Presbyopia Treatment

What is presbyopia?

Presbyopia is when the eyes gradually lose the ability to clearly see or focus on near objects. It is a normal part of aging that usually develops during the late 30s to early 40s. The word “presbyopia” means “old eye” in Greek. In Mandarin Chinese, presbyopia is informally called “lao hua” or “lao hua yan”. An ophthalmologist is a medical specialist who can advise patients with presbyopia on the appropriate management and treatment of the condition.

What are the different types of presbyopia?

There are five types of presbyopia. They include:

· Incipient presbyopia, the earliest stage when small print is difficult to read.
· Functional presbyopia, the next stage when small print is increasingly difficult to read.
· Absolute presbyopia, the stage when eyes cannot focus on near objects.
· Premature presbyopia refers to presbyopia that occurs before 40 years old.
· Nocturnal presbyopia refers to difficulty reading small print in low light conditions.

What causes presbyopia?

To be able to clearly focus on objects that are near, the lens of the eye needs to change shape and thickness. The ability of the lens to change shape is a result of the elasticity of the lens. As people age, the elasticity decreases resulting in a slow loss in the ability of the eye to focus on nearby objects.

Did you know?

According to a 2016 research study, one-third of Singaporean adults that were studied were diagnosed with presbyopia but did not have near correction. The Singapore Epidemiology of Eye Disease study included 7890 presbyopic subjects (3909 females, with an age range between 40-86 years) of Malay, Indian, and Chinese ethnicities. Those who were younger, male, of Malay and Indian ethnicities, and with lower education and income levels, were associated with higher odds of uncorrected presbyopia.¹

What are the possible complications of presbyopia?

If presbyopia is not corrected, individuals may experience ongoing eye strain and headaches. They will also begin to hold books and other materials at a distance in an attempt to focus and read the material. Other possible complications are problems when driving and working.

When should I see a specialist for presbyopia?

An ophthalmologist should be contacted if you experience continuous eye strain, have frequent difficulty focusing on close objects, or experience headaches often, especially after reading.

How should I prepare for my appointment?

Adults and adults accompanying their children should bring previous eye test results if they have them readily available and medical history. If glasses have been prescribed, please bring the glasses. If the patient has undergone any eye procedures or surgeries, you should be prepared to discuss the diagnosis and treatment with the specialist.

How do specialists diagnose presbyopia?

Presbyopia is diagnosed by an eye exam, which includes a vision (refraction) assessment and an eye health exam. A vision assessment determines will determine if you have nearsightedness, farsightedness, astigmatism, or presbyopia. The specialist will ask you to read eye charts to test distance and close-up vision. The specialist may also put drops in the eyes to dilate the pupils to view the inside of the eyes. Most ophthalmologists recommend regular eye exams, usually on an annual basis if you have been diagnosed with vision problems including presbyopia.

What treatments are available for presbyopia?

There are several treatment options for presbyopia. These options include wearing reading glasses to focus on near objects. If your ability to see objects at a distance is also impacted, you may need bifocal or varifocal lenses, where different areas of the lens are different prescriptions. With bifocals, the lower part of the lens supports close-up vision and the remainder of the lens assists distant vision. A varifocal lens, may have a center area to support work beyond a reading distance, for example a computer screen or monitor. Some individuals may prefer to wear contact lenses rather than glasses. Contact lenses can be worn with bifocal lenses or some individuals may wear a different contact lens in each eye to support near and distance vision or only one contact lens for reading and close work.

In addition to glasses or contacts, presbyopia can also be treated surgically by reshaping the cornea using a laser. The reshaping of the cornea allows light to properly focus on the retina for clear vision. Surgical options include LASIK (Laser-Assisted In situ Keratomileusis), which is the most popular form of laser eye surgery. LASIK modifies the cornea, usually only in one eye, to correct presbyopia. The LASIK procedure is accomplished fairly quickly and most people return to normal activities within 24-48 hours.

PRK (photorefractive keratectomy) is another type of laser eye surgery that was the predecessor to LASIK. PRK recovery may take longer than LASIK. However it may have advantages for selected patients.

Other surgical options include the Kamra corneal inlay. In this procedure, a thin opaque device is surgically implanted in the central cornea which creates a pinhole camera affect to sharpen near vision. The procedure is usually performed on the non-dominant eye to maintain distance vision and enhance near vision. The procedure is also accomplished fairly quickly and individuals can return to normal activities within 24-48 hours.

An ophthalmologist can determine the most effective treatment option for you.

[1] Man, RyanEyn Kidd, Fenwick, Eva Katie, Sabanayagamac Charumathi, Li Ling-Jun, Gupta Preeti, Tham Yih-Chung, YinWong Tien, Cheng, Ching-Yu, Lamoureux Ecosse Luc. Prevalence, Correlates, and Impact of Uncorrected Presbyopia in a Multiethnic Asian Population. American Journal of Ophthalmology. Volume 168. August, 2016, 191-200. https://doi.org/10.1016/j.ajo.2016.05.019