What Is Presbyopia? Symptoms and Solutions for Better Sight

If you’re over age 40 and you notice that words are starting to seem blurrier when you read, you’re not going crazy. There’s a good chance you’re experiencing presbyopia.

Presbyopia is an age-related, blurry near vision that starts around age 40. Near vision is the type of vision you use to see things close up. You may have heard the term nearsightedness, used for the ability to see things close up but not as well at a distance, or farsightedness, for the ability to see well at a distance but not close up.

It happens because the lens inside your eye stiffens and becomes less flexible, says Dr. Robert C. Layman, a Toledo, Ohio-based optometrist and president of the American Optometric Association.

When you’re younger, that lens flexibility makes it easier for your eyes to change focus from near to far objects.

Everyone will experience presbyopia when they reach middle age. In fact, about 1.8 billion people around the world lived with presbyopia in 2015, according to a report in the journal Ophthalmology.

[See: Foods That Are Good for Your Eyes.]

Symptoms of Presbyopia

Some symptoms of presbyopia include:

— Blurry vision when trying to read something on your phone, the computer or in a book.

— Having your eyes feel tired after reading. This is also called eye fatigue or eye strain. In addition to tired eyes, your eyes may get watery, and you have trouble concentrating.

Headaches after doing near-vision work, like reading your phone.

— Having to increase the font size on your electronic devices to read better.

— Needing to move something farther away so you can read it. This is jokingly referred to as “trombone arms” because you move your arms back and forth to hold something and try to read it.

— Problems reading in low-light situations.

— Squinting to read.

If you have blurry vision that you didn’t have before, you should set an appointment with an eye doctor for an exam. Although presbyopia may be the cause, there always could be another cause, such as dry eye (a condition where your eyes don’t make enough tears or make tears of poor quality) or an infection.

Regular eye exams can help track and address vision changes, as well as monitor your overall eye health, Layman says.

Although presbyopia can be frustrating, it’s a natural aging process and treatable, says Dr. George O. Waring IV, founder and director of the Waring Vision Institute in Mount Pleasant, South Carolina.

In fact, presbyopia has several treatment options, including:

— Glasses.

— Contact lenses.

— Eyedrops.

— Surgery.

[SEE: Do You Need Eyeglasses? Watch for these Common Signs.]

Glasses for Presbyopia

The first and easiest option that you may turn to for blurry near vision is over-the-counter reading glasses. These are the glasses that you find at your local supermarket or pharmacy, and are available in different powers. The powers are listed with a plus (+) sign followed by the letter D, which stands for diopters. Diopters are used to measure lens power for glasses.

The powers for reading glasses typically range from +0.75 D to +4.00 D, although you may find some that are stronger. The higher the number, the higher the corrective power they have.

If you don’t have any other vision correction, over-the-counter “cheaters” may be all you need,

says Dr. Thomas Steinemann, a spokesperson for the American Academy of Ophthalmology and professor of ophthalmology at MetroHealth Medical Center in Cleveland.

Before you buy inexpensive reading glasses, try them on to double-check that you buy the right power and that you like the way they look. The right power will help you to read more clearly, but shouldn’t feel too strong — which could give you headaches or make you feel dizzy. During an eye exam, an eye doctor also can let you know what the right power would be for you. When in doubt, start with a lower power like +0.75 D or +1.00 D.

If you have other vision correction needs, then prescription glasses are another option. Bifocals are a type of glasses that have a line in the middle and provide distance vision correction at the top and reading vision correction at the bottom. You need to look in the corresponding area depending on your vision needs.

Nowadays, more consumers use progressives, which are no-line bifocals, Steinemann says. Progressives provide a gradual transition from distance to near vision.

Some people, especially as the lenses in their eyes get stiffer in their mid-50s and beyond, may need trifocals. These provide near, intermediate and distance vision in one pair of glasses. The intermediate vision includes tasks like reading the computer screen or seeing a car dashboard, says Dr. Michael J. Shumski, an ophthalmologist specializing in cataract and refractive surgery at Magruder Laser Vision in Orlando, Florida.

Progressives also can address near, intermediate and distance vision issues.

