Presbyopia and presbyopia their causes the difference and how to treat them

Do you find it difficult to see objects up close as you age? Presbyopia and myopia are common vision problems many experience after the age of forty, and they are among the leading causes of visual confusion that people face as they get older. In this article on Daili Medical, we will explore the difference between presbyopia and myopia, how each affects vision, and the underlying causes contributing to their development. Additionally, we will discuss the available treatment options for each condition, helping you choose the best solution for your visual needs.

What is Presbyopia (Long-Sightedness) and Near-Sightedness (Myopia) with Age?

Presbyopia and myopia are common vision problems that occur with age, and they are typically seen after the age of forty. Both conditions affect close vision, but for different reasons. In this article, we will explore what these two conditions are, their symptoms, stages, and causes, as well as the treatment options available to help you improve your vision.

What is Near-Sightedness with Age?

Near-sightedness with age (also known as Myopia) is a condition where distant objects are blurred, and it typically worsens over time. However, age-related near-sightedness specifically refers to difficulty seeing things up close, which usually begins after the age of forty. The main cause is the loss of flexibility in the lens of the eye, making it harder to focus on nearby objects clearly.

Symptoms:

Difficulty reading books or using mobile phones.
Blurry vision when trying to focus on near objects.
Eye fatigue after reading or performing close-up work.

What is Long-Sightedness with Age?

Long-sightedness with age, or Presbyopia, is a vision problem that arises due to natural changes in the eye over time. As we age, the lens becomes stiffer and less flexible, which reduces the eye's ability to adjust to near distances, resulting in blurred near vision.

Symptoms:

Difficulty seeing things up close.
The need to hold reading materials or mobile phones farther away to read clearly.
Eye fatigue after extended reading or screen use.

Can Presbyopia and Myopia be Prevented?

Although it is difficult to completely prevent presbyopia and myopia due to natural changes in the eye, some tips may help reduce symptoms or delay their onset:

Perform regular eye exercises to stimulate the muscles around the eyes.
Maintain eye health by consuming foods rich in vitamins and minerals like Vitamin A and C.
Use protective glasses when working for extended periods in front of screens to reduce eye strain.

What are the Best Glasses for Treating Presbyopia and Myopia?

The right glasses depend on the severity of your condition:

Reading Glasses: Ideal for people with mild presbyopia who need help with close-up vision.
Bifocal or Multifocal Lenses: Suitable for those with moderate vision problems, addressing both near and far vision.
Progressive Lenses: The best solution for many, offering clear vision at all distances, providing smooth transition between near, intermediate, and distant vision in one lens.

Can Near Vision Be Restored After Treatment?

Yes, both laser treatments and surgery can significantly improve near vision. However, it's important to follow up with regular doctor consultations to ensure the stability of your condition and achieve the best long-term results.

Is Long-Sightedness with Age a Serious Health Problem?

No, presbyopia is a natural vision problem that occurs with age. While it can cause some inconvenience, it is not a serious health issue. However, if left untreated, it can affect daily life quality.

When Should I See a Doctor if I Experience These Symptoms?

If you have difficulty seeing objects up close after age 40, or if you experience headaches or eye strain after reading or using your phone, you should visit an eye doctor for an assessment. Early consultation ensures effective treatment and better vision improvement.

Stages of Near-Sightedness and Long-Sightedness with Age

Near-Sightedness (Myopia) Stages

This condition is common in people who have been near-sighted for a long time. Over time, the vision changes gradually:

Stage One: Early Forties
- Noticeable difficulty in close-up vision.
- The need to move objects farther away or closer to see clearly.
- Mild eye strain after reading.
Stage Two: Mid-Forties
- More noticeable difficulty with close vision, especially in low light.
- Need for reading glasses over regular prescription glasses.
- Frequent headaches after extended focus.
Stage Three: Late Forties to Early Fifties
- Significant difference between near and far vision.
- Need for bifocal or multifocal lenses to correct both near and far vision.
Stage Four: Fifties and Beyond
- The lens becomes less flexible, requiring greater strength to focus on nearby objects.
- Progressive lenses are often the best solution.

