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Entering the Presbyopia Zone

Without proper preparation, patients may think the onset of presbyopia signals a significant problem with their vision.

As someone who previously underwent LASIK and is now experiencing some myopic regression and presbyopia, I understand firsthand the frustration of today’s young presbyopic patients. I first noticed that I needed glasses to help me drive at night or read well at a distance. Now, when reading, I find myself removing my glasses and holding materials further away in order to focus. At 45 years of age, I am somewhat in “limbo,” as I see better without my glasses up close, but if I hold things too closely I do not see as well. I recently purchased my first pair of cheaters; however, they provide a bit more power than I need. Presbyopia is a condition that even we ophthalmologists do not fully appreciate until it happens to us. This is not an easy transition!


When young patients first notice presbyopic changes, they often believe that there is a problem with their vision. In a recent survey,1 1,339 patients with presbyopia were divided into three groups based on their age: 40 to 44 years (n = 315), 45 to 50 years (n = 519), and 51 to 55 years (n = 505). They were then asked about their experience with the condition. Among the youngest group, 20% of participants responded that they were worried when they first noticed symptoms, 32% of participants thought their symptoms were due to fatigue, and 26% of participants were concerned that something was wrong with their eyes.

Respondents in the youngest group were also far more likely to see a doctor in the first 6 months of noticing symptoms (41% compared with 33% of those aged 45 to 50 years and 27% of those aged 51 to 55 years). Those in the youngest group who did not see a doctor were more likely to think the symptoms would go away on their own.


In terms of attitudes toward presbyopia, the survey found that young presbyopes may be more aesthetically minded and more connected to their computers and smartphones than older presbyopes. For example, 62% of respondents in the youngest group said that they “stare at a computer for hours,” compared with 56% of 45-to-50-year-olds and 53% of 51-to-55-year-olds. Half of the respondents in the youngest group reported that they are “always” checking their phones, compared with 40% of those aged 45 to 50 years and 33% of those aged 51 to 55 years. Furthermore, 23% of the youngest respondents said that glasses are a “fashion accessory,” compared with 15% of respondents in the other two age groups.

The survey also showed that young presbyopes were the least likely to have purchased readers as soon as symptoms occurred (14% compared with 25% of those aged 45 to 50 years and 34% of those aged 51 to 55 years). The oldest respondents were more likely to have taken action to help their near vision: 71% had purchased readers, compared with 55% of the 45-to-50-year-olds and 33% of the 40-to-44-year-olds.


By Justin Schweitzer, OD, FAAO

Optometrists regularly encounter presbyopia and have become experts at managing the condition. Patients, however, don’t necessarily understand presbyopia. We want them to realize that it is not a pathologic condition and that it will get worse, but that a variety of options exist to manage it. The first step is explaining to patients that what they are experiencing is a normal part of the aging process, that it can be corrected, and that we are here to help them do that.

I often tell patients that obtaining a precise eyeglass or contact lens prescription that fits their lifestyles is a better choice than purchasing over-the-counter reading glasses that are not designed for them. Our patients with presbyopia have many different needs at different distances when performing near-point activities. Providing them with a set of glasses or contact lenses created specifically for their needs goes a long way in building trust with them.

Optometrists should also discuss surgical options with their presbyopic patients. Monovision correction with LASIK, PRK, or SMILE can be a solution, especially for emerging presbyopes. Having the patient do a test run in a pair of contact lenses to simulate monovision can help the patient to understand what to expect after surgery. Another option is a refractive lens exchange, as current IOLs enable patients to reduce their dependence on spectacle lenses not only at distance, but also at intermediate and near.

Several companies are investigating pharmaceutical options to aid in presbyopia correction. These options, some of which may become available soon, could allow patients flexibility throughout the day to enjoy some of their daily activities without the need for glasses or contact lenses.

As the primary eye care providers for our patients, it is our duty to educate them about their choices for treatment. Our recommendations hold a lot of weight in the eyes of our patients. With the variety of options available to manage presbyopia, and more on the way, we can provide exceptional near-point vision for these patients. We must not underestimate the impact the condition is likely having on their lives.


Eye care providers must properly educate their patients on presbyopia and communicate that what they are experiencing is part of the natural aging process. Knowing how to read your patients will help guide this discussion. I prefer to use scientific terms and descriptions so that patients understand there is a physiology behind the condition, and it is not merely an annoyance of getting older. Although not a pathologic condition, presbyopia is causing their lens to stiffen, making it harder to change shape and focus up close.

When relaying such information, it is important not to minimize the impact of presbyopia. I have an advantage because I can personally relate to my patients, and, for the next 5 years or so, I can say, “I’m going through this with you.” Overall, it is inappropriate and unhelpful to say, “Don’t worry about it.” Some patients do worry about having to wear reading glasses, and not simply due to vanity. Some have concerns about whether they can do their work while wearing glasses or whether their insurance will cover them.


As people age, they increasingly accept difficulties with near vision. But, for patients aged 40 to 50 years, there is a gap in terms of the effective solutions we can offer. When it comes to discussing treatment, I first inform patients of simple workarounds, such as increasing font size, adjusting brightness, and holding reading materials further away. Next, I suggest a pair of low-power reading glasses, and I give guidelines based on the patient’s age. I let them know that wearing reading glasses might not be comfortable at first and can take getting used to.

It is crucial to ensure that patients understand that presbyopia is progressive with age. This is not an acute process, and, although the eye has some accommodative reserve, when it is met, decompensation begins. I suggest that my patients see an optometrist to further assist them through their journey.


20% were worried when they first noticed symptoms

32% thought their symptoms were due to fatigue

26% were concerned that something was wrong with their eyes


I do my best to properly educate and reassure my young presbyopic patients. I let them know that surgical approaches to presbyopic correction (eg, refractive lens exchange) are available, and if it comes time for them to explore that option I will be happy to discuss it further. It is also helpful to give patients a peek at what might be on the horizon. Several companies are investigating pharmaceutical approaches to presbyopia correction that could be useful, especially during this “limbo” period. This is an exciting area of innovation with potential to bring new solutions to those joining me in navigating this rite of passage.

1. Ipsos. Presbyopia Patient Journey Age Group Differences. Allergan. June 2020.

Sumit “Sam” Garg, MD
  • Vice Chair of Clinical Ophthalmology; Medical Director; Director of Technology; and Associate Professor, Cataract, Corneal, and Refractive Surgery, Gavin Herbert Eye Institute, University of California, Irvine
  • gargs@uci.edu
  • Financial disclosure: Alcon, Allergan, Johnson & Johnson Vision
Justin Schweitzer, OD, FAAO