Blog post by: Eye Physicians of Long Beach

Presbyopia diagram

I can’t see up close- Presbyopia
Presbyopia will affect every person. No one can escape it but, don’t despair just yet. It usually affects people above 40. It is the result of the aging of the lens which makes it more rigid and unable to flex or focus on objects that are up close. As a result, people experience blurred near vision when reading, working at the computer or otherwise doing near work.
Presbyopia cannot be prevented but it can be treated. Almost half of all Americans are age 40 and older. All of these people are experiencing or about to experience presbyopia. Presbyopia is a refractive error and your ophthalmologist can help you find the treatment that best fits your needs.
Symptoms and Signs
In the initial stages, presbyopia forces the individual to hold things further away when reading. The affected individual may also need additional lightning to be able to read. When the person reads for a long period of time, they may feel strain, pain or feel fatigued.
Common symptoms of presbyopia are:

  • Difficulty reading fine print, particularly in low light conditions

  • Eyestrain when reading for long periods

  • Blurred near vision

  • Difficulty transitioning between viewing distances from close to far

  • The feeling that your arms have become “too short” to hold reading material at a comfortable distance

Non Surgical Treatment of Presbyopia

Eye glasses, single vision reading glasses or bifocals, are a common solution. Bifocals can be progressive addition lenses (PALs) or traditional (line) bifocals. All bifocals have a portion of the glasses for distance and another for up close. PALs offer a more gradual visual transition between the two prescriptions and have no visible line between them. Some lenses, trifocals, allow the patient to see intermediate vision.

You can also opt for contact lenses. Contact lenses can be used to correct one eye for up close and one for distance, monovision. Or you can wear bifocal contact lenses which have concentric rings of correction for distance and up close. Both the monovision and bifocal contact lenses can result in some difficulty seeing contrast.

Surgical Treatment of Presyopia

Nearvision CK is a solution available in which radiofrequency is used to change the curvature of the cornea in order to help you read. This method is not as stable as other options and may regress. As a result, you might need a repeat treatment in the future. Laser thermal keratoplasty (LTK) was a similar procedure which used laser and has been replaced by CK. PresbyLASIK is a new presbyopia-correcting surgery now undergoing U.S. clinical trials. This procedure uses an excimer laser to create a pattern in the cornea that facilitates distance and up close vision. LASIK can also be used to create monovision. In monovision, the distance eye is corrected to see well at distance and the non-dominant eye corrected to see up close.

The most definitive treatment is a Refractive lens exchange. During a refractive lens exchange, the doctor removes the old stiff lens and replaces it. Both presbyopia and cataracts can now be solved by replacing the lens within the eye, with what is referred to as a “Premium IOL”. In this outpatient procedure, the lens within the eye is replaced with an artificial lens that enhances most people’s ability to see both distance and up close. Many patients prefer to have this procedure before cataracts compromise their lifestyle. By choosing one of the advanced Presbyopia-correcting Premium IOLs, they can enjoy excellent vision, often completely free from glasses and never have to worry about getting cataracts again or changes in prescription.

Premium Intraocular lenses( IOLs):

Within the past several years, a second type of intraocular lens appeared which was designed to improve vision in all areas, close, mid range and far away and is referred to as a “Premium” IOL. The premium presbyopia correcting lenses are further classified into accommodating and multifocal based on their design. The multifocal lenses as well as accommodating IOLs offer the possibility of seeing well at more than one distance such as, far, close, and everything in between without glasses or contact lenses. A lens implant procedure with a premium IOL might be a better overall option for vision correction for baby boomers or cataract patients than LASIK eye surgery.

Presbyopia Correcting Accommodating Premium IOL

“Accommodation” refers to the ability of the eye to change focus. An Accommodating IOL is specifically designed to focus on points at different distances and to reverse the effects of presbyopia. By using the natural focusing ability of the eye, it dynamically responds to your needs to restore vision for distance, up close and everything in between.

Facts about this new type of IOL:

  • Most patients are able to read the newspaper or phone book without glasses.

  • Most patients are able to see their computers and dashboards without glasses.

  • Most patients are able to see 20/40 or better at a distance, after surgery without glasses.

  • More than twice the number of patients implanted with this new technology could see well at all distances compared to a standard IOL.

  • Many of our patients are completely independent of their reading glasses, bifocals, or contact lenses.

Premium IOLs: Presbyopia Correcting Multifocal IOL

There are several brands and models of multifocal intraocular lenses, some of which are designed with up to as many as five focusing zones pre-calculated on the lens to help vision at all distances – near, intermediate and far although some perform best for distance and near than for intermediate vision. Multifocal intraocular lenses enable most people to see the big picture without missing the details and in varying light conditions, usually without glasses.
One version enables you to see clearly at near, intermediate, and far distances without glasses in all light conditions — even in low light.

According to FDA trials for one of these models:

93.8% of bilaterally implanted patients functioned comfortably without glasses at all distances—near, intermediate, and far—at 1 year
94.6% of bilaterally implanted patients queried at 1 year would choose this model of Multifocal IOL again.
Some of these lenses provide better reading vision than others but may not be the best option for people who do a lot of night driving. Immediately after surgery, some patients may notice halos around lights when driving at night, but as the eye adjusts to the lens, the visual impression of halos may lessen or disappear over time. This may require anywhere from a few minutes to six months so that the brain can adapt and learn to use the new lens correctly.

Premium Intraocular Lenses immediately multiply the possibilities in your life. The simplicity of this procedure for patients and these life changing results inspires many to wish they had chosen the Premium intraocular lens sooner. Choosing the best Premium IOL for your vision requires that your doctor has multiple brands and models to offer and, has enough experience in working with them to be able to recommend the best combination for your unique pair of eyes.