Presbyopia…Explained by Dr. Paul J. Dougherty
Presbyopia, is a refractive error that eventually plagues every human being who lives long enough to experience this age-related loss of zooming (or focusing) power in the lens, requiring reading glasses (for people with no other refractive error) or bifocals (in patients that have nearsightedness, farsightedness, or astigmatism). Presbyopia usually begins between the ages of forty-two to forty-seven because of the loss of accommodation. Eye doctors often joke that there are three facts of life: death, taxes, and presbyopia!
Patients in their fifties, sixties, or seventies who claim that they have never needed glasses for distance or near visual acuity are still presbyopic, but they do not notice it, either because they have natural monovision (one eye set for distance, the other for near), or they have a low degree of nearsightedness in both eyes, which allows them to read; consequently, they have gotten used to the distance blur and do not realize that their distance is not perfect. Presbyopia and the loss of vision with age (due to farsightedness) both occur because of loss of accommodation, but they are distinct entities that are commonly confused.
Presbyopia alone results strictly from the loss of accommodation in an eye that has a perfect balance between the curvature of the cornea and length of the eye and requires glasses for reading only; hyperopia results from an eye that is too short or a cornea that is too flat. In hyperopia, glasses are at first needed for reading (due to presbyopia), but eventually required for distance as well. Presbyopia is treated with reading glasses, monovision LASIK/PRK or ICL or with presbyopic IOLs (accommodative or multi-focal).
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