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Presbyopia Treatment

Warsaw · Krakow · Vienna · Zurich

Vision is one of the most important senses, yet its efficiency naturally decreases with age. After the age of 40, many people begin to notice difficulties with reading up close, using smartphones, or working at a computer. This does not necessarily indicate a new vision defect—it is often presbyopia, a natural process associated with the aging of the eye. The good news is that this problem can be effectively corrected—with glasses, contact lenses, as well as modern laser methods or lens implants.

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What is presbyopia?

Meanwhile, human vision naturally deteriorates after the age of 40, and this has nothing to do with potential defects such as myopia, hyperopia (farsightedness), or astigmatism. Moreover, it also occurs in individuals who have never been diagnosed with any vision defect.

Presbyopia is associated with the progressive stiffening of the lens and the weakening ability of the eye to accommodate (the accommodative muscles become increasingly weak). These changes cannot be prevented—they result from the natural wear of our body. Even the healthiest lifestyle will not prevent them from occurring.

It is worth noting that certain diseases, such as diabetes, or the use of antihistamines or antidepressants, may accelerate the development of presbyopia.

It is estimated that by 2020, the number of people dealing with presbyopia worldwide will reach approximately 1.3 billion. This is a problem that is easy to diagnose and possible to correct. It is therefore advisable to seek the help of a specialist.

“Arms too short”—the farsighted person reads the newspaper

The first symptoms of presbyopia are impossible not to feel: accommodation disturbances are experienced as significant discomfort. This initial stage of lens stiffening occurs abruptly, and at a certain point the process slows down and progresses less rapidly.

Every two to three years, there is a loss of visual acuity of a quarter or half a diopter of near correction. We then joke that our arms are too short for reading—meaning we are unable to move the text far enough from the eye to see it clearly—and we refer to ourselves as farsighted.

But in reality, “ordinary” hyperopia may not be involved at all, or it is not the only factor. This is evolving presbyopia, also referred to as age-related farsightedness.

Symptoms of presbyopia

  • inability to read text up close—the smaller the letters, the greater the difficulty (text messages, footnotes in books, restaurant menus, text on a computer monitor)
  • headache and eye fatigue when looking up close
  • difficulties with visual accommodation during the so-called “gray hour” (when dusk falls or just after)

It is important to be aware that after the age of 35, our vision, regardless of previously diagnosed defects, begins to deteriorate. Presbyopia is most often diagnosed after the age of 40, with its greatest intensity occurring between the ages of 40 and 55.

Around the age of 60 (some believe between 65 and 70), this process comes to a halt.

How to check if it is the beginning of presbyopia?

Focus on reading text up close, then quickly look into the distance—for example, at a window, painting, or television. If shifting your gaze to distance vision takes several seconds (until you see a sharp image again), you should consult an ophthalmologist.

Presbyopia is easily corrected with glasses, but if you lead an active lifestyle, it is worth seeking other solutions as well.

Presbyopia correction

Reading glasses

If symptoms of presbyopia appeared in a person with a diagnosed vision defect, until recently they had to obtain two pairs of glasses—one appropriate for their defect and another for reading.

Later, bifocal glasses appeared, in which two powers are built in—in the main area (when looking straight ahead) the power for distance vision, and in its lower segment—a higher power to facilitate reading. However, the transition from one area to another is very unnatural for the eye, occurring abruptly, and not every patient was able to get used to wearing bifocal glasses. Therefore, progressive glasses were created. With progressive glasses, the change in corrective value on the lens surface occurs not abruptly, but smoothly. The upper part of the corrective lens is used for seeing distant objects, and lower down its power increases in such a way as to see intermediate distances clearly (from a few meters to several dozen centimeters). The lower area is used for reading and looking at distances below half a meter. Progressive glasses can also have lenses that correct other vision defects.

