Presbyopia: what are the symptoms and how to correct it

By Cristiano Antonino On Oct 13, 2022

Presbyopia is a physiological vision condition that arises due to gradual stiffening of the crystalline lens, a lens located in the posterior chamber of the eye, posterior to the iris, which normally allows images of objects placed at various distances to be focused on the retina, according to the accommodation mechanism

How presbyopia manifests itself: symptoms

It manifests itself from around the age of 40 with difficulty in focusing on objects located at a close distance, below 35-40 cm, and then progressively for those at intermediate distances (from 40 cm to 5 m).

The presbyope initially complains of discomfort experienced as transient: eye strain, eyestrain when reading, in manual work and when using video terminals, especially in the evening hours.

In an attempt to reduce the strain, he adopts a typical gesture: the recurring attitude of the presbyope is to move his head away and extend his arms to increase the distance to the object to be viewed.

With the passing of the years, people who do not have visual defects (myopia, astigmatism, hypermetropia) or who use lenses adapted to correct these defects, present a blurring in reading and are unable to distinguish the details of objects placed at short and medium distances without the addition of positive lenses, with a magnifying effect.

Presbyopia: Occurrence and incidence in the population

Statistically, presbyopia occurs around the age of 40 and affects men and women equally.

It is currently considered the most widespread visual disorder: it is estimated that, as a result of longer average life expectancy in the western world and improved health conditions, more than half of the Italian population will be presbyopic in the next few years.

How is presbyopia corrected?

The crystalline lens loses its elasticity with advancing age and is unable to change its shape in response to the contraction and relaxation of the ciliary muscle, which regulates focusing at various distances.

There are different stages of presbyopia progression; depending on the age of onset and the extent of its manifestations, there are three types of presbyopes

young presbyopes (40-45 years of age): manifests the first problems in reading close up and observing details at short distances. He generally makes flexible use of the correction as he retains a certain accommodation capacity and helps himself by moving objects away and looking for favourable lighting conditions.
Presbyopes (45-55 years): for most close- and intermediate-distance activities need correction with specific lenses.
Advanced presbyopes (over 55 years of age): need constant correction for close- and intermediate-distance activities (as their accommodation capacity has been significantly reduced).
Individuals with mild or intermediate myopia can in some cases compensate for their presbyopia and read without the use of glasses; in most cases a specific corrective lens is needed for short-distance activities or it is possible to use progressive lenses, which allow focusing at various distances, depending on the zone of the lens being used according to the direction of gaze.

Alternative solutions may be the use of multifocal contact lenses or the replacement of the crystalline lens with a multifocal or depth of focus intraocular lens, which can be used in selected cases during cataract extraction surgery.