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.

Eyeglasses

Eyeglasses are a simple, safe way to correct vision problems caused by presbyopia. You may be able to use over-the-counter (nonprescription) reading glasses if you had good, uncorrected vision before developing presbyopia. Ask your eye doctor if nonprescription glasses are OK for you.

Most nonprescription reading glasses range in power from +1.00 diopter (D) to +3.00 D. When selecting reading glasses:

  • Try different powers until you find the magnification that allows you to read comfortably, starting with the lower powers
  • Test each pair on reading material held at a comfortable distance

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 lenses). 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. Many people with presbyopia find progressive lenses to be a good solution.
  • 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.

Contact lenses

People who don't want to wear eyeglasses often try contact lenses to improve their vision problems caused by presbyopia. This option may not work for you if you have certain conditions related to your eyelids, tear ducts or the surfaces of your eyes.

Several lens types are available:

  • Bifocal contact lenses. Bifocal contact lenses 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 don't provide satisfactory results.

    Newer types of bifocal contact lenses offer distance correction through the edges (periphery) of each lens and near correction through the center. Or distance correction may be offered through the center of each lens and near correction in the periphery.

    You might want to try these for a trial period to see if either of these lens styles work for you.

  • Monovision contact lenses. With monovision contacts, you wear a contact lens for distance vision in one eye (usually your dominant eye) and a contact lens for close-up vision in the other 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 or multifocal contact lens in one eye and a contact lens set for distance in the other (usually your dominant eye). You use both eyes for distance and one eye for reading.

Refractive surgery

Refractive surgery changes the shape of your cornea. For presbyopia, this treatment is used to improve close-up vision in your nondominant eye. It's like wearing monovision contact lenses. Even after surgery, you may need to use eyeglasses for close-up work.

Talk with your doctor about the possible side effects, as this procedure is not reversible. You might want to try monovision contact lenses for a while before you commit to surgery.

Refractive surgical procedures include:

  • Conductive keratoplasty. This procedure uses radiofrequency energy to apply heat to tiny spots around the cornea. The heat causes the edge of the cornea to shrink slightly, increasing its curve (steepness) and focusing ability. The results of conductive keratoplasty are variable and may not be long lasting.
  • Laser-assisted in-situ keratomileusis (LASIK). With this procedure, your eye surgeon makes a thin, hinged flap in your cornea. He or she then uses a laser to remove inner layers of your cornea to steepen its domed shape.

    After LASIK surgery, patients usually have a more rapid, less painful recovery than they would with photorefractive keratectomy.

  • Laser-assisted subepithelial keratectomy (LASEK). Instead of creating a flap in the cornea, the surgeon creates a flap only in the cornea's thin protective cover (epithelium). He or she then uses a laser to reshape the cornea's outer layers, steepening its curve.
  • Photorefractive keratectomy. This procedure is similar to LASEK, except the surgeon removes the epithelium. It will grow back naturally, conforming to your cornea's new shape.

Lens implants

Some ophthalmologists use a procedure in which they remove the lens in each eye and replace it with a synthetic lens. This is called an intraocular lens implant. Some people choose this procedure even after having had LASIK surgery many years before to be free from glasses.

Many types of lens implants are available for correcting presbyopia. Some allow your eye to see things both near and at a distance. Some change position or shape within the eye (accommodative lens). But lens implants can cause a decrease in the quality of your near vision, and you may still need reading glasses. Possible side effects include glare and blurring.

In addition, this surgery carries with it the same risks as those associated with cataract surgery, such as inflammation, infection, bleeding and glaucoma.

Corneal inlays

Some people have had success with a presbyopia treatment that involves inserting a small plastic ring at the edge of each cornea to change its curve. You may be a candidate for this option even if you had LASIK surgery in the past.

If you don't like the results of your corneal inlay procedure, your eye surgeon can remove the rings, leaving you free to consider other treatment options. The corneal inlay procedure has fewer risks and side effects than the other surgical options for presbyopia.

Oct. 17, 2014

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