Presbyopia

What is Presbyopia?

Presbyopia is a vision problem that causes the gradual reduction in flexibility of the lens of the eye with age. A normal part of aging, presbyopia usually becomes noticeable between the ages of 40 and 50 as an inability to focus on near objects. People who first experience presbyopia often find they have to hold things further away to be able to see them clearly.

Take heart in the fact that you are not alone. Researchers estimate that nearly two billion people worldwide have presbyopia while the Australian Institute of Health and Welfare’s Eye Health web report (August 30, 2019) estimate that there are some 687,200 Australians with presbyopia which make it our nation’s fourth most common eye and vision condition after hyperopia, myopia and astigmatism.

Early signs of presbyopia usually become apparent when reading – especially when you’re tired or reading in dim light. It gets harder to read for longer periods of time because the letters start blurring. You have to strain your eyes to see clearly and they might start burning. You may also get a headache after a while.

Causes of Presbyopia

Inside the eye there is a lens about the size of a pea. To focus clearly on close objects, such as when you read, special muscles in the eye change the shape of the lens to provide clear focus.

The lens, unlike the cornea – which is the clear, dome-shaped front surface of the eye – has a degree of flexibility. However, with age the lens becomes less flexible and the muscles can no longer change the shape of the lens to provide clear focus on close objects. This is a completely normal change that occurs in all people.

Symptoms of Presbyopia

You may have presbyopia if you find yourself holding near objects at arm’s length to see them clearly, near print becomes blurry, or you find your eyes become tired very quickly when reading.

There is no difference between when a female gets presbyopia to a male, although women often start to wear reading glasses before men as women have a tendency to do something about the problem sooner than men.

It is important to have an eye examination with an optometrist who will test how well you see up close by placing different lenses in front of your eyes. Using information from this and other tests, your optometrist can tell if you have presbyopia.

Presbyopia Prevention

Presbyopia cannot be prevented – and there is no escape from it – and everyone will the symptoms of presbyopia at some stage in their lives. Even if you are myopic (i.e. you have the ability to read things in front of you but not see things clearly in the distance) at some stage, you will notice your vision will start to blur when wearing your usual lenses to correct your distance vision.

There is no exact age when presbyopia begins. The condition is most commonly apparent to people around 40 years of age. Some people may notice that presbyopia develops suddenly while others say the changes are gradual.

Likewise, presbyopia cannot be cured but properly prescribed glasses or contact lenses will make seeing clearly up close much easier. Once presbyopia begins, the lens continues to lose flexibility. Between the ages of 40 and 60 years, you may need to change your prescription every few years to ensure that you are able to see as well as you always did.

If you are experiencing difficulties with your vision, we recommend visiting an optometrist for an eye examination. Your optometrist will support you in managing your presbyopia.

If you don’t have a regular optometrist, you can find an optometrist near you by using our Find an optometrist search function and/or use the form located on the top of each page of goodvisionforlife.com.au.

Optometrist Tsu Shan Chambers interview on Channel Nine’s morning show, sheds light on ageing eyes and whether or not you need glasses. Credit: Channel Nine

Correcting Presbyopia With Prescription Lenses

The best way to correct your presbyopia and to learn more about your vision and eye health, is to visit an optometrist.

Your optometrist will tell you if you need to wear prescription glasses or you may prefer to wear contact lenses, to help you see clearly. Contact lenses are a particularly good solution if you lead an active lifestyle that may be impeded due to wearing glasses.

You are likely to need to wear your prescription glasses, or contact lenses, when you are reading books and magazines, using computers and performing other tasks that require you to focus up close.

Often, prescription lenses for reading are prescribed first. These give excellent vision for reading but are blurry if you look through them into the distance and you have to take them off to walk around. If you need clear distance and near vision at the same time, talk to your optometrist about bifocals or multifocals, which are great options for vision correction.

Corrective Glasses From Retail Outlets

Many pharmacists, and retail outlets, sell vision correcting magnifying glasses which help with reading. Whilst they may appear to be a quick, easily accessible solution, we recommend always purchasing glasses from an optometrist who will ensure that they are fitted properly and that the prescription is correct for each of your eyes. Optometrists also take into account other factors, like the position of your eyes, the angle and position of the frame, and the distance between your pupils which make prescription glasses unique and optically safe for each wearer. Other options like bifocal and multifocal reading glasses are only available from an optometrist.

