presbyopia

Presbyopia is an age-related decline in the eye’s ability to focus on near objects. It results from reduced accommodative ability as the crystalline lens becomes stiffer and the supporting structures change with age. It typically becomes noticeable in the early to mid 40s and gradually progresses until around age 60 or beyond. It affects nearly everyone to some degree as part of aging.

Causes and mechanism: The lens loses elasticity, the capsule thickens, and the muscles that control accommodation weaken, reducing the amplitude of accommodation. These changes limit the eye’s ability to increase refractive power for near tasks, such as reading.

Symptoms: Blurred or distorted near vision, the need to hold reading material farther away, eye strain, headaches after close work, and difficulty with small print. Distance vision generally remains relatively unaffected.

Diagnosis: An eye examination including refraction, assessment of near visual acuity, and evaluation of the near point of accommodation helps determine the degree of presbyopia and guide treatment.

Treatment and management: The primary correction is for near tasks, using reading glasses, bifocals, or progressive addition lenses. Contact lenses can include multifocal designs or monovision. Surgical options include refractive lens exchange or implantation of multifocal or accommodating intraocular lenses in cataract patients; corneal inlays or laser procedures to improve near vision are also available in selected cases. Suitability and outcomes vary by individual, and ongoing eye health is considered in choosing treatment.