Overview

Presbyopia is the inability to focus on things that are at normal reading distance, such as text on your mobile phone and print on packaging. It is a natural part of ageing and happens as the lens inside your eye that changes shape to look at things at different distances loses elasticity. Presbyopia occurs as you age, and will happen to everybody, even those who have never previously had a problem with their eyesight. It usually starts to become noticeable in your late 30s or early 40s. 

People that already have long-sightedness (hyperopia), short-sightedness (myopia) and astigmatism will also experience presbyopia. They will notice that their glasses no longer seem as clear looking at text up close as they used to, they may even find (with myopia and astigmatism) that it is easier to read print without their glasses.

Getting your eyes tested

If you think you may have presbyopia, you should book an eye test at a local optometrists/opticians. Find an optician near you.

You should have a routine eye test at least every two years, but you can have a test at any point if you have any concerns about your vision.

An eye test can confirm whether you have presbyopia, and you can be given a prescription for glasses or contact lenses to correct your vision.

For some adults - such as those over 60s and people on certain income related benefits- eye tests are available free of charge on the NHS.

What causes presbyopia

Presbyopia is caused by a hardening of the lens of your eye, which occurs with ageing. As your lens becomes less flexible, it can no longer change shape to focus on close-up images. As a result, these images appear out of focus

You may find evidence online that some people think it can be prevented but there is no proven technique for preventing presbyopia. The gradual decline of the ability to focus on near objects affects everyone.

Diagnosis

You can find out if you have presbyopia by having an eye test at your local optometrists/opticians.

Find an opticians near you.

What happens during an eye test

Your eyes will usually be tested by an optometrist/optician

The optometrist will begin by asking you why you have come for an appointment and any issues you may be having.  They will also ask you some questions about your lifestyle and your job so they can work out what your visual needs are. They will ask some questions about your general health, any medication you may be taking, any past eye problems and some family history questions.

The actual tests that an optician carries out may vary and can depend on your age and your answers to some of the above questions but will likely include the following.

  • Checking what you can see in the long distance and close up by reading some letters or text.
  • Putting lenses in front of your eyes in a frame or a machine in front of your eyes to see if they improve what you can see
  • Several eye health checks which may include photos of your eyes
  • Machines that check your peripheral vision and an air puff test (not always done for younger adults and even more rarely for children) to check the pressure inside the eyeball (to check for glaucoma and other conditions)

This will help the optometrist find the right glasses prescription for you and check that your vision problems aren’t caused by an eye health problem.

Understanding your glasses prescription

If an eye test finds that you have presbyopia, you'll be given a prescription that describes what lenses you need to improve your vision.

This can be used to make glasses or contact lenses.

Your prescription will usually consist of 3 main numbers for each eye.

These are:

  • Sph (sphere) – a positive number here indicates that you're long-sighted, while a negative number indicates that you're short-sighted
  • Cyl (cylinder) – this number indicates whether you have astigmatism (where the front of your eye isn't perfectly curved)
  • Axis – this describes the angle of any astigmatism you have

With presbyopia there will be a separate number for something called the reading add. This is when you need a different prescription for reading and possibly using the computer. You may then be advised you need special glasses called bifocals or varifocals which have more than one prescription in one lens.

If you decide to just have reading glasses when you look through them objects will look blurry in the distance and walking around in them might make you feel disorientated.

Treatment

Glasses or contact lenses are the most common method of correcting presbyopia

Corrective lenses

Glasses

Presbyopia can usually be corrected using glasses made specifically to your prescription.

Wearing a lens made to your prescription will ensure light is focused onto the back of your eye (retina) correctly so near objects don't appear as blurry.

The thickness and weight of the lens you need will depend on how much presbyopia you have (tends to increase with age) and if you have pre-existing glasses for short-sightedness (myopia) or long-sightedness (hypermetropia)

Your eyesight often changes as you get older, which means you may eventually need to use two pairs of glasses: one pair for close vision activities such as reading, and the other pair for distance vision activities, such as watching television.

Some people prefer to use bifocal lenses that allow them to see objects clearly that are both close up and far away without changing their glasses.  These lenses have a distinctive line at the reading segment.

You can also get multifocal lenses that help you see nearby objects and those at middle and long distances (varifocal glasses).  These lenses gradually change prescription throughout the lens accounting for all distances.  Their appearance is the same as a single vision lens.

Contact lenses

Contact lenses can also be used to correct vision in the same way as glasses.  There are contact lenses available to correct for both distance and near objects.

Some people prefer contact lenses to glasses because they're lightweight and almost invisible, but some people find them more of a hassle than wearing glasses.

Contact lenses can be worn on a daily basis and discarded each day (daily disposables), or they can be disinfected and reused.

Your optometrist/optician can advise you about the most suitable type of contact lenses for you.

If you decide to wear contact lenses, it's very important that you keep your lenses clean and hygienic to prevent eye infections.

Availability and cost

You can get vouchers towards the cost of glasses or contact lenses if you're eligible. As an adult this is dependent on your receipt of certain income related benefits

If you're not eligible you'll have to pay for glasses or contact lenses. The prices can vary significantly, depending on your choice of frame or contact lenses

Laser Surgery

Presbyopia cannot be cured by laser surgery. In fact if you have laser surgery for short-sightedness (myopia) or long-sightedness (hypermetropia) over the age of 40, you are likely to still need reading glasses. If you are considering this surgery talk to your eye specialist about this and they will tell you what to expect.

Lens implant surgery

Bifocal or multifocal lens implant surgery is a relatively new type of surgery for short-sightedness. It involves implanting an artificial lens into your eye through a small cut in your cornea.

The lenses are specially designed to help focus light more clearly on to the retina.

For people who already wear reading glasses the main option is

  • artificial replacement - where the natural lens is removed and replaced with an artificial one, similar to cataract surgery

The implants are usually inserted under a local anaesthetic and you'll normally be able to return home the same day. Each eye will usually be treated on separate occasions.

Current artificial lens technology cannot guarantee you to be glasses free after surgery although this will be the aim.

Risk and complications

Like all medical procedures, surgery to place artificial lens implants in the eyes carries a risk of complications.

Posterior capsule opacification (PCO) is one of the most common complications of lens implant surgery. This is where part of the artificial lens becomes thickened and cloudy.

PCO usually occurs a few months or years after having surgery. Treatment for PCO can involve having laser surgery to remove the thickened part of the lens.

Other possible complications of lens implant surgery include:

  • retinal detachment (where the retina begins to pull away from the blood vessels that supply it with oxygen and nutrients)
  • seeing a halo of light around objects at night
  • reduced night vision
  • glaucoma

You should talk to your doctor or surgeon about each procedure so you're fully aware of any risks involved.

Availability and cost

This procedure can be expensive and is not available on the NHS.



The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 15/11/2021 12:16:11