Presbyopia Stages

Presbyopia usually starts after age 40, with clear stages of development:

Stage One: Early Loss of Flexibility (40-45 years)
- Difficulty reading small text or fine details.
- The need to move reading materials farther away.
- Eye fatigue after short periods of reading.
Stage Two: Dependency on Glasses (45-50 years)
- Near vision becomes blurry without glasses.
- Headaches and eye strain after using phones or reading.
- Light to moderate reading glasses needed.
Stage Three: Increased Near Vision Weakness (50-55 years)
- Need for stronger reading glasses.
- Difficulty with detailed tasks like sewing or reading small screens.
- May need multifocal glasses for seamless transitions between reading and screen use.
Stage Four: Near Focus Nearly Impossible (55-60 years and beyond)
- Near vision becomes nearly impossible without glasses.
- The lens requires maximum strength to focus.
- In some cases, intraocular lens implants or laser surgery may provide a permanent solution.

Causes of Near-Sightedness and Long-Sightedness with Age

Causes of Near-Sightedness with Age (Myopia)

Change in the Shape of the Eye
People with myopia have relatively longer eyeballs. As they age, it becomes harder to focus on near objects, especially in low light.
Weak Eye Muscles
The muscles that help the lens change shape for focusing on near objects weaken over time, making it harder to focus on close items.
Loss of Lens Flexibility
After age 40, the lens becomes less flexible, making it difficult to focus clearly on near objects.
Changes in the Retina
Aging decreases the retina's sensitivity to light, leading to reduced clarity when focusing on nearby items.
Dry Eye
Dry eye symptoms can worsen with age, affecting clarity and focus.

Causes of Long-Sightedness with Age (Presbyopia)

Hardening of the Lens
The lens becomes thicker and less flexible with age, making it harder to focus on close objects.
Weak Ciliary Muscles
These muscles, responsible for adjusting the lens, weaken with time, reducing the ability to focus on nearby objects.
Changes in Lens Tissue
The internal tissue of the lens changes with age, reducing its flexibility.
Minor Changes in Eye Shape
Over time, changes in the cornea or lens position may affect focus abilities.
Genetic Factors
If a family member experienced presbyopia early, it may occur earlier for you too.
Eye Strain
Long hours of reading or using screens without rest can speed up the development of presbyopia.
Health Conditions
Conditions like diabetes, high blood pressure, and thyroid disorders can accelerate the onset of presbyopia.
Medications
Medications like antidepressants, antihistamines, and diuretics can worsen presbyopia.

Symptoms of Near-Sightedness and Long-Sightedness with Age

Symptoms of Near-Sightedness with Age (Myopia)

Difficulty Seeing Clearly in Low Light
You may need stronger lighting to focus on small details.
Blurry Vision When Switching Between Near and Far Objects
The eye may take longer to adjust when switching between distant and nearby objects.
Frequent Headaches After Focusing
Eye strain from reading or using a phone for long periods can lead to headaches.
Increased Dependence on Reading Glasses
You may find that you need reading glasses more frequently as you age.
Quick Eye Fatigue
Your eyes may tire more quickly after reading or staring at a screen.

Symptoms of Long-Sightedness with Age (Presbyopia)

Difficulty Seeing Close Objects
Tasks like reading, using a mobile phone, or even sewing may become challenging.
Holding Objects Farther Away
You might need to move reading materials or your phone further from your eyes to see clearly.
Blurry Near Vision
Words or objects up close may appear fuzzy or blurry.
Headaches After Reading
Prolonged reading or screen use can lead to headaches.
Eye Fatigue
You may feel a mild burning or pressure in your eyes after focusing for long periods.

6. Need for Stronger Light

Close vision becomes unclear unless the lighting is strong enough.

7. Difficulty in Precision Tasks

Tasks that require precision, such as sewing, reading small print, or inspecting fine details, become more difficult.

