What is happening in the eye
The lens behind the pupil focuses by changing shape, pulled by a ring of muscle. It grows throughout life, adding layers like an onion, and stiffens as it does. By the early forties it can no longer round up enough to focus at reading distance, and the near point drifts outward year by year until, around 60, the lens has little focusing ability left. Everything else about the eye may be perfect; presbyopia is a mechanical limit.
The symptoms
Holding menus and phones farther away, needing brighter light to read, eye strain and headaches after close work, blurred near vision that clears when you look up, and, for people who have always been slightly nearsighted, the discovery that taking glasses off makes reading easier. Nearsighted people notice it later, farsighted people earlier.
Non-surgical options
- Reading glasses, the simplest solution, in a power that increases over the years
- Progressive or bifocal glasses that combine distance and near
- Multifocal contact lenses, or monovision with one eye set nearer
- Prescription drops that constrict the pupil to extend depth of focus for several hours, useful for occasional near tasks
Surgical options
Laser correction with blended vision, one eye for distance and the other slightly near, reduces reading glass use for patients in their forties with a clear lens, and is trialed with contact lenses first. The EVO ICL can be set the same way for high prescriptions in patients up to 45. From the late forties, Refractive Lens Exchange replaces the stiffening lens with a multifocal or extended depth of focus lens that provides near and distance vision, addresses the cause, and prevents a cataract, although the lens capsule can cloud later, which is treated with a quick laser. Which fits depends on the state of your lens and what you want from your vision, and the consultation examines both.
What does not work
Exercises do not restore lens flexibility, and no supplement reverses presbyopia. Standard LASIK on both eyes for distance does not address near vision and will leave a presbyopic patient in readers. Honest advice at 45 is different from honest advice at 30, and the consultation gives it.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is the right choice for you is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
