Presbyopia: Definition, Causes, Symptoms, Diagnosis, and Treatment

Published on July 31st, 2023

Updated on December 11th, 2024

Presbyopia is an age-related eye condition in which a person’s near vision is blurry, caused by the natural ageing of the lens which results in the lens becoming harder and less flexible. This article will discuss the presbyopia definition, its causes, symptoms, diagnosis and treatment. The symptoms of presbyopia include blurry near vision, headaches, eye strain and moving objects further away to see. Presbyopia can be diagnosed through a comprehensive eye test performed by an optometrist. The main treatments for presbyopia include corrective devices which are prescription glasses and contact lenses. Keep reading to learn more about presbyopia and how this age-related eye condition is caused.

What is Presbyopia?

The answer to what is presbyopia, or the presbyopia definition, is an age-related eye condition and refractive error that causes blurry vision when looking at objects close up and it typically presents after the age of 40. While presbyopia has similar symptoms to farsightedness (hyperopia), that being blurry near vision, they are different eye conditions with different causes. Presbyopia causes near vision to be blurry as, when a person ages, the lens in their eye becomes hard and less flexible which makes it more difficult for the eyes to focus on near objects. Presbyopia is a very common eye condition with the Australian Institute of Health and Welfare reporting that over 1.3 million Australian seniors have self-reported as having presbyopia in a 2005 study.

Is Presbyopia the Same as Nearsightedness?

No, presbyopia is not the same as nearsightedness although they are both refractive errors that cause vision issues. Nearsightedness, known scientifically as myopia, can cause a person’s distance vision to appear blurry. This eye condition causes blurry vision due to either an elongated eyeball or an overly curved cornea, as the eye is not as capable of bending and focusing light onto the retina correctly. A person can have presbyopia and myopia (nearsightedness) at the same time which may require a prescription lens with multiple prescriptions such as bifocals or multifocals as they correct both near and far vision.

How Does Presbyopia Work?

Presbyopia works or is concerned with the lens changing due to age which causes it to harden and lose flexibility, resulting in the eye losing its ability to change shape to allow for greater levels of focus. There are five different types of presbyopia which are incidental presbyopia, functional presbyopia, absolute presbyopia, premature presbyopia and nocturnal presbyopia. According to the National Eye Institute, once presbyopia is developed, it continues to get worse until approximately the age of 65.

What Parts of the Eye are Affected by Presbyopia?

The main part of the eye that is affected by presbyopia is the lens which then affects how light interacts with other parts of the eye including the retina. As a person ages, the crystalline lens, which sits behind the iris, naturally changes, becoming harder and less flexible. These changes make it difficult for the eye to focus on near objects as it loses its ability to easily change shape. Due to these problems in the lens, it stops light from correctly focusing on the retina.

The below image shows the parts of the eye that are affected by presbyopia.

What Causes Presbyopia to Occur?

Presbyopia is a refractive error that is caused by the natural ageing process. As a person ages, their lens gets harder and becomes less flexible, resulting in the eye not being able to focus light correctly on the retina. Due to this issue, it causes close-up objects to look blurry, although it is a different condition than farsightedness which also causes near objects to appear blurry. There are not any other major causes of presbyopia besides age which is why it cannot be prevented.

At What Age do People Normally Develop Presbyopia?

The age that people normally develop presbyopia is early to mid-40s, according to the Mayo Clinic. Presbyopia is an age-related eye condition, also called age-related farsightedness, that occurs as the lens becomes less flexible and hard as you age. People often notice the symptoms of presbyopia around the age of 40. Presbyopia will typically continue to worsen over time until the age of 65.

Do Kids Develop Presbyopia?

No, presbyopia does not typically develop in kids, although it is possible to develop this eye condition before the age of 40 with people showing signs of this eye condition as early as 35. This is called premature presbyopia and people may be at a higher risk if they have existing health conditions such as cardiovascular disease and diabetes or if the person has farsightedness or nearsightedness. People who work a lot with their near vision such as on a computer or working with small numbers are more likely to notice the signs of presbyopia developing as they are constantly using their near vision for tasks that require significant concentration.

Can Smartphones Cause Presbyopia?