Types of Near-Sightedness and Far-Sightedness with Age

First: Types of Near-Sightedness with Age

Near-sightedness with age typically occurs in people who have had myopia for a long time. As they age, their ability to focus changes. It can be classified into three types:

Simple Age-Related Myopia
- The person has myopia.
- As they age, mild difficulty with near vision begins to appear.
- Typically, the person will need light reading glasses over their existing distance glasses.
Complicated Age-Related Myopia
- The person needs distance glasses due to myopia.
- As they age, they begin to need additional power for near vision.
- Often, the person uses bifocal or multifocal lenses.
Age-Related Myopia with Astigmatism
- The person suffers from both myopia and astigmatism.
- As they age, focusing on near objects becomes more difficult.
- The person needs special glasses to correct all three issues: myopia, astigmatism, and near vision.

Second: Types of Far-Sightedness with Age (Presbyopia)

Presbyopia is the most common type of far-sightedness that appears after the age of 40 due to the loss of lens flexibility. It varies depending on its severity and progression:

Mild Presbyopia
- Typically starts in the early 40s.
- Difficulty occurs only with reading small print.
- Can be corrected with basic reading glasses.
Moderate Presbyopia
- The person starts moving reading materials farther away.
- Symptoms like headaches, blurry vision, and rapid eye fatigue appear.
- Stronger reading glasses are needed.
Severe Presbyopia
- Appears in late 40s or early 50s.
- The person becomes unable to read or perform close tasks without glasses.
- Multifocal lenses (progressive lenses) are needed.
Presbyopia with Astigmatism
- The lens loses flexibility, and astigmatism develops.
- Focusing on nearby objects becomes even harder.
- The person needs specialized lenses (Cylindrical + Add) to correct their vision.
Early Presbyopia
- Appears before the age of 40.
- Often linked to:
  - Diabetes
  - Dry eye syndrome
  - Significant eye strain
  - Genetic factors

Damage from Near-Sightedness and Far-Sightedness with Age

First: Damage from Near-Sightedness with Age (Myopia)

People with myopia who develop near-sightedness with age may experience some troublesome effects:

Significant Near Vision Impairment
- Difficulty reading books, using mobile phones, or working on a computer.
Persistent Headaches
- Due to eye strain from trying to focus more than usual.
Severe Eye Fatigue
- The eyes feel tired quickly, even with simple tasks.
Difficulty Transitioning Between Near and Distant Vision
- The eye takes longer to adjust when switching between near and far objects.
Need for Multiple Lenses
- The person may need two pairs of glasses or multifocal lenses, which can be inconvenient.
Problems While Driving
- Especially at night, where transitioning between distances can be slower.
Impact on Daily Life Quality
- Tasks like sewing, reading, and focusing on fine details may become challenging, affecting productivity and quality of life.

Second: Damage from Far-Sightedness with Age (Presbyopia)

Presbyopia, the most common type of far-sightedness after the age of 40, can lead to some damages as it progresses:

Severe Difficulty with Near Vision
- Tasks such as reading, using a mobile phone, or looking at medications become hard.
Chronic Headaches
- Especially after reading, studying, or working on a laptop for long periods.
Rapid Eye Fatigue
- Eyes become tired quickly, even after simple tasks.
Constant Need for Glasses
- It becomes difficult to see things clearly up close without glasses after a certain age.
Reduced Ability to Perform Precision Tasks
- Writing, sewing, repairing objects, and reading receipts become more difficult.
Impaired Work Performance
- People whose jobs rely on reading or screen use may be more affected.
Issues with Night Driving
- Due to eye fatigue and difficulty seeing fine details.
Increased Risk of Minor Accidents
- Like tripping, making mistakes while cutting or writing, and dropping things due to unclear vision.
Psychological Impact
- Some people may feel the sense of "aging" due to their reliance on glasses, leading to emotional or psychological effects.

Medications for Treating Near-Sightedness and Far-Sightedness with Age

First: Is There a Medication to Treat Near-Sightedness and Far-Sightedness with Age?

Currently, there is no medication that can permanently cure presbyopia or myopia with age because the main cause is the loss of lens flexibility over time. However, some medications can temporarily alleviate symptoms and improve near vision.