A visit to an optometrist is the best solution to help you manage any vision issue that you might be experiencing.

Contact Lenses

If you prefer to use contact lenses to correct your presbyopia, these must be professionally fitted by an optometrist. Due to the risk associated with wearing the wrong lens for your eye shape, and the impact that this may have on the health of your eyes, we strongly recommend that you do not purchase any contact lenses online unless you are asked to upload a copy of your valid contact lens prescription certified by an optometrist.  It is not healthy for your eyes to wear contact lenses full-time so a supplement pair of reading glasses is most often needed to give your eyes a rest from contact lens wear.

Prescription Lifespan

Once you have had an eye examination and your optometrist determines that you need corrective glasses, or contact lenses, they will write you out a valid prescription which will have an expiry date, which is commonly one or two years.

No Damage To Eyesight

Your eyesight will not deteriorate as a result of wearing prescription glasses or contact lenses. Prescription glasses are designed specifically to help correct a range of vision impairment conditions – such as long or short-sightedness. Over time however, your prescription may need changing to a stronger or weaker magnitude, but this has nothing to do with wearing glasses and/or your eyes becoming lazy.

Presbyopia Surgery

There are surgical techniques available to improve presbyopia such as multifocal intraocular lenses. Once they are performed, they cannot be reversed and may not be totally effective. We recommend if you are considering surgery, to talk to an optometrist about available procedures and if you believe this is a suitable course of action, to request a referral to an ophthalmologist.

Screen Time and Presbyopia

While too much screen time – such as sitting in front of a computer, mobile device and even television – can cause eye strain, there is no a direct link between the use of these devices and presbyopia. Presbyopia is a normal part of aging.

Over-use of screens however, can have other effects on your eyes such as dry eyes and blurred vision. We recommend the following tips for minimising eye strain when using digital devices:

• Sit at least an arm’s length from the computer screen, and try not to hold your tablet or smartphone too close to your eyes.
• Take regular breaks using the 20/20/20 rule: every 20 minutes, shift your eyes to look at an object at least 20 feet away (six metres), for at least 20 seconds.
• Use lubricant eye-drops or artificial tears to refresh your eyes when they feel dry. Consider using a humidifier if working in an air-conditioned or heated environment.
• Avoid using screens in an otherwise dark room and set up computer screens so there are not reflections from windows on the screen.
• Smart phone apps can help reduce light levels from LED screens, particularly helpful for those using devices late at night.
• Put away your screens at least one hour before bed.

Common conditions such as Myopia, Hyperopia, Astigmatism or Presbyopia can exacerbate eye strain so ensure you have regular eye examinations with your optometrist to maintain good vision, for life.

Presbyopia App

If you are hitting middle age, or have started to notice you’re finding it increasingly difficult to read phone messages or read labels at the supermarket, there is an app that could save you a lot of eye-straining energy. The Ageing Eyes (Presbyopia) Xplained app, produced by doctors at Medicine X, is a genuinely entertaining and informative app which has been created by deeply listening to people in their 40s and 50s talk about presbyopia.

The Ageing Eyes app is like having a big sister holding your hand through the whole presbyopia journey — from symptoms, diagnosis and management.

Presbyopia Risk

Other than the ability to see things as clearly as you would like close-up, presbyopia as an eye condition does not pose a risk in itself. It does, however, create a risk in situations that rely on you being able to see clearly to perform tasks – such as your ability to see the car dashboard when driving or if your job relies on hand-eye coordination (for instance).

If you are struggling to see things clearly, we strongly recommend that you make an appointment to see an optometrist to have a comprehensive eye examination.

Where Do I Go For More Advice?

We recommend making an appointment with an optometrist for a comprehensive eye examination. Comprehensive eye examinations, at regular intervals starting from childhood, ensure that most eye conditions can be prevented or corrected. Eye examinations can also be an important tool for determining your overall health.

Use our Find an optometrist search function if you do not have an optometrist, or would like to find an optometrist close to where you live.

Commonly Asked Questions

What causes presbyopia?

Inside the eye there is a lens, about the size of a pea. To focus clearly on close objects, such as when you read, special muscles in the eye change the shape of the lens to provide clear focus.

