What Is Presbyopia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Presbyopia is a common, age-related vision disorder that makes it difficult for you to see or focus on objects up close.

It's not considered a disease. While similar to simple farsightedness (hyperopia), presbyopia is a separate condition that's related to natural aging, typically beginning around age 40.

Signs and Symptoms of Presbyopia

If you have to hold reading materials at arm's length to focus on the words, you may be experiencing one of the most common first signs of presbyopia.

• Headaches from doing work up close
• Eyestrain
• Requiring more light to read
• Blurred vision

Causes and Risk Factors of Presbyopia

Presbyopia stems from an issue with the lens of the eye, which sits behind the iris (colored part) and pupil.

When a person is younger, the lens is soft and flexible. Tiny muscles in the eye can easily change the shape — and, as a result, the focus — of the lens, a process called accommodation.

With age, the elasticity of the lens and of the muscles around it starts to diminish. This makes it so the lens cannot focus on up-close objects, making them appear blurry.

• Cardiovascular disease
• Diabetes
• Farsightedness
• Medications such as antihistamines or antidepressants
• Multiple sclerosis (MS)

How Is Presbyopia Diagnosed?

Presbyopia is diagnosed during routine, comprehensive eye exams that test your ability to see objects nearby and far away.

• Age 20 to 29: At least once
• Age 30 to 39: At least twice
• Age 40 to 54: Every two to three years
• Age 55 to 64: Every one to three years
• Age 65 and older: Every one to two years

If you wear glasses or contacts or have an eye infection or pain, you may need to see your eye doctor more often.

Treatment for Presbyopia

There's no cure for presbyopia. Treatment consists of eyeglasses, contact lenses, corrective surgery, or eye drops.

Eyeglasses

• Reading Glasses These are worn only when reading or doing close-up work.
• Bifocals These glasses correct your distance vision when you look through them at eye level, and they correct your near vision when looking through the lower part of the lens.
• Trifocals These glasses have corrections for near, middle, and far vision.
• Progressive Lenses These lenses are similar to trifocals but don't have horizontal lines.

Contact Lenses

• Bifocal or Multifocal Like bifocal glasses, these contacts help you see far away and up close.
• Monovision You'll wear two different types of lenses: One corrects for distance vision and the other for near vision. These help you see better at all distances.
• Modified Monovision These involve wearing a multifocal lens in one eye and one lens in the other for near or far vision.

Medications

The U.S. Food and Drug Administration has approved two types of eye drops to treat presbyopia.

• Pilocarpine hydrochloride ophthalmic solution (Vuity, Qlosi) eye drops allow some people with presbyopia to see up close without glasses or contacts for several hours a day. Pilocarpine contracts the ciliary muscles, reducing pupil size. This results in an increased depth of focus and improved vision while looking at close objects. Eye drops under the brand name Vuity are once-daily and work in 15 minutes or less, lasting as long as six hours.

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   Eye drops under the brand name Qlosi can be used once or twice daily and work within 20 minutes, lasting as long as eight hours.

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• Aceclidine ophthalmic solution (Vizz) is a once-daily eye drop that helps people with presbyopia see up close without glasses or contacts. It uses aceclidine to shrink the pupil and create a “pinhole effect” that extends depth of focus. Eye drops under the brand name Vizz may start working within 30 minutes and last as long as 10 hours.

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Surgical Procedures

• LASIK Surgery A surgeon cuts a small flap in the cornea and removes part of it to increase its curve. This procedure usually causes fewer side effects and is faster than other surgeries.
• Photorefractive Keratectomy (PRK) As with LASIK, a laser reshapes the cornea without making an incision.
• SMILE Surgery With a small-incision lenticule extraction (SMILE) procedure, a laser creates a disc-shaped piece of tissue inside the cornea through a small incision.
• Corneal Inlays A surgeon places a small plastic ring in the cornea at the front of the eye, refocusing light to improve up-close vision.

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Prevention of Presbyopia

Presbyopia is considered a normal part of aging, and there is no way to prevent it altogether.

Complications of Presbyopia

• Getting the Wrong Correction Glasses or contacts that aren't quite right can leave you with blurry vision, eye strain, or trouble adapting. Certain lens types may cause “ghosting,” distortion, or dizziness, especially when you're new to them.
• Dry Eye This can be common, especially if you wear contact lenses. Age, long hours on screens, and changes in tear production can make dryness worse, causing burning, irritation, or blurry spots. Choosing the right lenses, using lubricating drops, or switching to daily disposables can help.
• Surgery These procedures can improve vision but also bring side effects, such as glare, halos, or reduced night vision.
• Emotional Challenges Some people see reading glasses or bifocals as a sign of aging, which can make them resist treatment. Adjusting to new vision aids can also feel frustrating. But it also can lower quality of life if you cannot read fine print, use screens, or otherwise meet your vision demands.

Research and Statistics: How Many People Have Presbyopia?

The Takeaway

• Presbyopia is an age-related change in vision that makes it harder to focus on close objects, usually starting around age 40.
• Treatment options include glasses, contact lenses, eye drops, and surgery.
• Although it isn't harmful on its own, untreated or poorly managed presbyopia can cause eye strain, headaches, or frustration with daily tasks.
• If you notice sudden vision changes, eye pain, double vision, or flashes of light, see a doctor right away to rule out more serious conditions.