No, there is no scientific evidence that states smartphones cause presbyopia. While there is much discussion about the rapid increase in smartphone usage and the impact it has on eye health, there is little evidence to support that presbyopia can be caused by smartphones. Presbyopia is an age-related eye condition meaning it occurs naturally as you age. While there is a condition called premature presbyopia, it is not very common and the risk factors according to the Cleveland Clinic include taking certain medications, having certain existing medical conditions and having farsightedness, none of which concern using a smartphone.

What are the Symptoms of Presbyopia?

The symptoms of presbyopia include headaches, blurred vision close-up, requiring a great focus distance when reading and eye strain. These presbyopia symptoms and their definitions are listed below.

Headaches: Headaches can be experienced by people with presbyopia when they are doing close-up work like reading or knitting.
Blurred vision close-up: Blurred vision when looking at close-up objects is a common symptom of presbyopia caused by the natural ageing in the lens that can be corrected using glasses.
Requiring a greater focus distance when reading: Presbyopia causes a person’s near vision to be blurry, therefore, when reading they may require a greater focus distance, meaning they will hold the item further away from their eyes.
Eye strain: Eye strain is caused by presbyopia as the eyes are working harder to focus on near objects due to their blurriness.

1. Headaches

Headaches can be experienced by people with presbyopia when they are doing close-up work like reading or knitting. According to Health Direct, because people with presbyopia have to strain their eyes to see near objects, it could lead to headaches. To prevent headaches caused by presbyopia, corrective devices are prescribed which magnify near objects, stopping the eye from focusing too hard.

2. Blurred Vision Close-Up

Blurred vision when looking at close-up objects is the main symptom of presbyopia and caused due to age-related changes in the lens. Blurred vision for presbyopia makes near objects appear hazy and unfocused, losing their sharp and precise details. Blurred vision can be corrected with prescription glasses using a plus-powered lens that acts as a magnifier. Experiencing blurred vision up close often leads to another common symptom which is requiring a greater focus distance when reading.

3. Requiring a Greater Focus Distance When Reading

People with presbyopia often require a greater focus distance when reading as they struggle or cannot see close up, meaning they hold the book further away from their eyes. Presbyopia causes a person’s near vision to be blurry, therefore, when reading they may be unable to focus on the small print which can be corrected using prescription glasses. As presbyopia only affects near vision, as a book moves further away from their eyesight, it becomes sharper and clearer.

4. Eye Strain

Eye strain is a symptom of presbyopia as this age-related eye condition causes a person’s near vision to be blurry, making it difficult to do near tasks such as reading, writing and knitting. Eye strain is caused by presbyopia as when performing these near tasks, the eyes have to work extra hard to focus, causing the eyes to strain, leading to discomfort and fatigue. By correcting presbyopia, the eyes will be able to see close-up tasks and objects clearly, which helps to eliminate eye strain.

How is Presbyopia Diagnosed?

Presbyopia is a refractive error that can be diagnosed in a standard eye test. According to John Hopkins Medicine, the tests used to diagnose presbyopia include a visual acuity test, a refraction test and a slit lamp test. A visual acuity test is a common eye test performed by an optometrist to assess the sharpness and clarity of a patient’s vision. Visual acuity is tested using a Snellen eye chart or other similar letter charts, set at a distance of 6 metres or 20 feet away. A refraction test is used to determine the prescription a patient needs for vision correction. This test involves the patient looking through different lenses on a special optometry device called a refractor or phoropter to determine what lenses make a person’s vision more clear. Finally, a slit lamp test is used to assess the structure of the eye including the lens, cornea and iris. A slit lamp test requires a patient’s head to be placed on a chin rest and forehead to rest on a band, which is connected to the microscope of the slit lamp. A beam of light from the microscope is then used to inspect the eye.

How Does Presbyopia Lead to Cataracts?

