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For most people, presbyopia becomes apparent when they need to hold print at arm's length in order to read it. Many people who are already nearsighted temporarily manage the problem by reading without their glasses.

A basic eye exam can confirm presbyopia. You can correct the condition with nonprescription reading glasses or prescription eyeglasses or contact lenses. Surgery also may be an option.

Signs & Symptoms

• Find that print appears unclear at a normal reading distance
• Experience eyestrain or headaches from prolonged reading or close work

Causes

In order to "create" an image, your eye relies on two anatomical structures to focus the light reflected from objects: the cornea — a clear, dome-shaped surface on the front of your eye, and the lens — a clear structure about the size and shape of an M&M candy. Both of these structures bend (refract) light entering your eye to focus the image on the retina, the inside back wall of your eye.

The lens, unlike the cornea, is somewhat flexible and can change shape with the help of a circular muscle that surrounds it. When you're looking at something far away, the circular muscle relaxes. When you're looking at something nearby, the muscle constricts, allowing the relatively elastic lens to steepen its curvature and change its focusing power.

A number of changes occur in the eye as you grow older, but most experts agree that a hardening of your lens causes presbyopia. As your lens becomes less flexible, it can no longer change shape, and close-up images appear out of focus.

Screening & Diagnosis

Presbyopia is diagnosed by a basic eye exam. A complete eye examination involves a series of tests.  Each test is necessary and allows your doctor to examine a different aspect of your vision.

According to the American Academy of Ophthalmology, if you don't wear glasses or contacts, have no symptoms of eye trouble and are at a low risk of developing eye disease, you should have your eyes examined at the following intervals:

• At least once between ages 20 and 29
• At least twice between ages 30 and 39
• Every two to four years between ages 40 and 64
• Every one to two years beginning at age 65

However, if you wear glasses or contacts, have your eyes checked more often. And if you notice any problems with your vision, schedule an appointment with your eye doctor as soon as possible, even if you've recently had an eye exam. Blurred vision may suggest you need a prescription change or have another eye problem that may need evaluation and treatment.

Treatment

The goal of treatment is to compensate for the inability of your eyes to focus on nearby objects. Treatment options include wearing corrective lenses and undergoing refractive surgery.

Corrective lenses
If you had good, uncorrected vision before becoming presbyopic, you may be able to use nonprescription, over-the-counter reading glasses. But check with your eye doctor about what's right for you.

Reading glasses sold over-the-counter are labeled on a scale that corresponds to the degree of magnification (power). The least powerful are labeled +1.00, and the most powerful +3.00. When purchasing reading glasses, test a few different powers by holding printed material about 14 to 16 inches in front of your eyes, until you find the pair that allows you to read comfortably.

You'll need prescription lenses for presbyopia if over-the-counter glasses are inadequate or if you already wear corrective lenses for nearsightedness, farsightedness or astigmatism. Your choices include:

• Prescription reading glasses. If you have no other vision problems, you can have prescription lenses for reading only.
• Bifocals. These glasses come in two styles — those with a visible horizontal line and those without a line (progressive bifocals). Progressive bifocals change gradually from distance correction at eye level to reading correction at the bottom.
• Trifocals. These glasses have corrections for close work, middle-distance vision — such as computer screens — and distance vision. Trifocals can have visible lines or progressive lenses.
• Bifocal contacts. Bifocal contact lenses, like bifocal glasses, provide distance and close-up correction on each contact. The bottom, reading portion of the lens is weighted to keep the lens correctly positioned on your eye. These are frequently difficult to fit and often do not provide altogether satisfactory visual results.
• Monovision contacts. With monovision contacts, you wear a contact lens for distance vision in your dominant eye and a contact lens for close-up vision in your nondominant eye. Your dominant eye is generally the one you use when you're aiming a camera to take a picture.
• Modified monovision. With this option, you wear a bifocal contact lens in your nondominant eye and a contact lens set for distance in your dominant eye. You use both eyes for distance and one eye for reading.

Refractive surgery
Refractive surgery changes the shape of your cornea. For presbyopia, this treatment — equivalent to wearing monovision contact lenses — is used to improve close-up vision in the nondominant eye. The American Academy of Ophthalmology recommends that people try monovision contacts to determine if they can adjust to this kind of correction before considering refractive surgery.

Most refractive surgical procedures were developed to correct nearsightedness, farsightedness and astigmatism. Few studies have been published about the long-term effectiveness of monovision refractive surgery for people with presbyopia. Eventually, many people who have had refractive surgery will still need corrective lenses for reading.

Refractive surgical procedures include the following:

Laser-assisted in-situ keratomileusis (LASIK). With this procedure, your eye surgeon uses an instrument called a keratome to make a thin, hinged flap in your cornea. Your surgeon then uses an excimer laser to remove inner layers of your cornea to steepen its domed shape. An excimer laser differs from other lasers in that it doesn't produce heat.

Photorefractive keratectomy (PRK). This procedure is similar to LASEK, except the surgeon removes the epithelium. It will grow back naturally, conforming to your cornea's new shape.

Call Eyes Over Texas Eye Care Center at 281-398-0747 to schedule your consultation today or use our convenient online appointment/consultation request form.