What Is Presbyopia?

Medically Reviewed by Jabeen Begum, MD on December 12, 2023
6 min read

Presbyopia is a decline in your vision when your eyes lose the ability to focus on things close to you. In spite of the big name, it isn't a disease. It's a natural part of the aging process, and it's easy to correct.

Presbyopia vs. hyperopia

Presbyopia is often confused with hyperopia (or hypermetropia), more commonly known as farsightedness. Your vision is farsighted when the shape of your eyeball causes light rays to focus incorrectly (behind the retina vs. on the retina) once they have entered your eye. Your retina, located at the back of your eyeball, helps images reach your brain via the optic nerve. In presbyopia and hyperopia, far away objects may be clear, but those near you look blurry.

Presbyopia vs. myopia

Myopia, or nearsightedness, means that nearby objects appear clear to you, but things farther away seem blurry. In this case, your eye shape causes light rays to bend inaccurately, focusing light in front of your retina vs. on your retina.

While presbyopia usually begins when you're older, around your 40s-60s, being farsighted or nearsighted can develop during childhood and run in your family.

You may have presbyopia if you notice:

  • You need to hold reading material at arm's length
  • Your vision becomes blurry at a normal reading distance
  • Headaches or fatigue when working on things close to you

In each eye, you have a cornea and lens that help your eyes see by focusing light on your retina. When objects are close or far from you, your lens will flex to change your focusing power. But your eye's lens hardens as you age, causing presbyopia.

As the lens in your eye gets less flexible over time, it's harder for you to shift your focus on close-up objects, and they'll seem blurry to you.

Risk factors for presbyopia include:

  • Your age. Most people will develop presbyopia as some point, usually between the ages of 40 and 65.
  • Certain medical conditions. You may develop presbyopia at a younger age, also known as premature presbyopia, if you're dealing with heart disease, diabetes, or multiple sclerosis.
  • Being farsighted. If you're already experiencing farsightedness, you may develop presbyopia symptoms sooner.
  • Medications you take. Some drugs can cause presbyopia to start. Examples include antihistamines, antidepressants, and diuretics.

Your eye doctor can diagnose presbyopia with an eye exam. They may have you undergo two tests:

  1. Refraction assessment: Your doctor will have you look through lenses and assess how well you see objects near and far away. They'll determine if you have presbyopia, or another condition like hyperopia, myopia, or astigmatism, where your vision is blurry at any distance.
  2. Eye health exam: Your doctor will dilate the pupils of your eyes, making it easier for them to examine the inside of your eyes.

There's no cure for presbyopia, but there are a lot of ways to improve it.

Presbyopia glasses

  • Reading glasses/Readers: Yes, those cheap glasses you see at the drugstore can often do the trick because they magnify, or enlarge, what you're viewing. Pick the weakest pair that lets you see what you need to read.
  • Bifocals: They work for many people. If you have prescription glasses already, this might be the option for you. They're eyeglasses with two different prescriptions in one lens. The top part corrects for distance vision. The lower section helps you see objects up close.
  • Trifocals: They have three different prescriptions in the lens that will help you see close-up, far away, and an intermediate distance. 
  • Progressive lenses: These are similar to bifocals, but there's a gradual or blended transition between the two prescriptions instead of separate sections.

Presbyopia contacts

Contact lenses can also treat presbyopia. You might try:

  • Multifocal lenses: They come in soft or gas-permeable versions.
  • Monovision lenses: One lens helps you see objects at a distance. The other is for close-up vision.

Presbyopia eye drops

Pilocarpine eye drops (Vuity) are available by prescription to help treat presbyopia. The drops work by making your pupil smaller, improving your focus on objects nearby. There are some side effects, like headache, that can occur. While using this treatment, there's also a risk of retinal detachment or retinal tears, so it's important to let your doctor know if you have sudden changes in vision like flashes of light or floating spots in your eyes.

Presbyopia surgery

Laser surgery for presbyopia involves correcting one eye for distance vision and the other eye for near vision. Three options include:

  • Laser-assisted in situ keratomileusis (LASIK): LASIK surgery improves your eyesight by changing the shape of your cornea, the outermost layer of your eye. Light can more easily reach your eye's retina going forward. You can have this surgery if you have astigmatism or are nearsighted or farsighted.
  • Photorefractive keratectomy (PRK): It also changes the shape of your cornea to improve your vision. Compared with LASIK, the PRK method doesn't involve cutting into your cornea, and it aims the laser on the surface of the cornea. PRK surgery can help astigmatism, nearsightedness, and farsightedness. It's recommended if you have thin corneas or dry eyes or are very active. PRK has a longer recovery time than LASIK, however.
  • Small-incision lenticule extraction (SMILE): A SMILE surgery uses a laser to remove a portion of your cornea shaped like a disc called a lenticule. Changing the shape of your cornea with this method can improve your vision. You may have this surgery if you have astigmatism or are nearsighted.

Presbyopia lens implants

An intraocular lens (IOL) is an artificial lens for your eye. There are three presbyopia-correcting IOLs that can improve your focusing power. Your eye surgeon can determine which type you'll need:

  • Multifocal IOLs, which provide both near and distance focus, enabling your brain to select the right one needed
  • Accommodative IOLs, which change shape much like your natural eye lens to focus on objects at different distances
  • Extended depth-of-focus lenses, which are similar to multifocal lenses. Here, there's one corrective zone vs. multiple, but it still helps you see both near and far away.

Presbyopia corneal inlays

Intracorneal inlays are minimally invasive implants that help improve presbyopia, but they're not as popular as other surgery treatments like LASIK. Your doctor will surgically place the implant in one eye. It typically works if you have presbyopia but haven't had cataract surgery. The availability and cost of corneal inlays has been a barrier to usage in the U.S., however.

In 2015, the KAMRA Inlay was the first FDA-approved corneal implant in the U.S. As of 2022, KAMRA is no longer produced, but there's still support from the manufacturer, CorneaGen, if you've had the implant.

Corneal inlay products are still available, and others are being designed and tested. Presbia Flexivue Microlens is undergoing FDA trials. Another type, Raindrop Near Vision Inlay, received FDA approval in 2016. It was recalled in 2018 due to corneal haze issues, which causes the cornea to be cloudy and affects your vision.

Other treatments continue to be researched to help presbyopia. Ask your eye doctor about options for your presbyopia and what's best for you.

It's hard to truly prevent presbyopia because it's part of the natural aging process. Still, you can work to take care of your eyes at any age by doing the following:

  • Get regular eye exams. Talk to your doctor about how often you need a checkup based on your current vision and age.
  • Use glasses or contact lenses with the correct prescription. If you need them, keep your contacts and glasses current so you're not straining your eyes doing regular activities.
  • Protect your eyes when in the sun. Wear sunglasses that block ultraviolet radiation when you go outside for long periods.
  • Still, let the light in. Good indoor lighting can help you avoid eye strain.
  • Keep up with treatment of other conditions. If you have high blood pressure, diabetes, or other conditions, your vision may be affected.
  • Avoid eye injuries. Wear protective eyewear appropriate for your job, sport, or other activities where your eyes could be hurt or exposed to toxic fumes, dust, or other irritants.
  • Eat healthy. You may have heard that carrots are good for your eyes; they are because they contain beta-carotene, which your body converts into vitamin A. Vitamin A is a nutrient that supports eye health, and it can be found in a variety of fruits and vegetables. Foods with antioxidants also benefit your eyes—try leafy greens like spinach or kale.