Some patients find it hard to get used to prescription glasses like progressives. Initially, you may find it hard to do tasks like going down steps or driving because you aren’t sure where to look. “You have to train yourself on how to use them,” says Steinemann, who uses glasses for presbyopia. Give yourself a week or two to adjust to them. It helps to move your nose instead of just your eyes in the direction of what you want to see or read when wearing progressive lenses.

[See: 9 Signs of Dry Eye Disease.]

Contact Lenses for Presbyopia

If you already wear contact lenses, or perhaps even if you don’t, you may decide to give contact lenses a try for blurry near vision. There are a few options.

One common option is called monovision. With monovision, you use a contact lens to correct distance vision in your dominant eye and another contact lens to correct near vision in your non-dominant eye. “Even though the two eyes are different from each other, they are close enough that your brain blends them together,” Shumski says.

Another option is the use of multifocal contact lenses, which provide areas of distance vision and near vision in the same contact lens. Or, the contact lens might have a design somewhat like progressive eyeglasses, with a gradual change in lens power for a natural visual transition from distance to near, Layman says.

Modified monovision is another option where a distance contact lens is used in one eye and a multifocal contact lens is used in the other eye.

Contact lenses can eliminate or reduce the need for glasses. That can make life easier for sports or other outdoor activities. However, contact lenses require good hygiene practices to avoid eye infections. Not everyone will like contact lenses for presbyopia. Still, many people adjust to them, Steinemann says.

Eyedrops for Presbyopia

In October 2021, the Food and Drug Administration approved the first prescription eyedrops for presbyopia called VUITY. The eyedrops contains pilocarpine hydrochloride, a type of medication also sometimes used in eye care for glaucoma.

VUITY works by making the pupil smaller, so it’s easier to see things in the close and intermediate-range without affecting your distance vision.

You can use VUITY once a day, and it will work for up to six hours, says Waring, who was the principal investigator in the two trials used to gain FDA approval for the drug. When administered in the eye, it works within 15 minutes.

VUITY is best if you have early, mild to moderate presbyopia, Waring says. If you use contact lenses, you should remove them when inserting the drops. You can reinsert your contact lenses about 10 minutes afterward, according to Allergan, the makers of the drops.

In the time period when the drops are effective, they can help you avoid the need for glasses or contacts for your presbyopia. Take caution with night driving or in low-lighting conditions when using VUITY because the medication can make your vision dimmer, Steinemann says.

Headaches and eye redness are possible side effects of the drops. The eyedrops, which require a perscrition, aren’t currently covered by insurance or Medicare, and the out-of-pocket cost is about $80 for a 30-day supply.

Surgery for Presbyopia

There also are surgical options for presbyopia.

One option that you may have heard of is LASIK, used for different types of vision correction. LASIK may be used to reshape the cornea (the dome-shaped front of the eye) and set one eye for distance vision and the other eye for near, Shumski says. LASIK for presbyopia will not stop natural aging of the lens, or the potential development of cataracts, Layman says.

Another option is custom lens replacement, also called refractive lens exchange or CLEAR. With this procedure, the eye surgeon removes the dysfunctional lens from the eye and replaces it with a lens implant that can correct both near and distance vision.

With custom lens replacement, the eye will not develop a cataract as the original lens is removed.

Not all patients are suited for LASIK or custom lens replacement. This is where an eye exam is helpful to determine whether you’re a good candidate for surgery or not.

You have to pay out of pocket for LASIK and custom lens replacement.

Cataract surgery is another surgical option for presbyopia. A cataract is a natural clouding of the lens that becomes more common with age, especially after age 60. The eye surgeon will remove your natural lens and replace it with a lens implant.

If you haven’t yet had presbyopia corrected, the lens implant you select may help to improve it. Sometimes, you still need to use glasses after cataract surgery. Some lens implants are more customized and require out-of-pocket payments because they aren’t covered by insurance or Medicare.

Looking Ahead at Presbyopia Treatments

In addition to the current treatments, some other potential presbyopia treatments in their early stages include:

— More eyedrop formulations.

— More multifocal contact lens options.

— Drops that can be used in the early stages of presbyopia to help soften the lens and temporarily keep it more flexible.

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What Is Presbyopia? Symptoms and Solutions for Better Sight originally appeared on usnews.com

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