Presbyopia correction

Two pairs, bifocal lenses, and progressive lenses

If symptoms of presbyopia appeared in a person with diagnosed myopia, until recently they had to obtain two pairs of glasses—one appropriate for their vision defect and another for reading. Later, bifocal lenses appeared, in which two powers are built in—in the main area (when looking straight ahead) the power for distance vision, and in its lower segment—a higher power to facilitate reading.

However, the transition from one area to another is very unnatural for the eye, occurring abruptly, and not every patient was able to get used to wearing bifocal glasses. Therefore, progressive lenses were created.

With progressive lenses, the change in corrective value on the lens surface occurs not abruptly, but smoothly. The upper part of the lens is used for seeing distant objects, and lower down its power increases in such a way as to see intermediate distances clearly (from a few meters to several dozen centimeters).

The lower area is used for reading and looking at distances below half a meter. Progressive glasses can have lenses with vision defect correction.

Presbyopia correction

Contact lenses

Multifocal lenses are very effective in presbyopia correction. They are multifocal, enabling vision both at distance and up close. Multifocal lenses look the same as other contact lenses, but are designed to enable vision regardless of distance. The center of the lens has different light refraction than the periphery, which allows clear perception of objects located at most distances.

However, it is worth knowing that the adaptation period for comfortable wearing of multifocal contact lenses can be quite long, and in the case of individuals with anisometropia (a different defect in each eye), adaptation may not only be significantly more difficult, but often even impossible, and will require trial and error.

Presbyopia correction

Monovision

Monovision can be performed in various ways: with contact lenses, through correction with an ophthalmic laser, or with intraocular lens implants.

Monovision is a vision correction method used to eliminate the effects of presbyopia, which involves subjecting each eye to different correction in order to prepare one eye for distance vision and the other for near vision.

In short: one myopic and one hyperopic eye are artificially created.

Laser correction

Laser vision correction for presbyopia

Depending on whether presbyopia is the only eye dysfunction or is accompanied by vision defects, the patient has the following laser correction methods to choose from:

LASIK

(laser assisted in situ keratomileusis): a two-stage technique; the cornea is incised using a scalpel (microkeratome), and then the inner surface of the cornea is reshaped so that it can properly focus the image on the retina.

Femto-LASIK

(All-Laser-LASIK): Using a precise femtosecond laser, the surgeon makes an incision in the cornea, creating a thin flap 0.1 mm thick. An excimer laser is used to reshape the previously exposed cornea for a few seconds, then the flap is closed again; it adheres and forms a protective corneal barrier. This method allows for multifocal correction and monovision.

LENS REPLACEMENT

Also called refractive lens exchange, it can be performed using various individually tailored lenses. In the treatment of presbyopia, the following are used:

  • Latest-generation multifocal lenses (trifocal lenses, EDOF, for near and distance vision as well as the intermediate range);
  • Monofocal lenses (also known as “enhancing lenses,” often used in cataract surgery);
  • Toric lenses (for astigmatism correction);
  • Toric trifocal lenses (correct presbyopia and astigmatism);
  • PHAKIC lenses implanted in addition to the natural lens.

Presbyopia treatment—step by step

Before the procedure—preliminary examinations

At the beginning of the first visit, we conduct a comprehensive medical history. We record not only previous illnesses, surgeries performed, and medications taken by the patient, but also explain what is particularly troublesome in the case of presbyopia and what correction methods are available. We provide comprehensive information on various presbyopia correction options.

Complete eye examination

We then thoroughly examine the eyes. We determine the exact visual acuity and the exact degree of presbyopia. We examine the retina and measure intraocular pressure. These examinations serve to determine whether other eye diseases are also present. In the next step, we measure the eye and perform optical biometry, considered the most precise method for measuring axial length and partial segments of the eyeball. We also record corneal curvature—this is done completely non-contact using a laser that measures along the eye axis. This method is fully safe and eliminates measurement errors that occur with ultrasound measurement.

