Presbyopia (Age-Related Long-Sightedness): Causes, Symptoms & Treatment

Presbyopia, presbyopia or presbyopia is the cause that most people have to buy reading glasses from about 45 years. Presbyopia is understood to be a normal defective vision, which is caused by getting older.

What is presbyopia (presbyopia of old age)?

Presbyopia does not count in the sense directly to a refractive error, such as farsightedness, nearsightedness or astigmatism, because it is not the result of a change in the pathological sense. Presbyopia is a natural consequence of the aging process of the eye, in which the lens of the eye loses elasticity. One person’s presbyopia will not be as bad as another’s, but everyone suffers from it at some point. The lens is no longer as able to adapt to objects that are close in front of the eye and thus see them sharply. This ability to adapt is also known as accommodation, and it decreases more and more after the age of 40.

Causes

The cause of presbyopia, simply put, is age. During the aging process, changes take place in the lens that make it difficult to focus. As the nucleus of the lens hardens, the lens capsule loses its elasticity. As a result, the lens is no longer as capable of curving during accommodation, which is necessary for sharp vision. Although this process of presbyopia develops in childhood, it does not become noticeable until between the ages of 40 and 50. Already from the age of 10 the lens begins to stiffen. The process is slow and must already have progressed to a certain extent for one to notice the first difficulties in reading.

Symptoms, complaints and signs

The first sign may be a gradual change in arm position when reading the newspaper in the morning. The newspaper reader may also focus more on the light conditions than before. The problem is the same: Recognizing sentences, words and numbers becomes more difficult for the viewer. These signs can also occur when reading a sell-by date in the supermarket or a menu in a restaurant. The perception of the early symptoms of presbyopia, also called presbyopia, is often ignored at first. The signs become clearer when other disturbing symptoms appear. It may be that reading is increasingly perceived as strenuous and tiring. An unpleasant, dull feeling of pressure can also develop in the area of the forehead and eyes during prolonged reading. Headaches of varying intensity and dizziness may even develop. These phenomena are intensified by the ongoing aging process. Perceptions at short distances are increasingly perceived as blurred and fuzzy due to the decreasing elasticity of the eye lens. Muscular tightening and clenching in the eye area also indicates possible presbyopia. Symptomatic of presbyopia is also when other people’s reading glasses are used on loan because the writing has allegedly become so small. If minor injuries occur unusually frequently during manual work, it may also be a case of age-related visual impairment. Signs of changes in near vision also arise when using screens.

Diagnosis and progression

Presbyopia is diagnosed by means of a vision test at the ophthalmologist‘s office, which is performed based on a noticeable deterioration in vision. A more specialized examination is usually not necessary when presbyopia is detected. The course is, as already mentioned, quite slowly progressive, so that the adaptability of the eye has decreased only in the 4th or 5th decade of life so that it becomes noticeable. From this point on, in principle, one must become a wearer of reading glasses.

Complications

Normally, presbyopia is a normal concomitant of aging, which can be compensated by wearing glasses for near vision or by eye lasers. Since with increasing age the near point moves further and further away from the eye, most people suffer from this form of ametropia from around the age of 40. Complications usually only occur if the defective vision is not compensated for by a suitable, individually adapted visual aid, for example reading glasses or glasses for the workplace.Without glasses, the eye muscles become strained and fatigue, headaches, and a dull feeling of pressure in the forehead or eyes may occur. In addition, vision may further deteriorate due to eyestrain. In addition, poor close-up vision can cause further problems when objects with which one must work can no longer be properly identified, increasing the risk of accidents in some occupations. In any case, if presbyopia is accompanied by a clouding of the lens, as in the case of cataracts, surgery must be performed and an artificial lens inserted.

When should you go to the doctor?

