Presbyopia: Symptoms and Causes

Do you need reading glasses? Chances are, you have presbyopia, a disorder that causes a decrease in the eye’s ability to focus, typically as a result of the natural aging process that nearly everyone eventually experiences. The first signs usually appear in the early to mid 40s, which is why so many middle-aged people begin to need reading glasses or bifocals around this time.

While the exact cause of presbyopia is still under research,1 the common theory is that the muscle fibers around the eye's natural lens stiffen and lose their elasticity, decreasing the eye's ability to change the lens' shape. As our natural eye lens becomes less flexible, we are less able to focus on close objects. Trauma, lifestyle, and occupation, such as sitting long hours in front of a computer, can also play a part in its development.2

You may start having difficulty reading very fine print, such as the phone book, a newspaper, or a medicine bottle, as letters appear to have less contrast and your eyes tire more easily from reading or viewing a computer screen.

Presbyopia: Treatment Options

Early on, holding reading material further away may help you read. This is why presbyopia is sometimes informally referred to as the "long arm disease." Eventually, you may need reading glasses or contact lenses for up-close work. To determine whether contact lenses or eyeglasses are better for you personally, talk to your doctor. In the meantime, here are 3 options to discuss with your doctor.

  • Reading glasses. These eyeglasses are designed to be worn when reading text up close.
  • Bifocals. Offering 2 focal points, bifocal lenses allow you to see far away when you look through the top portion or see up close when you look through the bottom. This dual option is good for those with astigmatism and is available in contact lenses as well.
  • Trifocals. These lenses have 3 focusing points: one for near vision, one for immediate vision, and one for distance.

Presbyopia Surgery Options

When it comes to permanently fixing presbyopia, there are 2 pathways you can choose from:

LASIK. The LASIK procedure can be used to treat presbyopia as well, but in a unique way. Called monovision LASIK, one eye is left slightly nearsighted for reading and the other eye is treated for distance vision. As with monovision contact lenses, the brain gradually adapts and learns to choose which eye to rely on for certain tasks depending on the distance.* Since all current LASIK procedures for presbyopia give the patient monovision, it is better to try out monovision contact lenses or eye glasses before surgery to understand what the experience will be like. For more information, go to LASIK Technology.

IOL surgery. Artificial intraocular lenses   Intraocular lens (IOL): An artificial lens made of plastic, silicone, or acrylic, which is designed to be implanted in the eye to improve its focus and correct vision problems related to cataracts.   (IOLs) to treat cataracts are becoming even more advanced, with some designed specifically to treat presbyopia and cataracts   Cataract : A clouding of the eye's lens that blocks passage of light to the retina, resulting in impaired vision. Often a result of normal aging, cataracts form when protein clumps cloud areas of the eye's lens. As the cataract progresses, vision worsens and often requires surgical replacement of the damaged lens with an artificial one.   simultaneously. To understand your choices, read about Cataract Technology.

Next: What Are Cataracts?

*The Allegretto Wave® and Allegretto Wave® Eye-Q Laser are not approved for presbyopia/monovision in the United States.

In Alcon clinical studies, over 92 percent of patients implanted with the AcrySof® IQ ReSTOR® IOL were so satisfied with their new spectacle freedom, they said they would do it again.


  1. Ziebarth NM, Wojcikiewicz EP, Manns F, et al. Atomic force microscopy measurements of lens elasticityin monkey eyes. Mol Vis. 2007;13: 504-510. Accessed October 16, 2010.
  2. American Optometric Association. Adult Vision: 41-60 Years of Age. Accessed October 17, 2010.