If you are over 40 and squinting to read this page without any form of visual assistance, chances are you may be developing presbyopia. Presbyopia is also known as age-related long-sightedness or more commonly, a loss of your near vision due to age.
If you have presbyopia, you are not alone, it affects over a billion people around the world. While the impacts to vision are not as drastic as cataracts, glaucoma or macular degeneration, it does affect your day-to-day vision preventing ultra-common tasks such as reading, using a mobile phone, computer or many manual tasks that need you to see things up close.
Presbyopia is due to a stiffening of the natural lens of the eye, which prevents it flexing enough to provide the eye with its full range of vision. There are a number of short and long-term treatments for Presbyopia. The following options may be recommended to you by your eye doctor depending on your specific eye structure, vision quality, lifestyle preferences and of course budget.
1. Over the counter reading glasses
The simplest and most common solution for Presbyopia is reading glasses. Often these can be bought over the counter at a chemist or even service station. These generally have magnifications from +1.00 up to around +3.00. These can help overcome the early stages of Presbyopia and will usually worn only when needing to perform activities that need better near vision.
Pros of over-the-counter reading glasses
- Cost - Over the counter glasses can be bought from almost anywhere and are very affordable as a quick fix to see things up close.
- Easily replaced - if you lose or break over the counter glasses you can get a new pair without too much time, trouble or expense. In fact, you could have multiple in different locations for convenience.
Cons of over-the-counter reading glasses
- Suitability of glasses unproven - if you need a specific magnification or different magnification for each eye or have astigmatism, then over the counter reading glasses generally won’t work so well.
- Absence of an eye exam - Presbyopia is a deterioration of vision quality. It is a very good idea to get a prescription to measure your vision deterioration over time. It also allows for other age-related eye conditions to be monitored.
2. Prescription reading glasses
Prescription reading glasses may be required if you’re not able to get the right vision quality from what’s available in over-the-counter glasses. These are prescribed by your eye doctor.
Pros of prescription reading glasses
- Customised lenses - Apart from being prescribed to the precise magnification for each of your eyes, the lenses can be designed to cater for near and far vision allowing you to wear the glasses all time if you wish.
- Customised frames - choosing from a range of frame designs and colours vs the standard options most often available with over-the-counter varieties.
Cons of prescription reading glasses
- Cost - Prescription glasses will cost a bit more than over the counter glasses and if style is important the costs could increase. Given Presbyopia will get worse, you may need to replace your glass lenses every few years.
- Wearing glasses - While this is not unique to just prescription glasses, many people want to be free of glasses as it impacts them in performing certain sports and activities, or simply how they look.
3. Contact lenses
To avoid the need for glasses, contact lenses have provided a popular alternative and specific presbyopia contact lenses can be prescribed to overcome the deterioration in near vision as you age.
Pros of contact lenses
- No visible glasses - If you don’t like wearing glasses or they get in the way during certain sports then have contact lenses as an alternative.
Cons of contact lenses
- Maintaining supply - carrying contact lenses and keeping a stock of contact lenses and solution on hand, particularly when travelling can be a hassle.
- Wearing contact lenses - putting in contact lenses (and taking them out) is a bit of an adjustment for many. And, the act of putting contact lenses in itself requires a degree of near vision!
4. Monovision LASIK
This surgical procedure is a form of laser eye surgery that makes a refractive correction to the cornea of the dominant eye to allow for distance vision and an adjustment to the other eye to assist near vision. The brain then adjusts its reliance on each eye based on the type of vision required.
Pros of Monovision LASIK
- No glasses or contacts - The intention of Monovision LASIK is to remove the need to wear glasses although in some circumstances glasses may still be needed for some people to get greater clarity in certain situations.
- Less invasive - LASIK involves laser surgery on the cornea surface on the outer of the eye. This is a quick painless procedure with a quicker recovery than more invasive procedures.
Cons of Monovision LASIK
- Adaptation - many people adapt well to monovision, but others do not. A trial is performed using contact lenses prior to surgery to see how you adapt.
- Compromise - Overall, monovison is a compromise on both distance and near vision and a certain amount of depth perception is lost. So, jobs or sports where depth perception is vital may rule out monovision as a treatment for some people.
5. Refractive Lens Exchange
Given the cause of presbyopia is to do with the natural lens of the eye, a Refractive Lens Exchange (RLE) replaces this lens with an artificial lens. This is the most direct treatment to overcome the loss of near vision. When combined with a tri-focal replacement lens you may dispense the need for glasses and as an added bonus, avoid cataract surgery later in life.
Pros of Refractive Lens Exchange
- Visual outcomes - 90% of patients obtain 20:20 vision.1
- Safe and common procedure - a Refractive Lens Exchangeis identical to cataract surgery, the most common of all eye procedures.
- No cataracts in later life - As a Refractive Lens Exchange replaces the lens of the eye, this removes the need for almost inevitable cataract surgery later in life
1. Based on outcomes at Envison Eye Centre for cataract surgery
Cons of Refractive Lens Exchange
- Invasive procedure - despite being a very common procedure, an RLE is the most invasive of presbyopia treatments requiring a slightly longer recovery.
- Cost - A Refractive Lens Exchange is not covered by Medicare in Australia (unless you have also been diagnosed with cataracts).
When looking to improve your near vision as you age there are quite a few options. To consider all the alternatives available to you it’s best to see your eye doctor. After an assessment of your vision they can recommend the options to you to consider based on your lifestyle, preference or vision outcome.
Envision Eye Centre are well placed to provide advice for patients with Presbyopia. We regularly perform Refractive Lens Exchange procedures for patients. We are proud of our results achieving 20:20 vision for 90% of patients following surgery. If you are losing your near vision as you age, book an appointment to discuss your options for overcoming Presbyopia.