Treatments and drugs

By Mayo Clinic Staff

The goal of treatment is to compensate for the inability of your eyes to focus on nearby objects. Treatment options include wearing corrective lenses, undergoing refractive surgery or getting lens implants.

Corrective lenses

If you had good, uncorrected vision before developing presbyopia, you may be able to use nonprescription over-the-counter reading glasses. Ask your eye doctor if nonprescription glasses are OK for you.

Reading glasses sold over-the-counter are labeled on a scale that corresponds to the degree of magnification (power). The least powerful are labeled +1.00, and the more powerful are labeled in increasing increments up to +4.00. When purchasing reading glasses:

  • Try different powers until you find the magnification that allows you to read comfortably.
  • Test each pair on printed material held about 14 to 16 inches (35 to 40 centimeters) in front of your face.

You'll need prescription lenses for presbyopia if over-the-counter glasses are inadequate or if you already require prescription corrective lenses for nearsightedness, farsightedness or astigmatism. Your choices include:

  • Prescription reading glasses. If you have no other vision problems, you can have prescription lenses for reading only.
  • Bifocals. These glasses come in two styles — those with a visible horizontal line and those without a line (progressive bifocals). When you look through progressive bifocals at eye level, the lenses correct your distance vision. This correction gradually changes to reading correction at the bottom.
  • Trifocals. These glasses have corrections for close work, middle-distance vision — such as for computer screens — and distance vision. Trifocals come with visible lines or progressive lenses.
  • Bifocal contact lenses. Bifocal contact lenses, like bifocal glasses, provide distance and close-up correction on each contact. In one type of bifocal lens, the bottom, reading portion of the lens is weighted to keep the lens correctly positioned on your eye. These are frequently difficult to fit and often do not provide altogether satisfactory visual results.

    Newer types of bifocal contact lenses offer distance correction through the peripheral part of the lens and near correction through the more central part of the lens, or alternately, distance correction through the center of the lens and near correction in the peripheral part of the lens. A trial of wearing these lenses will let you know if either of these lens styles can provide you with satisfactory vision. Early results with these lenses have been encouraging.

  • Monovision contact lenses. With monovision contacts, you wear a contact lens for distance vision in your dominant eye and a contact lens for close-up vision in your nondominant eye. Your dominant eye is generally the one you use when you're aiming a camera to take a picture.
  • Modified monovision. With this option, you wear a bifocal contact lens in your nondominant eye and a contact lens set for distance in your dominant eye. You use both eyes for distance and one eye for reading. Your brain learns which lens to favor — depending on whether you're viewing things close up or far away — so you don't have to consciously make the choice of which eye to use.

Refractive surgery

Refractive surgery changes the shape of your cornea. For presbyopia, this treatment — equivalent to wearing monovision contact lenses — may be used to improve close-up vision in your nondominant eye. The American Academy of Ophthalmology recommends that people try monovision contacts to determine if they can adjust to this kind of correction before considering refractive surgery.

Refractive surgical procedures include:

  • Conductive keratoplasty (CK). This procedure uses radiofrequency energy to apply heat to very tiny spots around the cornea. The degree of change in the cornea's curvature depends on the number and spacing of the spots, as well as the way in which the corneal tissue heals after the treatment. The results of CK are variable and may not be long lasting for many people.
  • Laser-assisted in-situ keratomileusis (LASIK). With this procedure, your eye surgeon uses either a special laser or an instrument called a keratome to make a thin, hinged flap in your cornea. Your surgeon then uses an excimer laser to remove inner layers of your cornea to steepen its domed shape. An excimer laser differs from other lasers in that it doesn't produce heat. A newer procedure, known as epithelial laser in situ keratomileusis (epi-LASIK), is believed to avoid some of the risks associated with LASIK.
  • Laser epithelial keratomileusis (LASEK). Instead of creating a flap in the cornea, the surgeon creates a flap only in the cornea's thin protective cover (epithelium). Your surgeon will use an excimer laser to reshape the cornea's outer layers and steepen its curvature and then reposition the epithelial flap.
  • Photorefractive keratectomy (PRK). This procedure is similar to LASEK, except the surgeon removes and discards the epithelium. It will grow back naturally, conforming to your cornea's new shape.

Lens implants

Another procedure used by some ophthalmologists involves removal of your clear natural lens and replacement with a synthetic lens inside your eye (intraocular lens implant). Some newer lens implants are designed to allow your eye to see things both near and at a distance. However, these special lens implants haven't been entirely satisfactory. The optical advantages of these lenses are sometimes outweighed by visual side effects that include glare and blurring.

In addition, this surgery carries with it the same risks associated with conventional cataract surgery, such as inflammation, infection, bleeding, glaucoma and retinal detachment. However, development of newer technologies will likely improve these implants in the future.

Small-diameter corneal inlays

A newer surgical procedure involves inserting small plastic rings at the edge of the cornea. However, this surgery hasn't had totally predictable results, and is still considered experimental. Although the rings can be removed, the surgery is not without risks.

Sep. 30, 2011

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