What is Presbyopia? Symptoms, Causes, and Treatment Methods

Presbyopia is a series of symptoms of near-vision impairment that occurs as a result of changes in the structure of the lens that allows light to refract in the eye. It can prevent the eye lens from forming a clear image on the retina. This is a normal process that develops with aging. During this process, the lens loses its flexible structure and begins to harden, which may worsen as age progresses. Since it is a natural result of the aging process, it is a condition that is easy to correct. Generally, other refractive errors may also be seen in people with presbyopia. Presbyopia, which can be diagnosed upon the inability to see objects at close range clearly, tends to progress gradually. Compared to early stages, it may negatively affect daily life in advanced cases.

Certain diseases such as cardiovascular diseases, MS, and diabetes can trigger its development. At the same time, long-term use of antidepressants, diuretics, and antihistamines may also be associated with early-onset near-vision impairment. Presbyopia and hyperopia are medical conditions that cover vision impairments in near vision. The difference between hyperopia and presbyopia can generally be determined by the age at which symptoms begin to appear. While a vision problem that emerges after the ages of 40-45 is usually defined as presbyopia, hyperopia is considered to tend to appear at earlier ages.

What is Presbyopia?

Presbyopia is a health problem that causes the eye lens, located behind the iris, to become less flexible, leading to a loss of focusing ability. The deterioration of the lens structure can cause objects nearby to not be seen clearly. When light enters the eye through the iris, it undergoes refraction in the eye lens and the image falls onto the retina. The lens can change shape to focus on objects at different distances. Parallel to aging, the eye lens may begin to harden and lose its ability to change shape and refract light. Generally, starting from the 40s, blurring may begin to occur, especially in near-distance vision. The course of the vision impairment may worsen by the age of 65. Difficulties may arise during near-distance activities such as reading, writing, handicraft skills, and repair work, etc.

Adult age groups, including those who already have myopia and hyperopia, can be affected by this condition. For this reason, it is generally not defined as a disease on its own. It can manifest itself with symptoms such as headaches, fatigue in the eyes, and pain. Treatment options may include the use of contact lenses, glasses, and surgery.

What Are the Symptoms of Presbyopia?

Near-vision impairment, which shows gradual progression, can be seen with various symptoms. Generally, the course of near-vision impairment may continue to worsen until the age of 65. Symptoms may not be seen in the same way in everyone, and their severity may vary. In this context, common symptoms of presbyopia may include:

Blurred near vision,

The need to move reading materials further away,

Feeling pain or fatigue in the eyes,

The need for brighter light for clear vision,

Muscle tension and headaches,

An uncomfortable sensation in the eyes while working,

Feeling sleepy as a result of eye muscle strain.

Additionally, symptoms may become severe in low-light environments and with fatigue.

How Does Presbyopia Occur?

The main cause of presbyopia symptoms is the structural changes that occur in the eye. Although these structural changes are primarily related to aging, a number of risk factors can also support their development. In the first years of life and during young adulthood, the eye lens that refracts light is in a flexible and soft structure. The flexible and soft structure adjusts the positions, sizes, and shapes of objects at different distances to be seen clearly. This adjustment determines the extent to which the light forming the image is reflected onto the retina. Therefore, objects in distant or near positions can be seen clearly. Advancing age causes the structure of the lens to begin to change. New cell layers begin to form in the lens, and thickening is observed. The growing and thickening lens tends to lose its flexibility. The lens with a changed structure cannot refract light as it should, and it brings along focusing problems. As focusing problems progress, presbyopia symptoms begin to manifest themselves. Since it is a natural formation, it is a series of clinical symptoms that can be seen in almost everyone. However, the use of some medications, cardiovascular diseases, MS, diabetes, and health problems such as obesity can support the formation of near-vision impairment.

How is Presbyopia Diagnosed?

In the diagnosis of near-vision impairment, signs and symptoms are evaluated. In the early period, small vision changes may not be noticed. This situation may end with the negative impact on daily life. Some individuals may ignore the symptoms, causing the diagnosis to be delayed, and vision problems continue to develop.

The diagnosis is made by an ophthalmologist or optometrist. In addition to a physical examination, medical history, family history, medication use, and other existing diseases are evaluated. In a basic eye examination, several tests can be applied to determine how clearly objects at different distances are seen. Reading text at certain distances and ensuring focus with various corrective lenses are within the scope of the physical examination. In addition to this examination, dilation of the pupil may be required. The pupil is dilated by applying eye drops, and the internal structure of the eye is examined. In this examination, the eyes become more sensitive to light. For people who use contact lenses or glasses, routine check-ups are expected to be more frequent.

How is Presbyopia Treated?