If there is a deterioration of vision in old age, the family doctor or ophthalmologist should be consulted. Problems reading magazines or labels indicate presbyopia, which is best clarified quickly. In most cases, wearing a visual aid and resting the eyes is sufficient to alleviate the condition. Older people are at particularly high risk of developing presbyopia. People who work a lot at a computer screen or come into contact with pollutants at work are also among the risk groups and should consult a doctor if vision problems occur. In addition to the ophthalmologist, an optometrist and, if necessary, a surgeon must be consulted. If the complaints become more severe, the visual aid must be adjusted. Surgical treatment of the condition is possible if vision is severely reduced or occurs in conjunction with external influences. Typical presbyopia is a normal age-related loss of function and can be corrected only to a limited extent.

Treatment and therapy

Schematic diagram showing the anatomy of the eye with myopia and after treatment. Click to enlarge. Presbyopia cannot be treated in the direct sense, but the defective vision can only be corrected by wearing reading glasses. The lens of the glasses is convex. How strong the glasses have to be depends on how old the wearer is and how far the reading distance is from the eye. The closer something should be in front of the eye, the more strength the glasses must have for presbyopia. In the case of an already existing defective vision, i.e. short-sightedness or long-sightedness, varifocals are suitable, with which close reading or work can be done at the same time in the case of presbyopia. Contact lenses can also be worn in case of presbyopia. Those who are already used to contact lenses due to other refractive errors can also choose progressive contact lenses for correction in case of preybyopia. If presbyopia is very pronounced in older people, it may be advisable to have eye surgery to replace the patient’s own lens with an artificial one. However, laser surgery unfortunately cannot correct presbyopia because the cornea is altered during surgery; the lens stiffens in presbyopia and thus cannot be treated with this method.

Prevention

Since presbyopia is the natural consequence of the aging process of human beings and thus of their eyes, it cannot be specifically prevented. However, an attempt can be made to delay presbyopia by training the eyes. The musculature, which is responsible for the accommodation of the eye, is strengthened for example by regular focusing in the distance and in the proximity. This exercise can be done several times a day, especially when outdoors. Sitting in front of the PC or the TV for long periods of time can negatively affect vision. However, it is not possible to determine for sure whether this can slow down presbyopia.

Follow-up

Presbyopia is not a medical condition in the true sense of the word. For this reason, follow-up care in the medical sense is not necessary. The development of presbyopia persists over a longer period of time, during which some signs of progression can be observed. These include, for example, increasing blurriness at close range. Initially in activities such as reading books, tablets, looking at the clock, later more distant activities such as reading the newspaper or working at the screen on the computer. If there is a deterioration there, it is advisable to turn to the local optician, who can remedy the situation with glasses specifically for your needs. But other signs can also indicate that presbyopia has worsened again. Headaches, dizziness and also nausea can indicate this.In principle, it is advisable to have the eyes checked every two to three years, from a certain age also in connection with a medical check-up. If one or more of the above-mentioned difficulties occur before then, it is advisable to consult an ophthalmologist or optometrist immediately. Properly adjusted and fitted reading, workplace or progressive glasses can significantly improve the quality of life.

What you can do yourself

Presbyopia is one of the natural developments of humans. It does not affect every aging person and the intensity is also individual, yet it should be understood as a normal part of the human development process. In the context of self-help, the attitude towards the natural changes of the organism should be checked and changed as soon as necessary. Otherwise, emotional stresses will occur, which will contribute to a deterioration of well-being and thus increase the risk of further diseases. The eyes should not be exposed to overload. Intense light exposure or looking into bright sunlight should be avoided. Wearing visual protection outdoors is advisable when exposed to sunlight. Optimized lighting conditions are necessary at all times of the day so that vision can be achieved without great effort. Work at screens should be interrupted at regular intervals. Breaks relieve the eyes and allow regeneration to take place. Strained or cramped vision should be avoided. If headaches occur as a result of the vision, an ophthalmologist should be consulted. The own behavior is to be optimized, so that the inner tension is reduced. Wearing glasses is advisable at the first age-related loss of vision. At regular intervals, the existing visual ability should be checked so that optimizations can be made as quickly as possible in the event of changes.