Corneal examination

In order to achieve optimal presbyopia correction, a detailed corneal map is created. Using corneal tomography, the anterior and posterior walls and their thickness are precisely measured. This examination serves to determine all anatomical properties of the cornea. Based on such a “map,” the refractive power of the eye is determined, which plays a very important role during the correction procedure.

We additionally offer another painless examination of the anterior corneal surface—optical coherence tomography of the anterior segment of the eye. The examination is non-contact and can be compared to ultrasound examination, except that laser light is used instead of sound.

Wavefront examination

A wavefront examination is then performed. A light beam is sent to the eye, focused precisely on the retina. From this point, a wavefront of light spreads through the lens and cornea. Using this method, it is possible to precisely determine where laser treatment is required to optimize visual acuity.

Important for the preliminary examination

Soft contact lenses should not be worn for one week, and hard contact lenses for three weeks before the examination.
During the examination, eye drops are used to dilate the pupils. This causes increased sensitivity to light, so you should not drive vehicles or operate machinery for two to three hours after the examination.

Scheduling an appointment

After the preliminary examination, we discuss whether ophthalmic laser surgery is appropriate in the given case. The patient is informed about the course of the procedure, risks and side effects, and further treatment.

If the patient decides on presbyopia correction, we schedule an appointment that is ideally suited to them. Contact lenses can be worn again up to two days before the procedure.

Day of the procedure

On the day of the procedure, you should arrive with an accompanying person. On this day, no creams, powders, makeup, mascara, aftershave, or other substances applied to the face should be used. This is important for preventing eye infections. You may eat and drink normally. Final questions are clarified. Patients also receive medications and instructions for their use after the procedure. Before we begin, we schedule a follow-up visit for the next morning. The procedure itself is very quick—it takes only 10-20 minutes and causes no pain.

After the procedure

After the eye correction is performed, the patient receives protective glasses and can go home with the accompanying person. Symptoms such as watery eyes, slight burning, or a foreign body sensation may occur. On this day, the eyes should be closed as much as possible (except for, e.g., going to the toilet or eating). Watching television, reading, working on a computer, using smartphones, etc., should be avoided. The eyelids compress the cornea, which accelerates its healing. To prevent boredom, you can listen to an audiobook or music. Otherwise, rest should be maintained.

Protective glasses should also be worn at night to prevent accidental injury to the eye. Rubbing and pressing the eyes should be avoided in the first days after the procedure. After laser surgery, makeup should be avoided for two weeks to prevent eye infection. After lens replacement, the “makeup ban” applies for four weeks. For two weeks, you should not take baths, go to spas or saunas, or take showers with your face directly in the water stream. For two weeks, you should also avoid drafts, smoky, windy, and dusty rooms. This also applies to physical exertion.

Patients receive from us an eye drop schedule and two types of drops (drops with cortisone and antibiotic). The schedule indicates when and with which medications the eyes should be treated.

The day after the procedure, you should come for the next scheduled visit. Usually on this day, patients have no complaints and regain approximately 90% of their vision. The next examination is scheduled for the following month.

Summary

Several methods of permanent presbyopia correction are available. All procedures can be performed on an outpatient basis and are completely painless for the patient.

Monovision is a method suitable for older individuals who manage well with one eye for distance vision and one for near vision (a simulation using contact lenses is performed before the procedure).
Lens replacement is needed if laser correction is not an option, the patient is over 50 years old, and their natural lens is already slightly clouded (early cataract).

In refractive lens exchange, the natural lens is removed using computer-controlled ultrasound and replaced with an appropriate artificial lens.

At SwissLaser, we use the most advanced multifocal lenses (trifocal lenses), which allow for good near and distance vision and excellently cover the area between near and distance vision (intermediate range).

Just a few days after the procedure, the patient regains good vision and no longer needs to wear glasses.

If residual vision defects remain after lens replacement, they can usually be corrected with laser correction.