Presbyopia: symptoms and treatment options

Questions about Presbyopia

Each answer below is the short version; the question links to the page that carries it in full, with sources.

• What is presbyopia?

  Presbyopia is the age-related loss of the ability to focus on close objects, caused by the natural lens inside the eye becoming less flexible. It affects almost everyone eventually, including people who have had laser eye surgery.

• Why do I need reading glasses after 40?

  Reading glasses become necessary because the lens inside the eye can no longer change shape enough to focus on near objects. The change is gradual and usually noticed first in low light or when tired.

• Can LASIK correct presbyopia?

  LASIK does not restore the lens’s ability to change focus, so it cannot undo presbyopia. It can be used in strategies that reduce reading dependence, at the cost of some distance sharpness or binocular balance.

• Can SMILE correct presbyopia?

  SMILE corrects the focusing error of the cornea, and presbyopia originates in the lens, so SMILE does not restore near focus on its own. It can form part of a plan designed around reading vision, and that plan is a decision made with your surgeon.

• What options exist for reading vision?

  The options for reading vision include reading glasses, varifocals, multifocal contact lenses, and surgical approaches such as monovision or lens replacement. Each trades something, and none restores youthful focusing power.

• What is monovision?

  Monovision means deliberately correcting one eye for distance and the other for near, so the brain combines them. It reduces dependence on reading glasses at the cost of some depth perception and sharpness.

• Is laser eye surgery suitable after 40?

  Age alone does not rule out laser eye surgery after forty. What changes is that presbyopia is arriving, so the discussion includes near vision and the trade-offs involved rather than distance vision alone.

• Can LASIK correct reading vision?

  Standard LASIK corrects distance vision, and it does not restore the near focus that is lost with presbyopia. Some clinics offer specific strategies aimed at reducing reading dependence, and each involves its own trade-offs.

• Is long sightedness the same as presbyopia?

  No. Long sightedness (hyperopia) is a focusing error you are born with, where the eye’s optical power is too weak for its length. Presbyopia is the age-related stiffening of the lens that affects near focus later in life. Both blur close vision, and they are different problems with different corrections.

• When does presbyopia start?

  It usually begins to be noticeable around the early forties and continues to change, slowly, for decades. The timing varies considerably between people, and it is affected by your existing prescription: short sighted people often notice it differently from those who have never worn glasses.

• What causes presbyopia?

  The lens inside the eye becomes less able to change shape, so it cannot increase its focusing power for near objects. The muscle that changes it still works; the lens itself becomes thicker and stiffer with age.

• Can presbyopia be reversed?

  No. The change in the lens is not reversible by laser treatment, drops or exercise. What can be done is to compensate for it: reading glasses, varifocals, contact lenses designed for it, monovision, or lens replacement that substitutes an implant for the stiffened lens.