Presbyopia is the deterioration of vision that happens to us all in middle age, usually around our 45th birthday. It makes it difficult to adjust to looking at objects that are different distances away. Typically, it is the near vision that deteriorates the fastest, resulting in long-sightedness. The need to hold books and newspapers further and further away to be able to read them, sometimes longer than arms length away, will be all too familiar to those with presbyopia.

Presbyopia treatment involves correcting this deterioration in vision, either through wearing glasses or contact lenses, or through Presbyopia surgery. Getting presbyopia treatment right can take a little time as the eyes continue to change but it is well worth persevering to be able to see clearly to read and do close work.

This article on presbyopia treatment is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

Causes and how is it diagnosed?

Presbyopia affects all of us as we age, and is caused by the lens in the eye gradually stiffening and the muscles that are used to focus the lens becoming weaker. The signs of presbyopia become obvious and most people make an appointment with an optician, where it is officially diagnosed.

Treatments: glasses and contact lenses

Providing you don’t have any other eye problems, the simplest presbyopia treatment is wearing glasses. If your eyesight is otherwise OK, or if you wear contact lenses, getting some reading glasses for close work is straightforward. You can even buy some over the counter.

If you already wear glasses to improve your long-distance vision, you may be need bifocal or varifocal lenses as presbyopia treatment to correct both your short and long-distance vision at the same time, depending on which part of the lens you look through. Alternatively, you may prefer to have two pairs of glasses, one for reading and one for distance vision. People who are 40-something often feel ‘too young’ for bifocals!

Contact lenses can also be a useful form of presbyopia treatment. You may be prescribed bifocal contact lenses, or you may be given monovision lenses. In this case, one contact lens corrects for near vision and the other for distance vision. Your brain soon adapts to this type of presbyopia treatment, making it possible to see both near and far easily, and allowing you to wear the same contact lenses for all activities.

Treatment using laser surgery

Traditional eye laser surgery, which changes the shape of the cornea to correct vision, is not an effective presbyopia treatment. This is because presbyopia affects the lens of the eye, not the cornea. However, conductive keratoplasty, a relatively new type of laser presbyopia treatment, is now available in some clinics. In fact, this is not strictly an eye laser treatment; it involves the use of radio waves. Heat from the radio waves tightens the minute fibres on the surface of the eye. This type of presbyopia treatment is usually performed as a ‘blended vision’ treatment, giving primarily long-distance vision in one eye and short-distance vision in the other, as with monovision lenses.

Lens replacement surgery

Clear lens replacement surgery (also known as refractive lens replacement [RLR] surgery or Presbyopic Lens Exchange [PRELEX]) is growing in popularity as an effective presbyopia treatment. It involves removing the defective lens and replacing it with a synthetic one. This is quite similar to cataract surgery, and can be carried out as day operation, usually taking less than 4 hours. You only need a local anaesthetic, so you won’t need to stay overnight in hospital.

An additional benefit of having this type of presbyopia treatment is that you will never suffer from cataracts, as the lenses in your eyes will be synthetic. There two main types of lenses that can be used in clear lens replacement surgery:

  • Multi-focal lenses enable people with presbyopia to see close up, but this type of presbyopia treatment is not usually recommended for people who do a lot of night driving. Multifocal lenses reflect light differently, causing a halo effect in your vision.
  • Monovision lenses are a sort of implantable version of monovision contact lenses. You may need to try the contact lenses first, before having the surgery, to see if this approach works for you.

Scleral expansion surgery

Scleral expansion surgery has been used as a presbyopia treatment but this is now falling out of favour. The technique involves inserting bands to stretch the part of the eye that controls focusing. However, the National Institute for Clinical Excellence (NICE) recently recommended that, due to the risks and lack of proven benefit, this presbyopia treatment should no longer be used.

Are there any complications?

As with any surgery, there are some risks with presbyopia treatment such as developing an infection. You could also suffer some complications because of the surgery itself. A wide range of complications have been reported with PRELEX presbyopia treatment, including a minute chance of blinding. However, it is reassuring to know that the chances of ending up with vision that is worse than that you had before surgery is only 1%.

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