Skip to main content

Between Church and Wellington on Queen St.

Between Church and Wellington on Queen St.

various_colorful_sunglasses_row_1280x480
Home »

presbyopia

Presbyopia Diagnosis and Treatment

As we reach middle age, particularly after age 40, it is common to start to experience difficulty with reading and performing other tasks that require near vision. This is because with age, the lens of our eye becomes increasingly inflexible, making it harder to focus on close objects. This condition is called presbyopia and eventually it happens to everyone who reaches old age to some extent.

To avoid eyestrain, people with untreated presbyopia tend to hold books, magazines, newspapers, and menus at arm's length in order to focus properly. Trying to performing tasks at close range can sometimes cause headaches, eye strain or fatigue in individuals who have developed this condition.

Causes of Presbyopia

During our youth, the lens of our eye and the muscles that control it are flexible and soft, allowing us to focus on close objects and shift focus from close to distant objects without difficulty.  As the eye ages however, both the lens and the muscle fibers begin to harden, making near vision a greater challenge.

Presbyopia is a natural result of the aging process and not much can be done to prevent it.  Its onset has nothing to do with whether you already have another vision impairment such as nearsightedness, farsightedness or astigmatism.  Everyone will notice some degree of loss of near vision focusing power as they age, although for some it will be more significant than others.

Symptoms and Signs of Presbyopia

Presbyopia is characterized by:

  • Difficulty focusing on small print
  • Blurred near vision
  • Experiencing eyestrain, fatigue or headaches when doing close work or reading
  • Needing to hold reading material or small objects at a distance to focus properly
  • Requiring brighter lighting when focusing on near objects

Presbyopia can be diagnosed in a comprehensive eye exam.

Treatment for Presbyopia

There are a number of options available for treating presbyopia including corrective eyewear, contact lenses or surgery.

Eyeglasses

Reading glasses or “readers” are basically magnifying glasses that are worn when reading or doing close work that allow you focus on close objects.

Eyeglasses with bifocal or multifocal lenses such as progressive addition lenses or PALs are a common solution for those with presbyopia that also have refractive error (nearsightedness, farsightedness or astigmatism). Bifocals have lenses with two lens prescriptions; one area (usually the upper portion) for distance vision and the second area for near vision. Progressive addition lenses or PALs similarly provide lens power for both near and distance vision but rather than being divided into two hemispheres, they are made with a gradual transition of lens powers for viewing at different distances.  Many individuals prefer PALs because unlike bifocals, they do not have a visible division line on the lens.

Bifocal and Multifocal Contact Lenses

For individuals that prefer contact lenses to glasses, bifocal and multifocal lenses are also available in contact lenses in both soft and Rigid Gas Permeable (RGP) varieties.

Multifocal contact lenses give you added freedom over glasses and they allow you to be able to view any direction - up, down and to the sides - with similar vision. People wearing progressive lenses in glasses on the other hand have to look over their glasses if they want to view upwards or into the distance.

Another option for those that prefer contact lenses is monovision. Monovision splits your distance and near vision between your eyes, using your dominant eye for distance vision and your non-dominant  eye for near vision. Typically you will use single vision lenses in each eye however sometimes the dominant eye will use a single vision lens while a multifocal lens will be used in the other eye for intermediate and near vision. This is called modified monovision.  Your St. Marys eye doctor will perform a test to determine which type of lens is best suited for each eye and optimal vision.

Surgery

There are surgical procedures also available for treatment of presbyhopia including monovision LASIK eye surgery, conductive keratoplasty (CK), corneal inlays or onlays or a refractive lens exchange (RLE) which replaces the hardened lens in the eye with an intraocular lens (IOL) similar to cataract surgery.

Since it affects so much of the older population, much researc and development is going into   creating more and better options for presbyopes.  Speak to your eye doctor about the options that will work best for you.