Treatment of near-vision impairment can be provided with many different methods. The treatment plan is shaped according to the individual's complaints and requests. In addition, other existing vision impairments may also be effective in creating the plan. The methods preferred as presbyopia treatment are as follows:

Glasses: Reading glasses are recommended for people who do not have myopia, hyperopia, and astigmatism. Apart from this, lenses designed as special spectacle lenses can be used. Bifocals are lenses that have two different areas in one spectacle lens. In bifocal lenses, both near (lower part) and distance (upper part) vision can be provided. In trifocal glasses, the lens is divided into three areas: near, intermediate, and distance. In progressive lenses, the lens provides a gradual distance transition from top to bottom.

Contact lenses: They are available in different types, including bifocal, monovision, and multifocal.

Surgery: Near-vision impairment surgery can be applied in three different forms. LASIK surgery helps correct vision in cases with hyperopia, myopia, and astigmatism. PRK (photorefractive keratectomy) is applied for people with high-degree myopia, hyperopia, or astigmatism. In the SMILE procedure, a disc-shaped incision is made within the cornea. With the help of precise lasers, the excess tissue piece is removed from the eye, and near vision is improved. Laser treatment for near-vision impairment may not be necessary for everyone.

Eye drops that shrink the pupil for clearer vision are another treatment option.

Frequently Asked Questions

Near-vision impairment is usually started to be calculated with the instruction to focus with one eye while the other eye is closed on the Snellen chart. It is requested to focus on the 20/20 chart with one eye while the other is closed. Based on the working distance, the amplitude of accommodation of the eye is recorded. However, with the help of Hofstetter formulas, the estimated amplitude of accommodation can be found. The Sheridan letter test, Bailey-Lovie chart, Landolt C test, Beale Collin charts, and Sjogren test are other scales used. The eye lens, which usually begins to thicken and harden at the ages of 40-45, may continue to progress by worsening. In most people, it may show parallelism with other vision impairments such as myopia and hyperopia. The cessation of the development of near-vision impairment occurs most of the time at the age of 65 without being dependent on specific reasons. With the classification of presbyopia, mild, moderate, and severe near-vision impairment can be detected. In the guidelines recommended for near-vision impairment, an addition of < +1.25 D is made in mild cases, > 1.25 to +2.00 D in moderate cases, and > +2.00 D in advanced cases. At the same time, age-related estimated or expected additions are +0.75-1.50 for ages 40-50. For ages 50-60, this value is +1.50-2.50. There are contact lens types that help improve near-vision impairment. The vision of one eye for distance can be cleared while the vision of the other eye for near distance can be cleared with monovision contact lenses. Adapting to monovision lenses is important in terms of the treatment plan. In addition to this, lenses that use lenses with different focusing powers and areas are multifocal lenses. In this way, focusing at distance and near at the same time can be provided. Near-vision impairment can create disruptions in the fulfillment of near-distance tasks. During this time, behaviors such as people using brighter light, reading from a closer distance, and extending screen time can cause complaints in the form of fatigue, pain, headaches, and dizziness in the eyes. Presbyopia has treatment options that allow for lens use. However, solutions can be provided for vision problems caused by astigmatism, myopia, and hyperopia. Bifocal contact lenses are lenses that can adjust near and distance focal points. Multifocal lenses have more than two focal point areas such as distance, intermediate, and near, etc. Monovision lens application involves wearing a lens that helps with near vision in one eye while wearing lenses that help with distance vision in the other eye. In addition, multifocal lenses can be used for all distances, for near or distance vision. Since near-vision impairment is part of the natural aging process, it cannot be prevented. However, the protection of the eyes can be ensured by taking a number of precautions. Recommended practices for protecting eye health may include routine eye check-ups, general health problem check-ups, use of sunglasses, reducing screen time and distance, and healthy and balanced nutrition. It is important to provide good lighting to ensure better vision. Presbyopia surgery may include laser-assisted applications. In LASIK and PRK procedures, it can be preferred for individuals who already have astigmatism, hyperopia, or myopia. It involves making an incision in certain areas of the cornea with the help of a laser. Usually, one eye is adjusted to see near well, while the other eye is adjusted to see distance well. Possible complications of presbyopia surgery may include pain and a decrease in night vision. Presbyopia shows progression in direct proportion to advancing age. It is the most common clinical complaint seen in adults between the ages of 40-65. The focusing problem of the eyes tends to continue to worsen until the 60s. However, after the ages of 60-65, it does not continue to worsen. Myopia, which is a distance vision impairment, can be seen at the same time as near-vision impairment. Treatment options for presbyopia and myopia include LASIK, PRK laser surgeries, and the use of glasses and contact lenses. As a long-term solution, LASIK and PRK laser surgeries allow for the reshaping of the cornea. In addition, spectacle lenses and contact lenses that have two or three focusing areas or have the ability to focus gradually from top to bottom can also be used.

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