For 128 million U.S. presbyopes, doctors of optometry can provide treatment options

Doctors of optometry have a role in educating the public about presbyopia, an eye condition in which the ability to focus on near objects declines among middle-aged adults, the AOA’s Heath Policy Institute reports in a new brief. An estimated 128 million Americans are impacted or nearly 90% of adults over age 45, the brief says.

It cites three risk factors for presbyopia.

• Aging. Not only does the crystalline lens at the front of the eye lose its elasticity over time, making it harder for light to pass through the eye to bend and form an image on the retina, but also millions of Americans are aging. Sixty-one million Gen Xers are now in their early 40s and mid-50s, while 73 million millennials turn 40 this year, the brief says.
• Certain conditions and drugs. Such conditions as diabetes, cardiovascular disease and multiple sclerosis can lead to higher risk of presbyopia as well as earlier onset. Among drugs associated with premature symptoms for presbyopia are antidepressants, antihistamines and diuretics.
• “Ubiquitous use” of digital technologies. “The adoption of digital technology has made better near vision a necessity due to exponential increase in the use of screens for work and leisure,” the report says.

“It’s critical for the public to understand presbyopia and the range of treatment options available to patients,” the report says, later adding, “Human beings have also depended on high-quality near vision for survival through the millennia. The ability to identify a potential risk or threat, or the ability to identify food, which is edible and not poisonous or toxic. In more recent times, the ability to read medication names or proper instructions on a pill bottle or identify a proper measurement on an insulin syringe for medication dosage or dial 9-1-1 in case of emergency can mean the difference between life and death. All these tasks require high-quality near vision. Uncorrected presbyopia challenges all of them.”

Options for correcting presbyopia

The brief discusses a number of treatment options, including fixed- and variable-focus lens systems and surgical interventions that have dramatically expanded the care optometrists can provide patients.

Glasses

Near vision or reading glasses: Generally considered the simple treatment option, near vision glasses are designed to supply the additional focusing needs of the patient when needed. Typically, the patient puts them on for near tasks and then removes them. Usually, because left and right eyes are not identical, and other refractive errors may be present, these glasses are prescribed by an eye doctor. However, some patients require only very simple prescriptions, which can be obtained in over-the-counter reading glasses.

Bifocals: Intended for people with a need for distance vision correction as well as a near correction. Both corrections are incorporated into the same spectacle frame with the distance correction on the top and the near correction on the bottom.

Progressive addition lenses (PALs): Progressive addition lenses treat presbyopia using the same concept as the bifocal but utilizing more modern technology wherein the transition from distance to near is gradual and results in giving the patient not only distance and near correction, but also an intermediate one.

Contact lenses

Multifocal contact lenses: Multifocal contact lenses have multiple lens powers, similar to the progressive or bifocal lenses in eyeglasses, and are used to help with improving vision at all distances.

Monovision contact lenses: Monovision contact lenses, in which one eye wears a distance prescription and the other eye a near vision prescription, are an option in patients who typically already are contact lens wearers. For the successful patient, the brain learns to switch between left and right eyes depending upon the task at hand.

Eye drops

Presbyopia eye drops contain a prescription medication that helps constrict the size of the pupil to improve near vision. When the pupil is constricted, patients find that the range of clear focus is extended, resulting in an enhanced ability to accomplish near tasks without the need of lenses, either spectacles or contacts.

Surgical options

Monovision LASIK: Monovision LASIK is a refractive surgery that corrects one eye for distance vision and one eye for near vision. Akin to monovision contact lenses, this method requires the brain to adapt to relying on different eyes for different distances. A LASIK surgeon will typically trial the monovision approach with contact lenses before surgery, as not everyone will adapt well.

Refractive Lens Exchange: Refractive Lens Exchange is a surgery in which each eye’s natural lens is replaced with an advanced intraocular lens. It can correct a variety of refractive errors and reduce or eliminate the need for reading glasses. Often multifocal lens implants are used depending upon the counsel of the eye doctor.  

The brief wraps up with some added recommendations for doctors of optometry managing the care of presbyopes. Doctors  should examine patients to assess whether they are candidates for the various interventions. When considering the use of therapeutic drops for presbyopia, a comprehensive eye examination should pay particular attention to the retina. Manage patient expectations regarding expected outcomes, including risks and benefits.

“Given the huge number of Americans impacted by presbyopia, additional interventions can trigger excitement in the patient community and provide an opportunity for doctors of optometry to work with patients to find treatments and interventions that best suit the patient’s unique needs,” the brief concludes.

More resources on presbyopia

See what the AOA Evidence-based Clinical Practice Guideline: Comprehensive Adult Eye and Vision Examination, Second Edition, says about presbyopia.

Find a doctor of optometry.

Read more about presbyopia and aging in the March/April 2022 issue of AOA Focus.