Learn what presbyopia is, how it differs from hyperopia, and what treatment options are available to help you see clearly up close again.

What is Presbyopia? A Complete Guide to Age-Related Farsightedness

Presbyopia is a common refractive error that typically affects adults between the ages of 40 and 65. It is a progressive, naturally occurring condition—not an eye disease—that causes difficulty seeing up close. Around age 65, vision changes may cease, but up-close vision will not return to normal.

For a closer look at the anatomy of an eye with presbyopia, watch this brief video from the American Academy of Ophthalmology.

When Presbyopia Typically Starts and How It Progresses 

Presbyopia’s symptoms—blurred up-close vision (particularly in low light), headaches, and eye strain—first appear in the early 40s and progress until about age 65. Meaning “old eye” in Greek, presbyopia develops gradually as we age. It is caused when the lens of our eye, which is soft and flexible in youth, becomes increasingly hard, rigid, and less able to focus up close.

Who Gets Presbyopia?

Nearly everyone over age 40 will develop presbyopia, whether they had perfect vision until middle age or were born with or subsequently developed other eye conditions.

Presbyopia Symptoms to Watch For

Eye strain, headaches, fatigue, and holding reading material farther away than usual areindicators of presbyopia. These symptoms are often worse in dim light or when you’re tired. Any change in your vision should prompt a visit to your eye doctor. The American Academy of Ophthalmology recommends baseline comprehensive eye exams every five to ten years for people under 40, and every year or two if you’re over 65. Learn more about eye exam basics and recommended screening intervals.

How the Eye Loses the Ability to Focus with Age

The corneal hardening and thickening that impair up-close vision in middle age also increase opacity, filtering, and scattering of incoming light.  

The eye operates similarly to a camera: the outermost portion of the eye is the cornea, protected by an invisible membrane, the conjunctiva. Over time, the conjunctiva, which contains blood vessels that feed the cornea, becomes less smooth, causing incoming light to be less focused. The cornea covers the colored portion, the iris, which has the pupil at its center. The pupil expands to admit light or contracts to reduce light. Behind the cornea and iris is the lens, a flexible, disc-shaped part of the eye that focuses light back on the retina. To see things at a distance, the lens doesn’t have to bend, but to see close up, it is pressed inward by surrounding muscles to achieve near focus. The suppleness of the lens of a young eye does this easily. The lens of an older eye, however, can bend less, resulting in blurred vision.

Risk Factors That Can Speed Onset

While advancing age is the number one risk factor for presbyopia, onset can be caused earlier by some antihistamines, antispasmodics, antidepressants, and other medications. Medical conditions, including MS, diabetes, and cardiovascular disease, as well as being born farsighted (hyperopia), can also lead to premature presbyopia.

Can Presbyopia Be Prevented?

Presbyopia cannot be prevented or reversed, but a balanced diet rich in eye-healthy nutrients such as zinc, lutein, zeaxanthin, vitamins C and E, and omega-3 fatty acids helps maintain overall eye health.

Presbyopia vs. Hyperopia: What Is the Difference?

Both conditions affect near vision and can be diagnosed by an eye doctor during a comprehensive eye examination. Presbyopia is sometimes confused with hyperopia, or farsightedness. Hyperopia is a common eye condition caused by structural issues such as a flatter-than-normal cornea or a short eyeball. Many children outgrow hyperopia, whereas presbyopia develops as we age.

Can You Have Both at the Same Time?

If you’re born with hyperopia, you will still develop presbyopia in middle age, when your near vision worsens. The combination of presbyopia and hyperopia can sometimes negatively affect distance vision.

Presbyopia Treatments: What Are Your Options?

Reading Glasses: The Simplest Fix

Reading glasses improve up-close focus by magnifying and bending light before it enters your eye. Reading glasses are available through your eye doctor or can be obtained in select magnification levels without a prescription.

Off-the-shelf, mass-produced, and readily available readers are convenient, affordable, and may seem ideal if presbyopia is your only eye condition. But how do you know if presbyopia is your only eye condition?

Any change in your vision should prompt a visit to the eye doctor for a comprehensive eye exam with dilation. In addition to identifying later-life eye diseases—including glaucoma, dry eye, cataracts, and age-related macular degeneration—an eye exam can also help diagnose serious health issues. Did you know that a visit to the eye doctor may be the first time someone hears that they might have diabetes, hypertension, or other underlying medical issues?

Prescription reading glasses are typically made of superior materials and tailored to each eye, including the distance between your pupils. Pupil distance matters and is unique to you. The mass-produced curvature of off-the-shelf readers might strain your eyes, cause them to focus incorrectly, or even cause double vision.

Bifocals and Progressive Lenses

For those who wore corrective lenses before presbyopia, bifocals, trifocals, and progressive lenses might be a good option. The bifocal lens is divided into two sections by a dividing line. The bottom section corrects close vision and the top addresses distance vision. Trifocals feature a middle area for mid-range vision. The refraction of progressive lenses does the same job, but gradually, without the sharp division of lines.

Multifocal and Monovision Contact Lenses

Contact lenses for those with presbyopia come in two varieties: monovision and multifocal. Monovision contacts are worn in both eyes, with one addressing close vision and the other distance. Like progressive lenses in eyeglasses, each section of the multifocal contact lens refracts light from objects at different distances.

Surgical Solutions

Nearly one third of Americans have presbyopia, and many of them opt for some form of surgical intervention:

LASIK and Monovision Laser Surgery: In Monovision laser surgery, the shape of the cornea is changed so that one eye focuses on near vision. In contrast, the other eye focuses on distance vision.

Refractive Lens Exchange and Intraocular Lens Implants: RLE removes and replaces an old, inflexible lens with an artificial intraocular lens (IOL). This newly implanted lens acts as a permanent multifocal contact lens.

Corneal Inlays: This procedure implants a small device, a corneal inlay, into the cornea to sharpen depth of focus. This surgery is reversible and only appropriate for those with presbyopia whose eyes are otherwise healthy.

Ask your eye doctor about which treatment for presbyopia and any other eye conditions will work best for you.

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