Presbyopia: Everything You Need to Know

25 April, 2021
This article has been written and endorsed by el médico Diego Pereira
Its prevalence is high, and it's usually accompanied by difficulties in daily activities. Fortunately, there are several treatments available.

Presbyopia is a common condition characterized by difficulties in reading or seeing nearby objects. This is produced by the natural deterioration of some tissues inside the eyes.

Although its appearance can’t be avoided, there are some measures that can be taken to delay when it starts to occur.

If you’re interested in knowing a little more about this condition, we’ve prepared a short article to tell you about its most salient aspects. Keep reading!

Why does presbyopia occur?

Presbyopia in an eye.
The visual system is complex, despite its size. The lens is of fundamental importance for its proper functioning.

Like many other diseases, presbyopia is a consequence of age. To understand how it happens a little better, we need to have a look at some basic aspects of the anatomy and the physiology of the visual system.

Inside the eyeball, there’s a flexible structure called the lens. This is responsible for focusing on nearby objects – reading the small print in a book for example. The process by which the lens flexes and focuses on objects is called accommodation.

For this to be carried out properly, we need the action of the ciliary muscle. From the age of 40, both the muscle fibers and the lens progressively deteriorate. This leads to difficulties in accommodation that are expressed as impaired visual acuity.

Risk factors

The risk of presbyopia increases considerably with advancing age. However, there are some situations that can favor its appearance prematurely. These are chronic diseases and the use of drugs or chemicals.

According to this research article (2019) the diseases that could be related to this are gastritis, anemia and diabetes mellitus. The same happens with certain habits such as smoking, alcoholism, and prolonged exposure to sunlight or cellphone screens.

The results of this study were collected from a considerable sample (494 participants) but not very representative. For this reason, until now, the relationship between these factors and the appearance of premature presbyopia hasn’t been proven.

Symptoms of presbyopia

Difficulty viewing objects and reading at a close distance is the most important clinical manifestation of presbyopia. However, as this occurs progressively, it can be difficult for patients to become aware of the symptoms.

Some indirect “signs” that could indicate presbyopia are:

  • Frequent headaches when reading a book or newspaper
  • Needing to bring objects closer to the face to better visualize them
  • Frown and close your eyes a little to read distant texts
  • Tiredness during prolonged reading

Although the presence of these alterations may suggest the diagnosis of presbyopia, it’s advisable to see an ophthalmologist to confirm the diagnosis.

How is it different from other diseases that affect eyesight?

There are other very common diseases that are capable of progressively affecting visual acuity. These can become confused and treated as if they were presbyopia when in reality they require a different approach.

Among these, we find refractive problems. This last term refers to a physical phenomenon that occurs within the eyeball and that allows the adequate projection of images on the retina. Here we find the following:

  • Myopia: Difficulty seeing distant objects
  • Farsightedness: Blurred vision up close.
  • Astigmatism: Vision problems with both near and far objects.

These three conditions can be accompanied by double vision (diplopia). In fact, this last symptom is also characteristic of neurological problems such as paralysis of some cranial nerves.

Diagnosis of presbyopia

The ophthalmologist relies on clinical findings to make a presumptive diagnosis of the disease. They’ll then proceed to do a basic eye exam to determine the presence of presbyopia and other refractive problems.

This may include the use of special charts to determine visual acuity (such as the Snellen chart) and some equipment such as a phoropter.

Treatment

Presbyopia should be treated by an ophthalmologist.
Presbyopia cases should always be treated by an ophthalmologist.

There are multiple therapeutic modalities for this condition, although not all of them completely resolve the condition.

Despite the fact that certain interventions are carried out, with advancing age the symptoms could reappear. For this reason, routine evaluations with an ophthalmologist are recommended.

Non-surgical

Wearing glasses or lenses is the most common option for treating presbyopia. They have the advantage of being inexpensive, reversible and generally comfortable. However, some people tend to reject them for cosmetic reasons, or discomfort related to their maintenance.

There are a large number of models available, although not all are effective for every patient. The choice of the ideal lens depends on the deterioration of visual acuity, something that can be determined by an eye doctor.

There are several types of glasses, such as bifocals or trifocals. Your choice will also depend on whether or not there are associated diseases, such as any of the aforementioned refractive errors.

Surgical

The most widely used surgical procedures for the treatment of presbyopia are refractive surgeries. There are several types, depending on the particular characteristics of each patient. One of them is conductive keratoplasty, in which the anatomy of the cornea is altered to improve near vision.

There are also procedures that use a laser to achieve optimal results, such as laser-assisted in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK).

How to prevent presbyopia?

The weakening of the lens and the ciliary muscle is inevitable with advancing age. However, it’s possible to delay the onset of presbyopia symptoms. To do this, it’s important to control the chronic diseases that we mentioned before, especially diabetes mellitus.

There are also basic recommendations to improve eye health, such as reading with good lighting and wearing protective glasses when performing high-risk occupational activities.

Taking care of your health

Going to the ophthalmologist early on is a good way to deal with presbyopia. The frequency of visits depends on age, although it’s generally advisable to go every 2-4 years from the age of 40, according to a publication from the Mayo Clinic.

The aforementioned recommendations can be extended to several aspects of health. A balanced diet, exercising regularly, and avoiding cardiovascular risk factors are fundamental pillars to maintain adequate visual health.

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