What is presbyopia? It's a farsightedness caused as we age by an inability to focus on nearby objects.

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You walk through the airport, luggage in each hand, as you head toward the gate where your flight awaits. You have no problem seeing the arrival times on the digital boards above you, the signs bearing gate numbers, or the person walking 20 feet in front of you. And then your cell phone rings, and you can’t see the display to find out who’s calling you—not unless you scramble to find your reading glasses or drop your bags and hold the phone an arm’s length away. Like many adults over age 45 or 50, you have presbyopia.

If you’re like many people who deal with presbyopia, you’re aggravated by the condition. You hate the hassle of putting on a pair of reading glasses any time you want to see something up close. Or, even worse, you’re frustrated when you want to read and can’t find your glasses.

If you can get by with reading glasses, great. If not, talk to your eyecare specialist about new surgical procedures to correct presbyopia and help you see clearly without your spectacles.

What Is Presbyopia? Definition of a Common Condition

The lens of your eye, in order to adjust its focus so you can see things up close and at a distance, must stay flexible. But with age, the lens hardens and loses its elasticity, and the ciliary muscles that control the lens weaken, all leading to presbyopia, or farsightedness caused by an inability to focus on nearby objects.

A natural part of aging, presbyopia isn’t preventable. It usually begins around age 40, and by age 45 or 50, most people with the condition require some vision correction.

The simplest way to correct presbyopia is to wear reading glasses or corrective lenses, such as bifocals, trifocals, or progressive lenses. But, you might find the visible line and the abrupt transition between the lenses in bifocals and trifocals to be too distracting. Progressive lenses get rid of the visible line and offer a more gradual transition between the lenses, but they may distort objects when you look to your right or left. And, you may not like the idea of wearing reading glasses or keeping track of multiple pairs around the house.

Toss Your Reading Glasses

One way to function with presbyopia without the need for reading glasses is to wear contact lenses that create monovision, in which one lens allows you to see things up close and the other allows for distance vision. Your brain compensates by favoring one eye for distance vision and one for near vision.

If the contact lenses work well for you, you might talk to a refractive surgeon about creating monovision in your eyes surgically by reshaping the cornea with laser-assisted in-situ keratomileusis (LASIK). Monovision with LASIK has been performed since the early 1990s and is generally safe, although some people may experience dry eyes, nighttime starbursts, or a diminished ability to see in dim light. Note that people with advanced glaucoma, diabetes, dry eye syndrome, and corneal problems may not be good candidates for LASIK.

Some of the latest surgical approaches for treating presbyopia involve implanting a tiny inlay into the central cornea of your non-dominant eye. One inlay—the Kamra, approved by the U.S. Food & Drug Administration (FDA) in 2015—creates a pinhole that allows only focused light to enter the eye. The Raindrop inlay, approved by the FDA in 2016, helps to reshape the eye to restore near vision. Other corneal inlays are in development.

Additionally, for presbyopic patients who require lens replacement due to cataracts, the FDA has approved new intraocular lenses that not only replace the cloudy lens, but also correct presbyopia. Standard cataract replacement lenses are monofocal, allowing for clear distance vision without correcting for vision of nearby objects. However, a new intraocular lens—the Tecnis Symfony, which gained FDA approval in July 2016—is designed to improve both near and distance vision.
“The Symfony intraocular lens is a new option I can offer my patients to improve their vision following cataract surgery, especially those who have difficulty focusing on objects at near distances because of presbyopia,” Eric D. Donnenfeld, MD, of Ophthalmic Consultants of Long Island, NY, said in a press release. “Many of my patients live very active lifestyles and want to see clearly at all distances, and without glasses if possible. With the Symfony lens, I can give patients the freedom to enjoy activities that matter to them, while wearing glasses less.”

Presbyopia: Points to Remember

• Note that corneal inlays and other surgeries to correct presbyopia are elective, so they generally aren’t covered by insurance—the procedures can cost several thousand dollars.
• Ask your eyecare specialist whether you’re a candidate for presbyopia surgery. Consider all your options for treating presbyopia, and choose the one that best matches your lifestyle.