Presbyopia Treatment Options to Restore Near Vision
If you are between the ages of 35 and 60, you may have noticed that fine print is more difficult to read, that you have trouble focusing on up-close tasks, or that you experience eye strain when viewing screens – all of which are symptoms of presbyopia. Trusted Source Presbyopia Fact Sheet & Adult Vision: 41 to 60 years of Age National Eye Institute & American Optometric Association Go to Source 1,2 Presbyopia is a naturally occurring loss of near vision that is a result of age-related changes to the eye’s lens. Presbyopia affects everyone eventually, and symptoms are gradual. Trusted Source Presbyopia American Optometric Association Go to Source 3 You may hold your phone or book further from your face in an attempt to see more clearly. When that tactic is not enough to put things in focus, you have several options for near vision loss treatment.
Reading Glasses to Treat Presbyopia
Eyeglasses are the most common treatment option for presbyopia. There are several types of glasses that can be used to improve near vision:
Generally considered the simplest presbyopia solution, readers are available without a prescription. Trusted Source Presbyopia Fact Sheet National Eye Institute Go to Source 1 While they are easy to pick up at your local pharmacy, many people get frustrated with the “on, off, on, off” problem that can arise when using readers. You may find yourself taking them off while walking, putting them back on to check a text, taking them off to drive, putting them back on at work, and often searching for them when you need them.
Intended for people with nearsightedness (myopia) or farsightedness, bifocals support presbyopia by having two lens powers within one pair of eyeglasses. The bottom portion of the lens is designed to support near vision, or reading up-close. Then the top part of the bifocal lens is created to support distance vision.
Progressive addition lenses
Also called PALs, these glasses treat presbyopia for patients who do not like the look or feel of bifocals. The lenses are more blended, meaning the prescription change from distance, intermediate to near is progressive and not as abrupt as with bifocals.
While glasses are an accessible choice for many people with presbyopia, some patients do not like the way they look. Others may seek a presbyopia solution that allows them to avoid the hassle of taking glasses on and off for different tasks.
Contact Lenses to Treat Presbyopia
Multifocal contact lenses
These contact lenses have multiple lens powers, similar to the progressive or bifocal lenses in eyeglasses and are used to help with improving vision at all distances.
Monovision contact lenses
These contacts, in which one eye wears a distance prescription and the other a near vision prescription, may be an option if you already wear contacts and don’t want to be dependent on glasses. However, a monovision approach doesn’t work for everyone and some patients find that they cannot comfortably adapt to monovision.
While these contact lenses are designed to treat presbyopia, they are not as popular as glasses. Reasons people cite for not choosing contacts as a treatment for presbyopia include dry eye symptoms or the ongoing cost of contacts. Some patients are not able to get used to multifocal lenses and patients who try monofocal lenses sometimes experience a loss of depth perception or diminished visual acuity. Trusted Source Presbyopia: What causes it and how to treat it. All About Vision Go to Source 4
Your ophthalmologist can now prescribe eye drops approved by the FDA to treat presbyopia. Presbyopia eye drops contain a medication that helps constrict the size of the pupil to improve near vision. The drops are easy-to-use once a day and begin to work in as little as 15 minutes and helps clarify near vision for up to 6 hours. In clinical trials, presbyopia eye drops showed only rare and minor side effects, including eye redness and headaches. VUITY was the first presbyopia eye drop to gain FDA approval, and others are currently in development. Trusted Source FDA approves eye drops for treatment of presbyopia Ophthalmology Times Go to Source 5
Additional presbyopia drops are currently being investigated, and many ophthalmologists believe that this is a revolutionary advancement in helping to improve near vision compromised by presbyopia.
Are There Surgical Options to Treat Presbyopia?
Although there are off-label procedures available for the treatment of presbyopia, there are currently no FDA approved treatments that are widely used by ophthalmologists in the United States that have an indication to treat presbyopia.
This modified LASIK procedure is a refractive surgery that corrects one eye for distance vision and one eye for near vision. Similar to monovision contact lenses, this method requires the brain to adapt to relying on different eyes for different distances. A LASIK surgeon will typically trial the monovision approach with contact lenses before surgery, as not everyone will adapt well. Monovision LASIK carries a risk of visual abnormalities and glare, which can cause difficulty driving. Trusted Source Monovision LASIK in emmetropic presbyopic patients Clin Ophthalmol Go to Source 6 LASIK can also cause persistent dry eye symptoms. Trusted Source Chronic dry eye symptoms after LASIK: parallels and lessons to be learned from other persistent post-operative pain disorders Mol Pain Go to Source 7
Refractive Lens Exchange
RLE is a surgery in which each eye’s natural lens is replaced with an advanced intraocular lens (IOL). This surgery can correct a variety of refractive errors and reduce or eliminate the need for reading glasses, but not everyone is a candidate. Any surgery carries some risk and RLE risks include an increased likelihood of retinal detachment. Trusted Source Updates and Challenges In Refractive Lens Exchange US Ophthalmic Review Go to Source 8
Which is the Best Presbyopia Treatment for You?
If you are experiencing any vision changes, it is important to see an experienced eye doctor for a comprehensive eye exam. If you are diagnosed with presbyopia, your eye doctor can discuss which treatment options may be able to restore your near vision. Your eye health, medical history, lifestyle, and personal preferences are all factors in determining the best presbyopia treatment plan for you.
1 National Eye Institute. Presbyopia Fact Sheet. https://nei.nih.gov/sites/default/files/health-pdfs/Presbyopia.pdf Accessed October 9, 2019.
2 American Optometric Association. Adult Vision: 41 to 60 Years of Age. https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-41-to-60-years-of-age Accessed October 9, 2019
3 American Optometric Association. Presbyopia. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/presbyopia Accessed October 9, 2019
4 All About Vision. Presbyopia: What causes it and how to treat it. https://www.allaboutvision.com/conditions/presbyopia.htm Accessed October 8, 2019.
5 Ophthalmology Times. FDA approves eye drops for treatment of presbyopia. Available: https://www.ophthalmologytimes.com/view/fda-approves-eye-drops-for-treatment-of-presbyopia. Accessed April 18, 2022.
6 Peng MY, Hannan S, Teenan D, Schallhorn SJ, Schallhorn JM. Monovision LASIK in emmetropic presbyopic patients. Clin Ophthalmol. 2018; 12: 1665–1671. Published online 2018 Sep 4. doi: 10.2147/OPTH.S170759
7 Levitt AE, Galor A, Weiss JS, Felix ER, Martin ER, Patin DJ, et al. Chronic dry eye symptoms after LASIK: parallels and lessons to be learned from other persistent post-operative pain disorders. Mol Pain. 2015; 11: 21. Published online 2015 Apr 21. doi: 10.1186/s12990-015-0020-7
8 Dhaliwal DK. UPDATES AND CHALLENGES IN REFRACTIVE LENS EXCHANGE. US Ophthalmic Review, 2018;11(1):17–18 DOI: https://doi.org/10.17925/USOR.2018.11.1.17