Presbyopia - Diagnosis and Treatment

Diagnosis

Eye care professionals diagnose presbyopia during a standard eye exam. This exam usually includes a refraction test and a check of eye health. During the refraction test, the eye care professional uses different lenses.

The person looks at letters or shapes at different distances with each lens. This test helps the doctor determine if you are nearsighted, farsighted, have astigmatism, or presbyopia.

The eye health check often involves dilating the pupil with eye drops. Dilation lets the doctor see inside the eye more clearly. After you receive these drops, your eyes can be sensitive to light for a few hours.

Eye Exam Schedule By Age

Age Group	How Often to Have an Exam
Under 40	Every 5–10 years
40 to 54	Every 2–4 years
55 to 64	Every 1–3 years
65 and older	Every 1–2 years

People who wear glasses or contact lenses or who have other eye risks may need to visit the doctor more often.

Treatment

Using Glasses to Improve Vision

Eyeglasses provide a basic and effective way to correct problems caused by presbyopia. People who had good vision before noticing trouble with close-up tasks often try nonprescription reading glasses.

These are available in most drugstores and usually range from +1.00 to +3.00 diopters. Try different strengths and read something at a normal distance to select the right option.

Some people may need prescription lenses, especially if they already wear glasses for nearsightedness, farsightedness, or astigmatism. Several prescription choices are available:

Type of Lens	Use	Features
Prescription Reading	Reading only	Used just for close tasks, often taken off for other activities.
Bifocals	Reading + Distance	A visible line separates two lens powers.
Trifocals	Reading + Computer + Distance	Two visible lines, helps with reading, screens, and far sights.
Progressive Lenses	Multiple distances	No visible lines, gradual changes in lens strength.
Office Progressive	Computer and Close Work	Specially designed for screens and reading; not used for driving.

Ask an eye doctor which type best fits your daily needs. Office progressives are often chosen for desk work or using a computer.

Contact Lenses for Presbyopia

Contact lenses offer a good choice for those who do not want to wear glasses. Some people cannot use contacts if they have eye dryness or other eye surface problems.

Main options include:

Bifocal Contacts: These correct both near and distance vision. Some designs have a weighted lower part to keep the lens in the right position. Others have different focusing zones in the center and outer parts of the lens.
Monovision Contacts: One eye is fitted for distance vision and the other for close work. The dominant eye usually handles the far-off vision.
Modified Monovision: Combines a bifocal or multifocal lens in one eye with a single-vision contact in the other. This setup helps with both reading and seeing at a distance.

You may need time to adjust to contacts. Not everyone feels comfortable with all options. An eye care professional can help you select the best type.

Surgeries to Reshape the Cornea

Surgeons can perform several procedures to change the cornea’s shape and improve close vision. These options often focus on making one eye better at near tasks, similar to wearing monovision contacts.

Patients should know these surgeries cannot be reversed, and you might still need glasses later for some activities.

The major procedures include:

Conductive Keratoplasty: Surgeons use radiofrequency energy to heat tiny spots on the cornea, making the edge contract slightly and increasing its curve. Results vary and may not be permanent.
LASIK (Laser-Assisted In Situ Keratomileusis): The surgeon lifts a thin flap on the cornea and shapes the inside with a laser, which steepens the central curve. Recovery is often fast, with little discomfort.
LASEK (Laser-Assisted Sub-Epithelial Keratectomy): The surgeon loosens a thin outer layer, reshapes the cornea with a laser, and places the layer back. Healing may take a bit longer than LASIK.
PRK (Photorefractive Keratectomy): The surgeon removes the thin surface layer, reshapes the cornea with a laser, and allows the layer to grow back naturally, forming to the new shape of the cornea.

Quick Overview Table: Refractive Surgery Options

Procedure	Method	Outcome	Notes
Conductive Keratoplasty	Radiofrequency	Curves cornea for near vision	Results may fade over time
LASIK	Laser under cornea flap	Quick recovery, reshapes cornea	Common, less discomfort
LASEK	Laser after loosening	Steepens cornea, slower recovery	Surface layer put back
PRK	Laser after removing	Cornea reshaped, new surface regrows	May have more discomfort at first

Doctors often recommend trying monovision contacts first to see if this type of vision works well for daily life.