Presbyopia does not lead to cataracts but they are both age-related eye conditions with similar symptoms that are caused by problems in the lens. Both presbyopia and cataracts fall under the category of DLS (dysfunctional lens syndrome) which is a term that describes the natural changes in a person’s lens due to the ageing process, according to an article published in the National Library of Medicine. Presbyopia and cataracts occur due to the natural ageing process that causes the lens to become hard in the case of presbyopia and for cataracts, the proteins in the lens break down and clump together, causing clouding of the lens. Presbyopia and cataracts can both be treated using cataract surgery as this procedure, according to Better Health Victoria, involves removing the lens and replacing it with a permanent artificial lens, known as an intraocular lens. As the lens is completely replaced, it stops presbyopia and the accompanying symptoms.

Is Presbyopia the Same as Astigmatism?

No, presbyopia is not the same as astigmatism. While they are both refractive errors, presbyopia and astigmatism are separate eye conditions that affect the eye differently. Presbyopia is an age-related condition that causes a person’s near vision to become blurry. Astigmatism occurs as the cornea or lens is deformed or misshapen which leads to blurry vision and difficulty seeing fine detail. Both of these eye conditions can be corrected using prescription glasses to give a person clear and comfortable vision.

How Can Presbyopia be Avoided?

Presbyopia cannot be avoided as it is an age-related refractive error, therefore, it predominantly occurs along with the natural process of ageing. While there is no way to prevent or avoid presbyopia, the symptoms can be managed with glasses that correct a person’s near vision.

Can Presbyopia be Cured?

No, presbyopia cannot be cured or reversed, rather it can be corrected using corrective devices. Presbyopia is a refractive error that affects a person’s near vision and can be corrected using prescription glasses or contact lenses. The type of glasses that can correct presbyopia include reading glasses, bifocals and multifocal glasses.

What are Ways to Treat Presbyopia?

The ways to treat presbyopia include progressive/multifocal lenses, contact lenses, reading glasses, refractive surgery, bifocal glasses and corneal inlays. These treatments for presbyopia and their definitions are listed below.

Progressive/multifocal lenses: Progressive lenses, also known as multifocal lenses, are a type of glasses that contain three different prescriptions seamlessly in one lens. People with presbyopia can use progressive lenses if they also have issues with distance vision.
Contact lenses: Contact lenses are corrective devices that have curved lenses that are placed on the eye to give the wearer clear vision. Contact lenses can be worn by people with presbyopia.
Reading glasses: Reading glasses are a type of single-vision lenses that correct close-up vision. Reading glasses can be used for people with presbyopia and hyperopia.
Refractive surgery: Refractive surgery is a broad term for eye surgery that is performed to improve a person’s vision by correcting the eye so it focuses light correctly on the retina.
Bifocal glasses: Bifocal glasses are similar to multifocals in that they correct near and distance vision in one lens, but instead of a seamless transition between prescriptions, bifocals have clear segments separated by a visible line on the lens.
Corneal inlays: A corneal inlay, also known as keratophakia, is a device implanted in the eye used to correct presbyopia.

1. Progressive/Multifocal Lenses

Progressive lenses, also known as multifocal lenses, are used to treat presbyopia as the lens contains three different prescriptions, one for near vision (for those with presbyopia) one for intermediate vision and one for distance vision. Progressive lenses are a very popular choice of glasses for two main reasons. The first is, unlike bifocal glasses, multifocals have a seamless transition between the three prescriptions, meaning there is no interruption to the wearer’s vision. The second is the ability to experience clear and comfortable vision all in the one pair of glasses, so you don't have to constantly switch glasses depending on the activity. At Oscar Wylee, we offer three different types of multifocal lenses which can be chosen at an additional cost on top of your standard optical glasses. The three different types are Multifocal Elite, Multifocal Premium and Multifocal Standard.

2. Contact Lenses

Contact lenses are corrective devices with curved lenses that are placed on the eye to give the wearer clear vision. According to an article published in the National Library of Medicine titled, How can presbyopia be corrected?, contacts are worn on the cornea and they float on a layer of tear fluid. Contact lenses can be worn by people with presbyopia to correct the refractive error in their vision similar to prescription glasses. Contact lenses may be a good option for people who are very active and play sports as they will not get in the way. Contact lenses may not be suitable for everyone which is why you should consult an eye care professional if you are thinking about getting contact lenses to correct presbyopia or other vision problems. At Oscar Wylee, we do not offer contact lenses.