Second: Medications for Treating Presbyopia

Pilocarpine Drops (e.g., Vuity)
- How They Work: These drops reduce the pupil size (miosis), which increases the depth of the field of vision, thus improving near vision.
- Duration: Effects last for 4 to 6 hours.
- Suitable For: People aged 40–55 with mild to moderate presbyopia.
- Side Effects: Mild headaches, slight stinging, poor vision at night.
Lubricating Drops (e.g., Artificial Tears)
- Benefits: Reduce dry eyes, which can worsen age-related vision problems. They also help alleviate headaches and eye strain caused by visual fatigue.
- Suitable For: People of all ages, especially those who use mobile phones or screens frequently.
Parasympathomimetic Drops (e.g., Carbachol, Low-Concentration Pilocarpine)
- How They Work: Strengthen the contraction of eye muscles responsible for near focus, temporarily improving close-up vision.
- Still Under Research: These drops are still being studied in some countries.

Third: Medications for Treating Near-Sightedness with Age (Myopia)

Pilocarpine, Carbachol, and Lubricating Drops are also useful for myopia-related presbyopia, though their effects are less pronounced compared to presbyopia treatment, as myopia already alters the balance in the eye during focus.

Fourth: Future Research Medications

Scientists are developing new medications for presbyopia and myopia, including:

Drops to Improve Lens Flexibility
- These drops aim to "soften" the lens, making it more flexible and improving near vision. Still in trials.
Antioxidant Drops for the Lens
- These drops aim to prevent lens hardening with age and are currently under study.

Fifth: What Do Medications Not Treat?

Medications do not cure:

True myopia (nearsightedness)
True hyperopia (farsightedness)
Astigmatism
Cataracts

They only provide temporary symptom relief and improve near vision for a limited time.

Laser and Surgical Treatments for Near-Sightedness and Far-Sightedness with Age

First: Laser Treatment for Near-Sightedness and Far-Sightedness with Age

PresbyLASIK
- How It Works: This type of laser reshapes the cornea to create areas for both near and distant vision, similar to multifocal lenses but on the cornea itself.
- Suitable For: People over 40 with difficulty seeing close up, who have myopia or hyperopia (provided they don't have cataracts).
- Benefits: Improves both near and far vision, reduces or eliminates the need for glasses, provides quick and effective results.
- Drawbacks: May cause nighttime glare, requires an adjustment period, not suitable for everyone.
Monovision Laser
- How It Works: One eye is corrected for near vision, and the other for distance vision.
- Suitable For: People who have tried monovision contact lenses and found them comfortable, and those over 40 with mild myopia or hyperopia.
- Benefits: Reduces the need for glasses, offers a quick and simple solution.
- Drawbacks: Requires an adjustment period, may cause discomfort in balancing vision between eyes.
SMILE Laser with Near Vision Correction (Experimental)
- How It Works: Some centers have started applying the SMILE technique to improve near vision, though this approach is still under development.

Second: Surgical Treatment for Near-Sightedness and Far-Sightedness with Age

Multifocal Intraocular Lens (IOL) Implantation
- How It Works: The natural lens is removed and replaced with a synthetic lens that allows vision at all distances (near, far, and intermediate).
- Suitable For: People over 45–50 with presbyopia, myopia, hyperopia, or early cataracts.
- Benefits: Permanent solution, excellent vision at all distances, eliminates the need for reading glasses.
- Drawbacks: Nighttime glare or halos, higher cost.
Extended Depth of Focus (EDOF) Lenses
- How It Works: EDOF lenses provide excellent far and intermediate vision, with decent near vision.
- Benefits: Less glare at night compared to multifocal lenses, closer to natural vision.
- Drawbacks: Near vision may not be as sharp as with multifocal lenses.
Implantable Collamer Lens (ICL) for Presbyopia
- How It Works: This lens is added in front of the natural lens without removing it, and it is suitable for those who can't have LASIK.
- Benefits: Excellent vision, suitable for high myopia.
- Drawbacks: Expensive, not suitable for everyone, age restrictions.
Refractive Lens Exchange (RLE)
- How It Works: Similar to cataract surgery, but without the presence of cataracts.
- Suitable For: People over 45 who find laser treatment unsuitable and those with significant myopia, hyperopia, or astigmatism.
- Benefits: Permanent solution, prevents cataracts from developing.
- Drawbacks: Higher cost, may cause glare or halos at night.