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Presbyopia – Learn About the New Surgical Treatments

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Presbyopia is the normal age-related loss of ability to focus on close-up objects. This condition normally becomes noticeable sometime after age 40. Presbyopia affects everyone eventually—even if you've never had a vision problem or needed glasses before.

It's estimated that 90 million people in the United States either have presbyopia or will develop it within the next five years. Despite being part of the normal aging process, presbyopia is poorly understood by the general public. A 2008 Harris interactive poll found that 83 percent of people responding to the survey didn't know what presbyopia is.

Presbyopia Signs and Symptoms

The classic sign of early presbyopia is the need to hold reading material farther away from your eyes to see it clearly. You also may need to squint to read small print, or to use brighter light when reading.

Presbyopia also can cause eyestrain and headaches, especially when reading or using a computer for extended periods of time.

The Cause of Presbyopia

Normally, the lens inside our eyes is flexible and capable of changing shape to provide the power required to focus on objects far away, up close or in between. A muscle inside the eye (called the ciliary muscle) surrounds the lens. It contracts and relaxes to increase or decrease tension on the lens. This tension changes the shape and focusing power of the lens—a process called accommodation.

But as we age, the lens inside the eye thickens and loses its elasticity, diminishing its ability to change shape in response to the accommodative effort by the ciliary muscle. Focusing power is weakened, and small print becomes blurred.

Presbyopia differs from nearsightedness, farsightedness and astigmatism. These vision problems (also called refractive errors) are related to the shape and length of the eyeball and the power of the cornea and lens, not the ability of the lens to flex.

Presbyopia and Farsightedness

Presbyopia is often confused with farsightedness, which occurs when the eyeball is too short or the lens and/or cornea of the eye are too flat for light to focus properly on the retina.

Farsightedness (also called hyperopia) generally occurs early in life and can cause blurred near vision, or, in more severe cases, blurred vision at all distances. A young person with only mild farsightedness may be able to see clearly without glasses, but may experience eyestrain when reading or using a computer.

As a farsighted person ages, it becomes harder to compensate for their farsightedness without glasses. So they may need to wear eyeglasses full-time as an adult, even before they become presbyopic.

Eyeglasses for Presbyopia

Reading glasses are the most common treatment for presbyopia among middle-age adults who see clearly in the distance and have never needed prescription eyeglasses previously. Reading glasses are also a very popular option for contact lens wearers who have become presbyopic.

For people who already wear eyeglasses for nearsightedness, farsightedness and/or astigmatism, the most popular treatment for presbyopia is wearing eyeglasses with multifocal lenses—progressives ("no-line" multifocals), bifocals or trifocals.

Contact Lenses for Presbyopia

Contact lenses are another treatment option for presbyopia, and are often the preferred solution among people who have worn contact lenses successfully prior to becoming presbyopic.

Presbyopia can be corrected by wearing multifocal contacts or using a contact lens fitting technique called monovision.

In monovision, one eye is fit with a contact lens to correct for distance vision, and the other eye is fit with a lens to correct for near vision tasks, such as reading and computer work. Usually, standard (single vision) contacts lenses are used for monovision, but in some cases multifocal lenses or a combination of single vision and multifocal contacts are used.

Eye Surgery for Presbyopia

With recent advances in refractive and cataract surgery, eye surgery has become a viable solution for the correction of presbyopia. Presbyopia correction surgery, such as Presby-LASIK, offers decreased dependence on eyeglasses and the convenience of no need for daily contact lens care. In many cases, people who have eye surgery to correct presbyopia can see well at all distances without glasses (including reading glasses) after the procedure.

Options in presbyopia correction surgery include multifocal LASIK, accommodating IOLs, multifocal IOLs and conductive keratoplasty (CK). Whether you decide to undergo any of these procedures or another refractive treatment, inquire about the benefits and risks of each surgery. In addition, you should thoroughly research the professional record of your surgeon and obtain complete information about non-surgical treatment prices and LASIK eye surgery cost.

Note: This information is for general education purposes only. It is not to be used as a substitute for medical advice from your eye doctor or refractive surgeon.

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