With age the lens becomes less flexible and the muscles can no longer change the shape of the lens to provide clear focus on close objects. This is a completely normal change that occurs in all people.

At what age does presbyopia occur?

There is no exact age when presbyopia begins. Most commonly presbyopia is apparent to people from around 40 years of age. Some people may notice that presbyopia develops suddenly while others say the changes are gradual. Presbyopia cannot be prevented and everyone experiences its symptoms.

How can I tell if I have presbyopia and how will it affect me?

You may have presbyopia if you find yourself holding near objects at arm’s length to see them clearly, if near print becomes blurry or you find your eyes become tired very quickly when reading.

It’s important to have an eye examination with your optometrist who will be able to test how well you see up close by placing different lenses in front of your eyes, so he or she can then tell if you have presbyopia and prescribe the lenses that give you the clearest and most comfortable vision.

You are likely to need to wear glasses when you are reading books, using computers and performing other tasks that require you to focus up close. Often prescription glasses for reading are prescribed first. These give excellent vision for reading but are blurry if you look through them into the distance and you have to take them off to walk around.

If you need clear distance and near vision at the same time, talk to your optometrist about bifocals or multifocals, which are great options for vision correction. Contact lenses are also a great solution and also have multifocal options.

Why do I need a new prescription every two years?

Once presbyopia begins, the lens continues to lose flexibility. Between the ages of 40 and 60, you may need to change your prescription every few years to maintain good vision for life.

Will reading glasses make my eyes weaker?

No. Once presbyopia begins, the lens continues to change and lose flexibility regardless of whether or not you wear glasses. Between the ages of 40 and 65, you may need to change your prescription every few years to maintain good focus for objects up close.

Will it hurt to have a test for presbyopia?

No. It will not hurt to have this test performed by an optometrist. Your optometrist will use a series of lenses to measure the refractive power of your eyes. If you require corrective lenses, your optometrist will ask questions about your hobbies, occupation and/or lifestyle as this will assist with determining the final prescription strength of your glasses. Watch our video which highlights what happens during an eye examination.

Will it cost to have a test for presbyopia?

Testing for presbyopia is part of a standard eye exam. Some optometrists charge a private fee for the consultation, with a portion of that fee Medicare rebate-able (bulk billed). Others may rely entirely on Medicare rebates to cover your entire visit. If you don’t have a medicare card, you may be charged a full fee.

We recommend you ask your optometrist what charges you should expect to pay at the time you make the appointment.

Published date: 01 September 2016 Reviewed date: 28 January 2020

Author: Luke Arundel, BAppSci (OPtom) Hons, FIACLE, FCCLSA, FBLSA, FBCLS, AdjAssProf University of Missouri St Louis, GCOT, CASA CO

Bio: Luke Arundel is Chief Clinical Officer of Optometry Australia. He graduated with Honours in Optometry from Queensland University of Technology in 1998 and has worked extensively in Australia and Ireland. He currently holds fellowships with the BCLA, CCLSA and IACLE and became an Adj.Ass Prof. of the University of Missouri, St Louis, USA in 2008.  His professional interests include keratoconus, post-graft and scleral lens fitting, dry eye, ortho-k and paediatric contact lenses. He has worked in specialty contact lens practices in Brisbane and Melbourne and in the contact lens manufacturing field along with time in the public health and education sectors. Luke’s role at Optometry Australia sees him provide professional services assistance to members in audits, investigations and medico-legal matters along with leading development of resources and special projects.

LinkedIn profile.

Disclaimer: No information provided on the Good vision for life website is intended to constitute or substitute advice from visiting an optometrist. Many factors unknown to us may affect the applicability of any information on this website. You should seek appropriate personalised advice from a qualified optometrist about any eye health and vision conditions.

References:

1. NCBI. January 26, 2017. Presbyopia: Overview. [ONLINE] Available at: https://www.ncbi.nlm.nih.gov/books/NBK423833/. [Accessed 28 January 2020].

2. AIHW. August 30, 2019. How common is visual impairment? [ONLINE] Available at: https://www.aihw.gov.au/reports/eye-health/eye-health/contents/how-common-is-visual-impairment. [Accessed 28 January 2020].