Presbyopia: Causes and Treatments


Starting in the early to mid-40s, many people may have problems reading small print, whether it’s printed matter or on a computer monitor, even those who still have excellent distance vision. This condition is called presbyopia, a Greek word that literally means “old vision,” and it’s one of the most common problems among people ages 41 to 60. The changes are very gradual, and you won’t notice the loss until one day you find yourself squinting at a newspaper that’s held at arm’s length and still appears to be blurred, or you have trouble reading anything in a dimly lit room. Threading a needle becomes a marathon task. By the time people reach their 50s and 60s, most will need some type of assistance with their vision.

Symptoms of presbyopia

  • Blurred vision at normal reading distances.
  • Headache and eye fatigue after doing close work, possibly accompanied by symptoms of dry eye such as stinging, burning, or a gritty sensation in the eyes.

What causes presbyopia?

Presbyopia Causes

Many factors appear to contribute to presbyopia, including the lens of the eye becoming less flexible and thus less able to change shape and focus on close objects, especially in dim light. Other factors include the lengthening of the lens over time, which, along with age-related changes in the muscle fibers attached to the lens, make it harder for the fibers to effectively help the lens change shape to focus on close objects.

What if you do nothing?

Presbyopia will gradually get worse as you age, and you will find that it’s more difficult to read small print unless you begin using corrective lenses.

Home remedies for presbyopia

  • Get some drugstore reading glasses. Specialist-prescribed glasses can cost $200, yet over-the-counter glasses—which cost around $20 or less—may be just as effective. When you pick out nonprescription reading glasses, be sure you have the time to try on several pairs and to read the test cards provided. You might also carry along a book or newspaper for testing. Glasses are often labelled with a number between 1.00 and 4.00 that represents the magnification. Start with a low magnification, no higher than 1.25 or 1.50, and see how well you can read the card or reading material at a comfortable distance. If that magnification isn’t sufficient, gradually move up until you find the one that works.
  • Increase the amount of light you use for reading and other close-up activities. Go from 60- to 100-watt bulbs whenever possible.

Can presbyopia be prevented?

There is no way to prevent presbyopia. However, there is some thought that spending a lifetime reading at a near distance, such as when reading text messages on cell phones, may cause presbyopia to occur at a younger age.

When to call your doctor

Contact an eye doctor (optometrist or ophthalmologist) if the signs of presbyopia begin to interfere with daily activities. Many eye specialists advise glaucoma testing at age 40 or 50, when signs of presbyopia also often start to appear; so you can be tested for both conditions at the same time. If your vision is changing rapidly, consult an optometrist or ophthalmologist to make sure that magnifying glasses for reading are all you need.

What your doctor will do

You will be given an eye examination. After you explain to your eye doctor all the various tasks you do on and off the job that require clear vision, the doctor will use the information to help determine and fit the corrective lenses that will be best for you. There are several different surgical procedures that can be used totreat presbyopia, including using radio waves to reshape the cornea (called conductive keratoplasty, or CK) and LASIK, a technique that uses laser beams to reshape the cornea. In addition, the FDA has approved an implant, the Raindrop Near Vision Inlay, that looks like a tiny contact lens and is surgically implanted in the cornea.

Many nonsurgical techniques also show promise, including relying on eye drops that improve the lens’s flexibility, and electro-stimulation of the tiny muscles surrounding the lens.

Depending on your existing vision problems, you may need bifocals or trifocals—glasses with two or three kinds of vision correction, as the name implies. A progressive lens —which is manufactured to provide a gradual change in correction from top to bottom—is another option. Progressive lenses are more expensive than conventional bifocals and have a smaller field for reading. Progressives are also harder to prescribe and fit than regular bifocals, so buy them from someone who is experienced in fitting them.

If you wear contact lenses, you can consider bifocal or multifocal contact lenses, though these won’t work for everyone. Another choice is monovision—wearing a near-vision contact lens in one eye and a distance-vision one in the other, so that you see with one eye at a time. (Some people have trouble with this since it affects depth perception.) If you decide to investigate either of these options, discuss your needs with an experienced professional. Remember, too, that you may need new lenses every 12 to 18 months for a time to correct for worsening presbyopia.