What is and how does presbyopia occur?

Presbyopia is a refractive error along with(myopia, hyperopia, astigmatism), but it represents the difficulty in seeing clearly the objects which are close to the eye (40 cm), caused by the age-related decreasing of the eye accommodation power. The accommodation is a process whereby the lens change their shape, respectively they increases their power to provide a clear near vision.

The amplitude the lens changes its shape with decreases with age. This phenomenon is physiologically, no one can escape presbyopia, not even those who have never worn glasses. Therefore, the occurrence of presbyopia is the age-related process, which causes the loss in the elasticity of the lens and other ocular structures responsible for accommodation.


How does presbyopia manifest itself?

After the age of 40, all of us notice an unpleasant visual phenomenon: the decrease of the capacity to see well for near (reading, writing, telephone, watch, etc.) and therefore the need to to hold small reading materials at arm’s length in order to focus properly.

Presbyopic eye does not have sufficient accommodation anymore, respectively, even if we still see clearly the objects at distance, we have to wear reading glasses. They will be required only for the activities which take place at a distance of 30-40 cm from the eye, and the diopters will continue to increase until the age of 50, between 50 and 60 the progression being slower.

Presbyopia glasses

How is presbyopia diagnosed?

The diagnosis is established during an ophthalmological routine examination and all the available treatment options are presented. Around the age of 40-45, no matter if you had close vision difficulties before, it is recommended to undergo a complete ophthalmological exam which includes pressure measurement and also ocular fundus examination. After this age, there can emerge a lot of serious diseases which have to be detected and cured in due time.

vision check

How can presbyopia be cured?

Eye aging phenomenon is quite unpleasant for all of us and it is very often difficult to accept it, in the background of the variety of transformation our body incurs once with the increasing age. Nowadays, there is no way to prevent the occurrence of presbyopia or to stop its progression, but there are available several methods of correction.

We mean here the classical optical correction methods – reading glasses and the new surgical techniques which allow a definitive solution to the need to wear near glasses.

oculitst equipment closeup

Which are presbyopia correction methods?

We have available several methods for presbyopia correction, and the handiest are the glasses which can be of different kinds: monofocal (only for near vision), bifocal (with pill, which correct distance and near vision) and progressive and multifocal.

The latter are the most modern glasses: the diopter increases on the surface of the same lens starting from the central area and to the bottom thus providing a better vision at all distances by means of a slight vertical movement of the eyes. Unlike bifocal glasses, the areas of different diopters cannot be seen on the lenses. Nowadays, customized progressive glasses can be manufactured. The lenses of the glasses can have different qualities, more precisely photochromic (dimming) lenses which modify their color according to the UV quantity, computer protection lenses, anti steaming, anti scratching treatment etc.

There are also the so-called „office”, type progressive lenses, useful especially for the persons who perform their activity within an office, in front of the computer, due to the fact they provide a clear vision, both at near and at intermediate distance (ex. computer screen)

Another method for the optical correction of presbyopia is represented by the progressive or multifocal contact lenses.
Contact lenses are an increasingly common option, being handier for those who have worn contact lenses since they were young and by reaching the age of 40, they note that they need different diopters for near vision. These lenses have diopters which increase from the central area to the periphery, thus allowing the focus of light rays coming from objects located at different distances depending on the degree of expansion or contraction of the eyeball. In case of preexistent refractive errors, after the age of 40, solutions can be found for near vision by using multifocal contact lenses or monofocal lenses with different diopters for both eyes, thus the correction method called monovision being achieved. This is a method by which one eye is corrected with contact lens in order to see better at distance, and the other one is converted into a myopic eye in order to have a better reading vision. It is important to keep in mind that this option is not easily accepted by all of us, because it requires an effort of the brain in order to integrate different information received from the eyes so that there is no unpleasant phenomenon such as double vision, dizziness, headaches.

Lens casing and bottle of water isolated on black, contact lenses

Can presbyopia be cured by surgery?

The aforementioned methods represent temporary solutions which provide a better near vision, but does not remove the need of reading glasses completely. The sole presbyopia correction method consists in the change of the natural lens with a multifocal artificial lens . The method is chosen by an increasingly large number of presbyopic patients, because it provides a great satisfaction, especially when it is performed on both eyes and the patient meets certain conditions established during preoperative investigations. The great advantage of this method is that the respective patient will no longer need to wear glasses and will never suffer from cataract again.

In recent years, the technique called RLE (Refractive Lens Exchange) has become very known within the ophthalmologic surgery field, a wide range of „premium” artificial lenses being present on the market, namely bifocal or trifocal, with or without the possibility of further correction of astigmatism (toric). The difference of the two categories is given by the fact that in case of bifocal lenses, near vision (30 cm) and distance vision (over 5 m) are good, but after the surgery, some patients may need glasses for intermediate vision (50-70 cm), while trifocal lenses provide full independence of glasses. If the patient suffers from astigmatism before the surgery, we can choose a toric bi/trifocal lens, this being in fact a customized artificial lens which can correct in full the diopters of the patient for all distances.
The main steps that we have to follow before deciding to undergo such a surgery consist mainly in a complete ophthalmologic examination, where the specialist analyze the presence of certain diseases which can prevent us from enjoying the new artificial lens, the discussion with the ophthalmologist is extremely important and helps us to easily overcome the neuroadaptation term which occurs after the surgery and which can take several months.

We must know that after the surgery we may have certain absolutely normal symptoms related to the adaptation of our brain to the new „optical tool” represented by the multifocal artificial lens. Such symptoms: delayed focus when passing from distance/near/intermediate vision, decreased ability of perceiving contrast in low light, halos around light sources or their perception as being much brighter, especially during night, can be differently experienced depending on the patient, being transitory and rarely annoying.
In order to minimize these phenomena, the time interval between the surgeries performed at each eye must be short (few days – one week), postoperative vision should not exclude a substantiated visual effort at all distances, by „practicing” both eyes vision at the same time and of course, the observance of the ophthalmologist’s recommendations.

Therefore, after the age of 40, if you want to get rid of glasses, you should visit the ophthalmologist in order to find the presbyopia correction method that suits you best.