Presbyopia: symptoms and surgical treatments for correction

28/01/2025

Presbyopia is a common eye condition that affects most people over the age of 40. It is characterised by the progressive loss of the ability to focus on nearby objects, which can cause discomfort and make daily activities such as reading, writing, or using electronic devices more difficult. While it is not preventable, various treatments, including surgical options, may offer long-lasting solutions. Below, we explore the most common symptoms of presbyopia and the available surgical treatments for its correction.

Symptoms

Presbyopia develops gradually, and its symptoms tend to become more noticeable over time. The most common signs include:

1. Difficulty reading small print: People with presbyopia often find they need to hold text further away to focus better, especially in low-light conditions.
2. Eye fatigue: A frequent sensation of tired eyes, particularly after prolonged close-up work.
3. Headaches: Visual strain can lead to headaches, especially in those who try to compensate for the issue by straining their eyes.
4. Need for brighter lighting: A stronger light source is often required for tasks such as reading or sewing.
5. Blurred vision at close distances: Nearby objects may appear blurry, while distance vision remains clear in the early stages.

Causes

Presbyopia occurs due to the loss of elasticity in the crystalline lens, the eye’s natural lens responsible for focusing at different distances. With age, the lens becomes stiffer and less flexible, making it harder to change shape and focus on close objects. This process is a natural part of ageing.

Surgical correction

For those seeking a more permanent solution, various surgical techniques have been developed. However, it is important to note that no procedure has fully restored the eye’s natural focusing ability. The available options include:

• Corneal laser surgery: Procedures such as LASIK reshape the cornea to increase depth of focus, compensating for the loss of accommodation in the lens. A variant called monovision adjusts one eye for distance vision and the other for near vision. However, these procedures are irreversible and require careful evaluation.
• Intracorneal lens implants: This involves inserting small lenticules within the cornea to improve near vision. These implants can be refractive or function as diaphragms without optical power. Unlike laser surgery, this method is reversible.
• Intraocular lens implants (IOLs): This procedure replaces the natural crystalline lens with an artificial lens, which may be bifocal, multifocal, or extended-range. It is similar to cataract surgery and can also correct other refractive errors such as myopia, hyperopia, and astigmatism. However, it is not suitable for all patients and requires a thorough preoperative evaluation.

The choice of the most appropriate treatment depends on multiple factors, including age, ocular health, daily activities, and patient expectations. A comprehensive ophthalmological evaluation is essential to determine the most suitable and personalised option. While presbyopia has no cure, the available solutions can significantly reduce its impact and improve the quality of life for those affected.

Dr Anton Barraquer, ophthalmologist at the Barraquer Ophthalmology Centre