Bifocal and Multifocal Contact Lenses

If you are over 40 and have difficulty seeing close up, you probably have a common age-related condition called presbyopia which is when the eye’s natural lens loses the ability to focus on close objects. Presbyopia is a natural process as the eye ages and affects the majority of people from age 40 and upward. Individuals with presbyopia are often familiar with the need to hold reading materials such as newspapers an arm’s length away from their eyes in order to see clearly, yet reading glasses with bifocal or multifocal (progressive) lenses can help.

Fortunately for those who don’t like the look, feel or inconvenience of reading glasses, there is another option. Bifocal and multifocal lenses are also available in contact lenses in both soft and Rigid Gas Permeable (RGP) varieties.

Multifocal contact lenses give you added freedom over glasses and they allow you to be able to view any direction – up, down and to the sides – with similar vision. People wearing progressive lenses in glasses on the other hand have to look over their glasses if they want to view upwards or into the distance.

The Difference Between Bifocal and Multifocal Lenses

Just as the name indicates, bifocal lenses are divided into two distinct segments for different vision powers, the first for distance vision and the second for near vision. This enables you to clearly switch your focus from near to far as needed, but your vision will not necessarily be clear in between. The term multifocal lenses can refer to any lenses with multiple powers including bifocals, trifocals or progressive lenses. Non-bifocal multifocal lenses have a range of powers that enable you to constantly adjust your focus to see clearly from up close to far and in between.

Multifocal contact lenses are generally designed in one of two ways, as either simultaneous vision lenses or alternating vision lenses.

Simultaneous vision lenses

The most popular version of multifocal contact lenses, simultaneous vision lenses present the distance and near vision zones of the lens at the same time. Typically after a short adjustment period your eyes learn to utilize the segment of the lens that they need to focus on the desired object and essentially ignore the other.

They come in two designs:

  • Concentric ring design: In the most basic form these are bifocal lenses that are comprised of a central circular area of one power with a ring around of the alternate power, similar to a bulls-eye. In this design the power of the rings (either near or distance vision is interchangeable). For intermediate viewing (18-24 inches away) extra rings can be added to create a trifocal or multifocal lens. The width of each ring is variable depending on the power that is needed most and the edges of the rings can be blended for a smooth transition of focus, similar to progressive eyeglass lenses.
  • Aspheric design: These multifocal lenses attempt to provide a natural vision experience by blending many lens powers across the surface and center of the lens. In this design both distance and near vision power are located in the central visual area and your eyes will adapt to focus on the area needed to view what you are looking at.

Translating or Alternating Vision lenses

Similar to bifocal eyeglass lenses, these contacts are divided into distinct areas or zones and your pupil will move to the desired zone depending on your vision needs. Typically the top of the lens, which is what you look through when looking straight ahead is for distance vision and the bottom area (what you look through when you look down) is for near vision. However, this can be reversed according to unique vision needs.

Since contact lenses sometimes move within your eye, translating lenses are held in place by a ballast which is an area that is thicker than the rest of the lens or by truncating or flattening the bottom to stay in line by the lower lid. These lenses are only available in rigid gas permeable lens material.

An Alternative Option to Multifocal Contact Lenses: Monovision

Monovision is another contact lens alternative for presbyopia particularly if you are having

difficulty adapting to multifocal lenses. Monovision splits your distance and near vision between your eyes, using your dominant eye for distance vision and your non-dominant eye for near vision.

Typically you will use single vision lenses in each eye however sometimes the dominant eye will use a single vision lens while a multifocal lens will be used in the other eye for intermediate and near vision. This is called modified monovision. Our eye doctor in St. Marys, ON will perform a test to determine which type of lens is best suited for each eye and optimal vision.

Are Contact Lenses Right for You?

If you have presbyopia, contact lenses may be a great option for you. Many people prefer the look and convenience of contact lenses over traditional reading glasses. Speak to our St. Marys, ON eye doctor about the options available to you.

Click HERE to learn more.

Image of exam room and text