Presbyopia

Presbyopia is a normal sign of ageing that makes it harder to focus on nearby objects such as reading materials. It's very common over the age of 40 and can often be corrected simply by wearing reading glasses, contact lenses or a combination of both.

You might not notice the symptoms of presbyopia at first, which is one reason regular eye tests are recommended.

Presbyopia symptoms

The symptoms of presbyopia typically start in people over the age of 40 and worsen up to around 65. Symptoms tend to develop gradually and can be hard to distinguish from farsightedness. You might notice the following signs of presbyopia:

Trouble reading and seeing small print, especially in poor light.
Getting tired when doing a lot of close work.
Blurred vision when holding books, newspapers or other materials at normal reading distance.
Eye strain and headaches, especially after doing a lot of near vision work.
It may take longer for your vision to adjust between looking at near objects and then looking further away.
You may find yourself holding things further away to be able to read them (your phone, books and magazines, cooking instructions and so on).

The symptoms can worsen when you're tired or working in low light. You could also start having other age-related changes like being more sensitive to light and having trouble with glare.

Presbyopia treatment

It's not possible to prevent, slow or reverse presbyopia, but your vision can be corrected, so you don't struggle with near vision or suffer from eye strain or headaches. Your treatment will depend on whether you have any pre-existing refractive errors like near-sightedness or farsightedness, as well as presbyopia.

If you don't have any other refractive errors or vision problems, you can wear non-prescription reading glasses to correct your vision. These are widely available and reasonably priced. You'll wear these just for doing near vision activities rather than all day. If over the counter reading glasses aren't strong or accurate enough, you can get prescription reading glasses from opticians.

If you have another refractive error, you may be able to wear a combination of contact lenses and reading glasses. Alternatively, you can get prescription glasses to wear throughout the day:

Bifocals have a horizontal line separating your distance vision prescription from your near vision prescription below. The line can be seen on the glasses.

Trifocals are for close up, middle distance and distance vision. There are two horizontal lines visible on the lenses.

Multifocals are progressive lenses that give good vision at any distance without visible lines.

You can also opt for extras such as photochromatic lenses that help your eyes adjust to bright conditions.
There are a few options for wearing contact lenses with presbyopia:

Bifocal contact lenses allow you to see at distance and close up.

Multifocal contact lenses provide clear vision at any distance.

Monovision contact lenses involve wearing a lens for distance vision in one eye and another for near vision in the other eye.

Aspheric multifocal contact lenses can help correct presbyopia with astigmatism.
Refractive surgery to correct presbyopia differs from other types of laser eye surgery.

Monovision LASIK is one type of laser eye surgery used for presbyopia. The non-dominant presbyopic eye is treated because there is some loss of distance vision, so the other eye remains uncorrected to provide clear distance vision. The result is similar to wearing monovision contact lenses, and your eye doctor may suggest trying these first to find out whether it will suit you. Another option is a surgical technique called a multifocal lens implant.

Presbyopia surgery is not available on the NHS, so you'd need to pay for it privately.

Presbyopia diagnosis

Refractive errors, including presbyopia, can be diagnosed as part of a routine eye examination at high street opticians. Adults should have an eye test every two years. However, see your optician sooner if you notice any symptoms before your eye test is due.

The tests that happen during an eye examination include:

A visual acuity test in which you read the eye chart. If you already have prescription glasses or contact lenses, you'll wear them for this.
A refraction test. This involves wearing different strengths of lenses while looking at an eye chart. You'll say which lenses make the chart look clearer.
An astigmatism test to measure the curvature of the eye.
Checking your eye health with an ophthalmoscope (specialist torch) and slit lamp to examine the eye in more detail.

Prescriptions show the following numbers to explain any refractive errors:

Spherical – this explains whether you're nearsighted or farsighted and by how much. Positive numbers mean you're farsighted. Negative means you're nearsighted.
Cylinder – this measures any astigmatism in dioptres. A prescription of 1.5 or more generally means you'll need glasses or contact lenses to correct your vision.
Axis – this describes the location of astigmatism on the cornea.

What causes presbyopia?

Presbyopia is a normal part of ageing process in the eye. As the lens ages, it loses some elasticity, becoming thicker and more rigid. Because the lens helps the eye focus, this lack of flexibility prevents the lens from changing shape to focus on close objects.

Most people develop presbyopia after the age of 40, but premature presbyopia can occur. It's associated with other eye conditions, including diabetes, multiple sclerosis and cardiovascular disease.

When to get medical advice

The NHS recommends that everyone have an eye test at least every two years. Regular eye exams are an important part of eye care and can diagnose refractive errors and a range of eye conditions that can be treated to prevent vision loss.

If you wear prescription glasses or contact lenses, regular eye tests are still necessary to check your prescription is up to date and your vision as clear as possible. If you notice changes to your vision before you're due an eye test, see your optician as soon as possible, rather than waiting.

Living with presbyopia

Most middle-aged people are living with presbyopia, so rest assured you're not alone. As well as getting the right glasses, lenses or treatment to correct your vision, there are other ways to make the most of your vision as you age. Find out more about living with refractive errors like presbyopia.

Frequently asked questions

Medically reviewed by: The Royal College of Ophthalmologists on 18/10/2022

Edited by: Nick Astbury FRCS FRCOphth FRCP
Clinical Associate Professor
LSHTM

The Royal College of Ophthalmologists champions excellence in the practice of ophthalmology and is the only professional membership body for medically qualified ophthalmologists. The RCOphth is unable to offer direct advice to patients. If you’re concerned about the health of your eyes, you should seek medical advice from your GP, optometrist or ophthalmologist.

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Presbyopia

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