Understanding Presbyopia: Causes and Treatments

Symptoms of presbyopia 

Not long after turning forty, most people begin having trouble with reading the fine print and doing close-up work. Much to our annoyance, we find ourselves holding our smartphone or menu at arm's length in order to make out the small print. We also may find that we need more light to read or do close work. This reduction in vision prompts many people to seek out their eye care professional for an eye examination.

What causes presbyopia?

Presbyopia is partly due to age-related changes in the proteins within the lens of the eye that cause it to become thicker, harder, and less flexible. This loss of flexibility affects the lens's ability to refract light rays, which, in turn, affects your eye's capacity to focus. Age-related changes also occur in the muscle fibers surrounding the lens that aids in focus, further aggravating the problem.

Can you slow down presbyopia?

Unfortunately, presbyopia is a natural part of aging and cannot be prevented entirely. However, there are steps you can take to potentially delay the onset of presbyopia or slow down its progression:

• Regular eye exams: Regular eye exams can help detect vision changes early on and allow appropriate treatment.
• Healthy diet: Eating a healthy diet rich in vitamins A, C, and E, as well as zinc and omega-3 fatty acids, can help maintain good eye health.
• Quit smoking: Smoking can increase the risk of developing age-related vision problems, including presbyopia, so quitting smoking can help slow its progression.
• Reduce screen time: Spending too much time looking at digital screens can cause eye strain and fatigue, which may worsen presbyopia. Taking breaks and practicing good screen habits can help reduce eye strain.
• Corrective lenses: Wearing corrective lenses such as glasses or contact lenses can help compensate for presbyopia and improve vision for near tasks.

Treatment Options for Reading and Close Vision without Glasses

If you prefer not to wear over-the-counter readers or prescription glasses with bifocal or progressive lenses, there are several presbyopia treatment options available to free you from wearing glasses.

Non-surgical presbyopia treatment options

Bifocal contact lenses or multifocal contact lenses

You can choose to wear bifocal contact lenses or multifocal contact lenses that come in the soft or gas permeable lens material. These are designed to let you see distance seeing through different parts of the lens to focus on near or far objects.

The disadvantage of these corrective lenses is that since they float on your tear film, they move around continuously. This can sometimes cause a brief loss of focus until the lens gets into just the right position.

Monovision contact lens

This approach is where one eye wears contact with a distance prescription and the other eye wears a contact prescription for near vision. Over time, the brain learns to favor one eye for seeing far away and the other eye for close tasks.

Not everyone is able to make this adjustment, and some folks complain of reduced overall vision sharpness and depth of perception (ability to see in 3-D).

Surgical treatment for presbyopia 

For people not interested in dealing with contact lenses or wearing readers, bifocals or progressive reading glasses, refractive surgery options using LASIK are now available.

Monovision LASIK for presbyopia

Monovision LASIK creates the same result as monovision contact lenses by correcting one eye for better distance vision and the other for enhanced near vision.

Although monovision corrects presbyopia for most people, there are some compromises. Some people find that correcting one eye for near vision makes their distance vision somewhat blurred, particularly when driving at night or being in low-light conditions. Other folks might find that monovision doesn't provide enough magnification to clearly see reading material with fine print.

This is why many eye care professionals recommend that patients do a trial run with monovision contacts when considering monovision LASIK surgery.

At AGEI, we use state of the art LASIK technology to correct your non-dominant eye for distance vision and your dominant eye for near vision. We use the iDesign system to take pre-op measurements of your eye that are 25 times more precise than any other vision measuring system available today.

The iDesign measures your vision prescription (refractive error) at 1240 different points on your cornea and combines this with topography measurements of your corneal surface. These measurements are then used to create the template that guides your LASIK corneal sculpting.

Multifocal LASIK and PresbyLASIK for presbyopia

Another LASIK option to treat presbyopia involves sculpting your cornea into three different power zones for seeing at near, middle, and far distances. This lets your brain select which zone to look through in order to view near or far objects sharply. This approach mimics the experience of wearing multifocal contact lenses but with focal zones created directly on the surface of your eye. As such, you avoid the inconvenience and discomfort of contact lens wear.

It's important to know that your eyes can change in the years following multifocal LASIK surgery, and you can develop eye conditions making further LASIK surgery necessary to regain crisp vision for driving or reading.

If you develop cataracts in your natural lens after undergoing multifocal LASIK surgery, you will still be able to have cataract surgery, although it's possible that you might need to wear glasses or get additional LASIK vision correction to restore crisp driving and reading vision following your cataract surgery.

As you age, it is important to monitor your eye health with an annual eye exam and to discuss with your eye doctor any changes that you notice in your vision.

ReadingVision™️ LASIK for presbyopia

Invented by Dr. Kerry Assil, this procedure further customizes Multifocal LASIK by taking into account the variability of each individual patient's pupil size.

In ReadingVision LASIKTM the laser selectively sculpts only the segment of the cornea that you look through when reading. This allows you to obtain the correct prescription for seeing close up. The rest of your cornea does not get modified so your vision at middle and far distances remains unchanged.

Like Monovision, Reading VisionLASIK is usually performed on one eye, however, it has the advantage of creating separate focal zones for near and distance vision directly on the surface of your eye. As a result, the eye that’s been corrected for near vision can see better at intermediate and far distances than it would with Monovision LASIK.

Corneal Inlays for presbyopia

Corneal inlays are a treatment introduced over 20 years ago that involves placing an optical device underneath the corneal surface to improve near vision and reduce the need for reading glasses.  At AGEI we are happy to offer the latest generation corneal inlay called KAMRA, FDA approved in 2015.

The Kamra inlay is a thin plastic ring about one quarter of the size of a contact lens and less than one-tenth the thickness of a human hair. It has a 1.6mm diameter central opening and the remainder of the ring is opaque so it creates a “pinhole” effect which, when looked through, brings near and intermediate distance objects into sharper focus while allowing your distance vision to remain unchanged.

The Kamra is typically implanted in your non-dominant eye so that you can use that eye for sharp near vision and can see far away objects through both eyes. The inlay is inserted in less than 15 minutes at your eye surgeon’s office and involves no stitches.

On the Horizon… Presbia Flexivue Microlens for presbyopia

AGEI is proud to be a participating research site for the Phase III clinical trials for FDA approval of the Flexivue Microlens, the latest generation in corneal inlays.

The Flexivue is a 3mm diameter lens with a 0.15mm central hole made of a bio-compatible copolymer which reduces the risk of inflammation and complications like glare and halos. Like the Kamra, the Flexivue is implanted in the middle corneal layer (the stroma) and evidence from international studies suggests that the Flexivue provides better near vision than its predecessors.

We will keep you posted once clinical trials are finished.