Presbyopia

Presbyopia (Reading Problems)

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Presbyopia refers to the natural decrease in the eyes’ ability to see up close as we get older that occurs over time as the lens of your eye becomes less flexible than it once was. This lack of flexibility can make it difficult for your lens to change shape to help you focus, making it difficult to read small print.

The first symptoms people with presbyopia typically notice are difficulty reading fine print, particularly in low light conditions, and blurred vision close-up, and momentarily blurred vision when transitioning from a far or near object (and vice versa). Even a patient with perfect vision (Emmetropia) all their life will require glasses to help them read, usually at some point in the early to mid-forties.

Presbyopia starts to become noticeable usually as people reach the age of 40 and it affects everyone. 

Nearsighted people (with Myopia) can usually remove their glasses, hold the print up close, and read without glasses or have bifocals put in their distance glasses. Slightly farsighted people (with Hyperopia) will initially just need glasses to read but as they get older, they will need them for near and far. Moderately or severely farsighted people will already be wearing glasses for distance but will now need either bifocals or two separate pairs of glasses.

Normal sighted people (called Emmetropia) who have never needed glasses typically will begin to need them in order to read small print. Presbyopia gets worse as we get older and thus patients require changes in reading power every few years. If you are near age 40 or older, your laser eye surgeon should discuss Presbyopia with you and explain your options to minimize this annoying decrease in your near (reading) vision.

Non-Surgical Procedures to Help with Presbyopia include reading glasses, bifocal eyeglasses, contact lenses, and Presbyopia Eye Drops (which the FDA is expected to approve in 2021).

  • Reading Glasses:  For those who have no issues with their distance vision but who cannot read up close items like books or labels, an eye doctor prescribe a pair of reading glasses to improve your vision so you can read.
  • Bifocal eyeglasses: If you do have issues with your distance vision, your eye doctor can prescribe a pair of bifocal glasses, which contain one prescription for distance and one for close-up viewing so you can read.
  • Bifocal Contact Lenses: If you prefer contact lenses over eyeglasses, your eye doctor can prescribe a pair of bifocal contacts. Like bifocal glasses, these contacts contain a prescription for distance and a prescription for closeup viewing.
  • Monovision Contact Lenses: Some people have trouble trying to get used to bifocal contact lenses. In cases like this, your eye doctor can prescribe a lens for distance in one eye and a lens for closeup viewing in the other eye.
  • Presbyopia Eye Drops. The FDA will almost certainly approve Presbyopia Eye Drops in 2021. The drops will essentially constrict the pupils creating a “pin hole” pupil much like the KAMRA inlay or corneal inlay procedure (see below for a brief discussion on that procedures). Presbyopia Eye Drops drops should improve the near vision of people who are good candidates and may often even improve slight blurry vision in the distance vision of some patients who are slightly nearsighted, farsighted or have minor  astigmatism. These drops will last for about 4 to 8 hours (depending on the type of presbyopia drops). One benefit is that no surgery is involved so these are a very safe and inexpensive options compared to surgical procedures like monovision LASIK or the Kamra inlay procedure. However, unlike surgical procedures to treat presbyopia, the effects from the drops will wear off, so this is not a permanent solution. Presbyopic drop that may allow the lens to remain more elastic and slow down the progression of presbyopia that occurs as you age.

Presbyopia Video: Surgical Procedures to reduce the symptoms

Options to treat Presbyopia through vision correction surgery include the Kamra Inlay Procedure, Conductive Keratoplasty (or CK), and monovision LASIK and PRK. The only FDA-approved procedures for the correction of Presbyopia in emmetropic eyes (those who have otherwise normal vision requiring no glasses except for reading) are the Kamra Inlay Procedure and Conductive Keratoplasty.Although none of these procedures can “cure” Presbyopia, these procedures can reduce the need for reading glasses for everyday activities like reading a menu or looking at a cell phone.

  • Kamra Inlay Procedure.  The Kamra Inlay Procedure or Corneal Inlay Procedure is also referred to as the “Pinhole Technology. This procedure is ideal if you have distance vision but want to avoid the continual aggravation of having to use reading or bifocal eyeglasses or contact lenses in order to read. During the Kamra Inlay procedure a microscopic and small device is implanted on the cornea toward the center of your eye. This procedure was approved by the FDA in 2018. To learn more about this procedure, please visit our Kamra Inlay Surgery Discussion.
  • Monovision LASIK or PRK.  With “monovision” (or “blended vision”) laser eye surgery (using LASIK or PRK), one eye is focused better for reading while the other eye is focused primarily for distance. This can be a useful option for patients over the age of 40 who are considering laser vision surgery to correct their nearsightedness or farsightedness, with or without astigmatism. Monovision is also an option for patients who have always had natural excellent distance vision (Emmetropia) and who have a desire to be able to read without glasses. Although not FDA-approved, PRK is considered an “off label” use of the FDA-approved lasers. In fact, many refractive eye surgeons have used PRK and LASIK (which has now approved by the FDA) in both nearsighted and farsighted eyes to create monovision, with one eye focused for distance and the other focused for near vision.
  • Conductive Keratoplasty (CK). Conductive Keratoplasty is a procedure where radio-frequency energy is applied to 8 spots in the cornea to refocus one eye for a reading focus. The CK procedure results in a milder form of monovision than the typical laser procedure and it is often better tolerated by the patient because the CK eye is not usually as blurred for distance as it would be with laser induced monovision. However, not all patients are comfortable with mono or blended vision and it is best to have this demonstrated with either contact lenses or glasses before choosing this option.

Laser eye surgery may not always be the best option so it is important to find an experienced eye surgeon like those featured in our Trusted LASIK Surgeons™ Directory, most of whom perform a variety of refractive surgery procedures to give patients a more complete range of options. To learn more about these vision correction surgical treatments for Presbyopia, please clink on the links below:

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