Presbyopia & Bifocals

Presbyopia Treatment & Symptoms

As much as we all hope to be immune, each and every one of us must one day succumb to the reality of bifocal lenses. There comes a point in every person's life (even if you had LASIK or PRK laser surgery when you were younger) when reading just isn't like it used to be – you start holding the book further and further away from you, until your arms get tired from the workout! So either your arms are getting shorter... or you need glasses. What you are experiencing for the first time is an eye condition known as presbyopia. It is extremely common (we all get it!) and becomes progressively worse with time as our eyes age and the lens inside our eye becomes increasingly less flexible.

In a normal, young, healthy eye, the lens inside our eye is designed to change shape as we view distant and near objects. In this way, the eye really is acting like a living camera. When we view an object that is close up, the lens bulges out in a process known as accommodation. In order to do this, the muscles inside the eye must contract and pull on the zonules.

With age, however, the lens loses its ability to accommodate. The exact reason why this occurs is not clear, however, which is part of the reason why researchers have not yet found a cure for presbyopia (if there is one at all!). Without being able to accommodate, we are unable to make near objects come into focus like we used to. Pushing your reading material further away from you can only work as long as the print is large enough for you to still read it. At some point, however, you will need to get yourself either glasses or contacts.

Presbyopia Treatment

People with presbyopia have a lot more options available to them than they might realize. Most of us are aware that we can buy reading glasses and bifocals. People who already wear contacts when they realize they need bifocals have the option of continuing to wear their contacts and simply putting on reading glasses when close work is necessary. Reading glasses are the cheapest option available: heck, you can even buy them at the dollar store! Bifocals are much more expensive, but even more expensive still are progressive addition lenses (PALs). PALs are probably the most popular option for people with presbyopia, simply because they have no line. Your lenses will look the same as they always did, but will now have a gradient prescription in the lens that allows you to see clearly at all distances without line bifocals and without having to switch to reading glasses. Another alternative to eyeglasses are bifocal contact lenses. No one will even know you need glasses, let alone bifocals!

Surgery for Presbyopia

Presbyopia is a most unwanted eye condition that either complicates a current eyeglass prescription or forces people who have not worn glasses their entire life to pick up a pair every time they want to read something. Everyone, at one point in his or her life, will develop presbyopia. Aside from glasses and contact lenses, surgical remedies for presbyopia are a hot topic of research. Listed below are only a few of the current options that are either available now or will soon be:

Monovision with LASIK & PRK
One of the options available to people with presbyopia is laser eye surgery with either LASIK or PRK that produces monovision. What this means is that one eye is corrected for distance vision (this is usually the dominant eye) and the other eye is corrected for near vision. A major downfall of monovision is that the eyes can no longer work together, which means a loss of (or at the very least a drastic reduction in) depth perception and stereopsis.

Surgical Reversal of Presbyopia (SRP)
SRP involves the placement of 4 PMMA segments (scleral expansion bands – SEBs) that are positioned under the surface of the sclera, in an effort to increase the area between the lens and the muscles in the eye that contract to change the shape of the lens. Some researchers believe that it is because the lens grows with age and causes a decrease in tension that leads to presbyopia and with Surgical Reversal of Presbyopia, the tension is regained by increasing the distance between the muscles and the lens. This technique is still in clinical trials with mixed results.

Multifocal Intraocular Lenses
Recent advances in IOL technology have produced intraocular lenses (which are the pseudo lenses that are placed in the eye following cataract surgery) that incorporate a multifocal component, which enables people to see clearly at a wider range of distances. These lenses are currently only available to patients who are having a cataract removed.

Disclaimer

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