3. Reading Glasses

Reading glasses, also known as readers, are a type of single-vision lens used to treat presbyopia by providing correction for near vision. Single-vision lenses correct vision over a single distance for only one vision type, which in the case of reading glasses is near distance. Reading glasses work by magnifying nearby objects so the wearer can do close-up tasks comfortably like reading a book or knitting without eye strain or blurry vision. Reading glasses are different from distance glasses as the latter help people who need help seeing things far away.

4. Refractive Surgery

Refractive surgery is a broad term for eye surgery that is performed to improve a person’s vision by correcting the eye so it focuses light correctly on the retina. According to the American Academy of Ophthalmology, common types of refractive surgeries include LASIK (Laser-Assisted In Situ Keratomileusis), SMILE (Small incision lenticule extraction) and PRK (Photorefractive keratectomy). Refractive surgery will eliminate the need for glasses although it does come with certain risks. If you are interested in undergoing refractive surgery, talk to an eye care professional about your options.

5. Bifocal Glasses

Bifocal glasses are a type of glasses that can be used by people with presbyopia if they also struggle with distance vision. Bifocal glasses contain two prescriptions in a single lens, that being a near prescription and a distance prescription. Bifocal glasses are a good option for people who have the refractive condition presbyopia as they won’t have to switch between multiple pairs of glasses, rather they can experience clear and comfortable vision in the one pair. Bifocal glasses treat presbyopia as the bottom of the lens will contain a plus-powered prescription that makes near objects clear and the top of the lens will contain a distance prescription for those that have blurry vision when looking at both near and distant objects. Bifocal glasses are different to multifocal glasses as the two prescriptions are clearly separated with a visible line whereas, in multifocals, there is a seamless transition between three different prescriptions.

6. Corneal Inlays

Corneal inlays, also known as keratophakia, are devices implanted in the eye used to correct presbyopia. According to the American Academy of Ophthalmology, there are three types of corneal inlays which are refractive corneal inlays, corneal reshaping inlays and small aperture inlays. Refractive corneal inlays involve inserting a disc shaped corneal implant into the eye to change the refractive index of the cornea. This type of corneal inlay is used to correct both near and distance vision, working in a similar way to multifocal contact lenses. Cornea reshaping inlays correct presbyopia by changing the shape of a person’s eye, specifically increasing the curvature of the anterior corneal surface. Finally, small aperture inlays work by increasing a person's depth of focus, improving near vision.

Can Presbyopia be Prevented Through LASIK?

Presbyopia cannot typically be prevented or treated through LASIK (Laser-Assisted In Situ Keratomileusis). Although, in Australia, there is a new type of laser surgery called PRESBYOND which is a treatment for people with presbyopia over the age of 50 that corrects their near vision. According to an article published in the National Library of Medicine which was last updated in 2020, the potential benefits of eye surgery need to be weighed against the associated risks. Other refractive errors such as nearsightedness, farsightedness and astigmatism can be corrected through eye surgery.

What is the Difference Between Presbyopia and Hyperopia (Farsightedness)?

While they both are refractive errors and cause near or close-up vision to be blurry, presbyopia and hyperopia (farsightedness) are different eye conditions. The main difference between presbyopia and hyperopia is the cause of these eye conditions. Presbyopia is caused by the natural ageing process that affects the lens, causing it to lose its flexibility, meaning the eyes don’t change shape to allow for greater levels of focus. Hyperopia can occur at any age and is caused by issues with the structure of the eye being either too short or the cornea being flat. These structural issues cause light to refract incorrectly and focus behind the retina instead of on the retina, causing difficulty with near vision. Because the symptoms are very similar, is it important to have your vision tested by an optometrist as they can determine the differences between presbyopia and hyperopia.

Are Presbyopia and Eye Floaters Caused by Ageing?

Yes, both presbyopia and eye floaters can be caused by ageing. Presbyopia is caused by ageing as, when a person ages, their lens becomes less flexible making it more difficult for the eyes to focus on near objects. Ageing is related to eye floaters as the ageing process causes the vitreous to shrink, creating clumps of collagen in the eye, causing eye floaters in a person’s vision.

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