What Adults Over 40 Should Know About Presbyopia

As we age, we may undergo natural changes, and our vision is no exception. One common age-related vision change is presbyopia. 

According to the Singapore National Eye Centre (SNEC), age is one of the main causes of presbyopia, and it could start around one’s late 30s. This condition affects the eye's ability to focus on close objects, making tasks like reading small print more difficult. As a result, you might find yourself squinting at restaurant menus or holding your phone farther away to read messages. These could be early signs of presbyopia, indicating the need for corrective measures.

What is Presbyopia?

Presbyopia is the gradual loss of the eye's ability to focus on nearby objects. This happens as the eye's lens, responsible for focusing light onto the retina, becomes less flexible with age. This loss of flexibility, which is what causes the lens’ inability to change shape and accommodate near vision, may lead to blurred vision when looking at things up close.

It's important to note, however, that lens hardening is a normal part of the ageing process, typically beginning in the early 40s. 

Symptoms of Presbyopia

The signs of presbyopia often develop gradually and may include:

• Difficulty reading small print, even in good lighting
• Needing to hold reading material farther away to see clearly
• Eye strain or fatigue after close work
• Headaches or blurred vision after prolonged near tasks

If you experience these symptoms, scheduling an eye test in Singapore is essential to rule out other potential causes, and understanding your condition is important.

Diagnosis and Eye Exams

Having your eyes checked regularly is important for early detection and management of presbyopia. During a presbyopia screening at an eye care centre, the optometrist will:

• Review your medical and vision history
• Assess your visual acuity at various distances
• Perform a comprehensive assessment of your eye, including a refraction test, to understand the extent of your presbyopia
• Evaluate your eye health to rule out other conditions

Vision Correction Options

There are several presbyopia management options available in Singapore, including:

Non-Surgical Solutions

Reading Glasses

One of the most common corrective lenses for presbyopia is reading glasses, which help magnify objects or words for tasks. They use single-vision lenses designed to magnify near objects, making reading and close-up tasks easier.

Pros:

• Reading glasses are one of the accessible and cost-effective options.
• It could be convenient for occasional use.

Cons:

• It would need to be taken on and off frequently.
• It may not be suitable for activities requiring clear vision at multiple distances.
• It could be inconvenient for people who already wear glasses for distance vision.

Bifocals and Progressive (Multifocal) Lenses 

Multifocal lenses use distinct zones for different distances, which could help those with presbyopia and even those with myopia or nearsightedness. Bifocals have two zones (near and distance), and progressive lenses offer a seamless transition between zones.

Pros:

• It could help enhance vision at all distances without needing to switch glasses.
• Progressive lenses could offer a more natural visual experience compared to bifocals or trifocals.

Cons:

• It could take some time to adjust to the different zones.
• They may cause some distortion or "jump" in vision when moving between zones.

Contact Lenses

Multifocal Contact Lenses 

Similar to progressive glasses, multifocal contact lenses provide different zones for near-, intermediate-, and distance vision.

Pros:

• These contact lenses could help improve vision at all distances without the need for glasses.
• For some users, these contact lenses could be more convenient and cosmetically appealing than multifocal glasses.

Cons:

• It may take time to adapt.
• It may not provide the same level of clarity as glasses for some individuals.

Monovision Contact Lenses

This approach involves wearing one contact lens to address your farsightedness and the other for your nearsightedness.

Pros:

• This could be suitable for people with difficulty adapting to multifocal contact lenses.
• This could help in improving vision for those who are both farsighted and nearsighted. 

Cons:

• This could reduce depth perception and cause some difficulty with intermediate vision.
• This option would require some brain adaptation, which may not be successful for everyone.

Orthokeratology (Ortho-K) Lenses

Orthokeratology involves wearing specially designed contact lenses overnight to reshape the cornea temporarily. This reshaping could help address vision problems, including presbyopia, allowing for improved vision during the day without the need for glasses or contact lenses.

Pros:

• This could offer freedom from glasses and daytime contact lenses
• It is non-surgical and reversible

Cons:

• This may require consistent overnight wear for optimal results.
• This solution may not be suitable for everyone, and an eye exam from an orthokeratology specialist is necessary to determine candidacy.

Surgical Options

LASIK

LASIK, also known as laser-assisted in situ keratomileusis, is a procedure that involves using a cutting laser to change the shape of the cornea, which could potentially help with presbyopia. In most cases, it uses the same philosophy as MonoVision contact lenses, where one eye is corrected for distance and the other is for near.

Pros:

• This could address the effects of presbyopia directly on the eye
• This could minimise or eliminate the need for glasses or contact lenses

Cons:

• LASIK cannot be able to correct all ranges of presbyopia, especially those with a high degree of farsightedness.
• Usually a short term solution to presbyopia, patient will eventually need glasses as presbyopia power increases with age.
• There are certain risks associated with this surgery, such as dry eyes, astigmatism and more.

Lifestyle and Preventive Measures

While there are minimal chances of preventing presbyopia from occurring, certain lifestyle habits can help manage its symptoms and promote overall eye health. Here are a few ways on how to manage the progression of presbyopia:

Proper Lighting

Poor lighting conditions force your eyes to work harder, which can exacerbate the effects of presbyopia. As such, adequate lighting is essential when reading or performing tasks that require close focus. Opt for bright, evenly distributed light sources, like task lamps or natural daylight, to reduce strain and improve visual clarity.

Take Breaks 

Prolonged periods of reading or screen time can lead to eye fatigue, especially if you're struggling with presbyopia. Consider practising the 20-20-20 rule: every 20 minutes, take a 20-second break to look at something 20 feet away. This helps your eye relax its muscles and can minimise discomfort caused by prolonged close-up tasks.

Digital Device Care

As smartphones, tablets, and computers have become a prominent part of your daily life, it's important to adjust their settings to reduce strain on your eyes. A few ways to do so is to increase the font size and adjust screen brightness to comfortable levels. Additionally, consider using blue light filters or screen protectors to minimise your blue light exposure, which could contribute to digital eye strain.

Regular Eye Exams

Schedule regular eye check-ups, especially after age 40, to monitor changes in your vision. Early detection of presbyopia and other age-related conditions can help you manage symptoms and find suitable corrective solutions, such as reading glasses or multifocal lenses.

Have Your Eyes Checked for Presbyopia

Recognising and addressing presbyopia is crucial for maintaining clear vision and enjoying life to the fullest. If you're experiencing symptoms of presbyopia, don't hesitate to seek professional advice from an eye care specialist. They can help you explore the various vision correction options available and recommend the best solution for your individual needs.