Inserting Artificial Lenses Inside the Eye

Some doctors remove the eye’s natural lens and replace it with a synthetic one, called an intraocular lens. These lenses work for close and distant vision or can move or bend inside the eye to focus (accommodative lenses).

Side effects can include glare, blurred vision, or loss of image clarity at close range. Risks include swelling, infection, bleeding, or increased eye pressure, similar to those in cataract surgery.

Types of Lens Implants

Multifocal: Multiple focusing zones for near and far vision.
Accommodative: Adjust or move inside the eye to help focus.
Standard Monofocal: Typically set for distance; reading glasses may still be required.

Work with an ophthalmologist to choose the right lens implant for you. Not all types suit everyone.

Corneal Implants With Small Openings

Surgeons can place a minor device called a corneal inlay in the cornea of one eye.

This small plastic ring with an opening in the middle works like a small camera aperture, letting in enough focused light to help you see up close.

If you dislike the effect or develop problems, you can have the inlay removed. Other treatments remain available.

Main Points About Corneal Inlays

Typically placed in only one eye
Designed to boost near vision without harming distance sight
Reversible if results are unsatisfactory or side effects occur

Discuss the pros, cons, and possible risks with an experienced eye surgeon. Recovery time is usually short, but some people experience glare, dry eyes, or difficulty with night vision.

Lifestyle and Simple Remedies

Taking care of eye health supports good vision. Get your eyes checked regularly, even when you have no obvious problems.

Early detection of changes can help protect sight. Manage ongoing health issues such as high blood pressure and diabetes, as these conditions can affect how well you see if not controlled.

Wear sunglasses that block ultraviolet (UV) rays to protect your eyes from sun damage. This is important if you spend a lot of time outside or take medicines that cause sun sensitivity.

When doing chores like mowing the lawn, painting, or playing sports, wear proper safety eyewear to help prevent injuries. Regular reading glasses do not keep your eyes safe during these activities.

A healthy diet supports vision. Eat plenty of fruits, leafy greens, and other vegetables to give your eyes important nutrients, including vitamin A and beta carotene.

Use the right glasses to make daily tasks easier. Check your eyeglass prescription often so you can see as well as possible.

Good lighting, such as increasing the brightness in a room, can make it easier to read or perform other close tasks.

If you experience sudden problems like loss of vision, unclear sight, double vision, seeing flashes, black spots, or halos, see a doctor without delay. These symptoms can signal a more serious health concern.

Getting Ready for Your Visit

Steps You Can Take Beforehand

Make a list of any changes or problems with your sight. Include everything you have noticed, even symptoms that do not seem related. Write down the medicines, vitamins, and supplements you use every day.

Bring a close friend or family member if possible. This helps if you have trouble returning home after your eyes are checked, especially if your eyes will be dilated. They can also listen and help you remember details from your visit.

Think about what you want to ask. Write your questions in advance and prioritize what is most important. Put the most urgent ones at the top of your list. Some sample questions include:

What is the likely explanation for my symptoms?
Could anything else be causing my vision trouble?
Are any of my medicines leading to these issues?
Will I need more tests, or just an eye exam?
How often should I get my eyes checked?
What treatment options are there, and what are their risks?
Which approach would you suggest?
Are there other methods besides your main recommendation?
How do I manage any other eye conditions I may have?
Can I use store-bought reading glasses safely?

You can always ask more questions during your appointment if new topics come up.

What Questions the Doctor Might Ask You

The doctor will likely want to know about your symptoms and overall health. Typical questions could include:

Question	Purpose
When did the vision changes begin?	To understand how long you have had them.
Are the symptoms constant or come and go?	To see how often problems happen.
How bad are the symptoms?	To judge the level of impact.
Does anything help with your symptoms?	To learn if something makes it better.
Does anything make it worse?	To find possible triggers.
Do you do a lot of close-up work or reading?	To spot possible causes.

The doctor may also ask about your general medical and eye health, as well as your family’s history of vision issues.

Presbyopia – Diagnosis and Treatment