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Presbyopia

Presbyopia is a condition in which the lens of the eye loses its ability to focus. This makes it hard to see objects up close.

Causes

The lens needs to change its length or shape to focus on objects that are close. The ability of the lens to change shape is called the elasticity of the lens. This elasticity decreases slowly as people age. The result is a slow loss in the ability of the eye to focus on nearby objects.

People most often begin to notice the condition at around age 45, when they realize that they need to hold reading materials farther away in order to focus on them. Presbyopia is a natural part of the aging process and it affects everyone.

Symptoms


  • Decreased focusing ability for near objects
  • Eyestrain
  • Headache

Exams and Tests

The health care provider will perform a general eye exam. This will include measurements to determine a prescription for glasses or contact lenses.

Tests may include:

Treatment

There is no cure for presbyopia, but it can be corrected with glasses or contact lenses. In some cases, adding bifocals to an existing lens prescription is enough. The bifocal prescription will need to be strengthened as you lose the ability to focus up close.

Most peoples' eyes have lost the elasticity needed to focus up close by age 65. However, you may still be able to read with the help of the right prescription. You may find that you need to hold reading materials farther away, and you may need larger print and more light for reading.

People who do not need glasses for distance vision may only need half glasses or reading glasses.

People who are nearsighted may be able to take off their distance glasses to read.

With the use of contact lenses, some people choose to correct one eye for near and one eye for far vision. This is called "monovision." The technique eliminates the need for bifocals or reading glasses, but it can affect depth perception.

Sometimes monovision can be produced through laser vision correction. There are also bifocal contact lenses that can correct for both near and far vision in both eyes.

New surgical procedures are being evaluated that can also provide solutions for people who do not want to wear glasses or contacts. One promising procedure involves implanting a lens or a pinhole membrane in the cornea. Procedures very often can be reversed, if necessary.

Outlook (Prognosis)

Vision can be corrected with glasses or contact lenses.

Possible Complications

Vision difficulty that gets worse over time and is not corrected can cause problems with driving, lifestyle, or work.

When to Contact a Medical Professional

Call your health care provider or ophthalmologist if you have eye strain or have trouble focusing on close objects.

Prevention

There is no proven prevention for presbyopia.

References

Donahue SP. Presbyopia and loss of accommodation. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, MO: Mosby Elsevier; 2008:chap 9.2.

Crouch ER, Crouch ER, Grant TR. Ophthalmology. In: Rakel RE,ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 41.

Menassa N, Fitting A, Auffarth GU, Holzer MP. Visual outcomes and corneal changes after intrastromal femtosecond laser correction of presbyopia. J Cataract Refract Surg 2012; 38: 765-773.

Bouzoukis D, Kymionis G, Panagopoulou S, et al. Visual outcomes and safety of a small diameter intrastromal refractive inlay for the corneal compensation of presbyopia. J Refract Surg 2012; 28:168-173.

Doane JF. Accommodating Intraocular Lenses. In: Tansman W, Jaeger EA, eds. Duane's Clinical Ophthalmology. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol. 6, chap 14.

Updated: 5/8/2014

Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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