For Patients: Presbyopia I: Introduction

Remember that moment you first couldn’t see something close up?

It probably happened suddenly. Maybe you were reading a map in a car at night, or trying to read a text in dim light. Suddenly, it was there. And since that day, your near vision has never been the same. Focusing seems to occur more slowly. You are aware of eye strain. You keep readers around the house or use bifocals.

Presbyopia- the loss of accommodation (refocusing) to near vision that occurs as we get older- does not strike suddenly, no matter what our impressions might be. Loss of accommodation is an extremely slow process that begins early in childhood, but only becomes noticeable when we are in our 40’s or beyond. Believe it or not, a 20 year old cannot accommodate as well as a 10 year old can!

Think of presbyopia as a hardening of the human lens that prevents it from refocusing from distance to near. The mechanisms of presbyopia will be explored in more detail at another time, but this is a good start.

You may be experiencing presbyopia even if your near vision is fine. Presbyopia can look like a different problem, such as headache. It can present as a feeling, such as eyestrain.

We are most sensitive to presbyopia when reading numbers, letters, or music. We can do most other things close up without difficulty, such as cleaning dishes, cutting vegetables, or talking to a friend. At 56, I need reading glasses to type this blog. However I do not need reading glasses to mix and drink my coffee or choose which key will open my house.

Some people don’t want to get readers out of a fear that they will become dependent, or that having readers will further reduce the ability of the eye to accommodate. The fact is that presbyopia is hardwired into the aging process, and you cannot delay or prevent it by forcing your eyes to accommodate without help. Wearing a weak pair of readers may really make you more comfortable. It makes sense just like wearing galoshes in the rain.

You can do a few things to make presbyopia less noticeable, such as changing the font size on your computer and your cell phone. Larger letters are easier to read, and are still legible even when held further away from you. Increasing light helps, too, for reasons that will be explored later.

In summary, the slow march of presbyopia begins in childhood. It usually becomes apparent in our 40’s. It is typically noticed when performing challenging tasks at near in dim light, but can also present with headaches and eyestrain. The symptoms of presbyopia can be reduced by turning up the light and using larger font sizes on your computer or cell phone. Reading glasses or bifocals can reduce your symptoms quite a bit and will not make your presbyopia worse.