about the early detection of glaucoma, cataract and macular disease.
Presbyopia and dry eye
The age at which presbyopia appears is also the age at which dry eye becomes more common. When the surface of the eye is dry, near vision blurs more quickly and fatigue increases, so presbyopia seems worse than it really is. Treating dry eye often makes reading glasses much more comfortable. It is also essential before any presbyopia procedure, because it affects the measurements and the final result.
Myths about presbyopia
- “If I wear reading glasses, my eyes will get worse.” Presbyopia progresses because of the age of the lens, whether you wear glasses or not. Glasses simply make your vision comfortable.
- “Eye exercises delay presbyopia.” There is no exercise that can restore the flexibility of the lens.
- “People with myopia do not get presbyopia.” Everyone gets it. Short-sighted people may simply notice it later or differently, because they can see up close without glasses.
- “Ready-made glasses from the kiosk are the same as prescription glasses.” They have the same correction in both eyes, with no astigmatism correction and no proper centring. They may be enough for occasional use, but not for everyday use.
- “Laser cures presbyopia permanently.” Laser with monovision can reduce the need for glasses, but presbyopia continues to progress with age. The most lasting solution at older ages is the right intraocular lens.
Why you need a full eye examination, not just a glasses test
The age of presbyopia coincides with the age at which the risks of glaucoma, cataract and retinal disease begin to rise. Many people visit an ophthalmologist for the first time precisely because they are having trouble reading. That is why the first visit for presbyopia is an opportunity for a full check-up: measuring the intraocular pressure, examining the lens and checking the fundus. This way your glasses come with the reassurance that your eyes are healthy.
Presbyopia is a normal part of life. With the right solution, reading, work and driving can stay just as comfortable as before.
Frequently Asked Questions about Presbyopia
At what age does presbyopia start?
Presbyopia usually appears between the ages of 40 and 45, when reading up close starts to become difficult, especially in dim light. It progresses gradually until around 60, so reading glasses need changing every few years. Long-sighted people tend to notice it earlier, while short-sighted people notice it a little later.
Is there a permanent treatment for presbyopia?
There is no way to restore the natural flexibility of the lens. However, replacing the lens with a multifocal or EDOF intraocular lens can give lasting good vision at several distances, particularly when an early cataract is also present. Other options are glasses, multifocal contact lenses and laser monovision.
Are presbyopia and hyperopia the same thing?
No. Hyperopia (long-sightedness) is a refractive error caused by the shape of the eye and is present from birth, whereas presbyopia is a normal age-related change that affects everyone after 40 to 45. Both make near vision difficult, which is why they are often confused. A person can have both at the same time.
Do ready-made reading glasses from the pharmacy help?
Ready-made glasses can be a temporary solution when both eyes have the same prescription and no astigmatism. They do not, however, account for differences between the eyes or the distance between the pupils, so they can cause eye strain. The first signs of presbyopia are also a good opportunity for a full eye examination, including an eye pressure check for glaucoma.
Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO