Presbyopia is the gradual, age-related loss of the eye's ability to focus on near objects. The lens becomes stiffer with age, so most people notice it in their 40s and almost everyone has it by their 50s.
Key symptoms
- Trouble reading small print up close
- Holding books or phones at arm's length
- Eye strain or headache after near work
- Needing brighter light to read
- Distance vision unchanged
What you find on exam
- Normal-looking eyes
- Normal distance visual acuity if there is no other refractive error
- Reduced near acuity on a near reading card
- Near point of focus moved farther away
- Screening for cataract, glaucoma and diabetic eye disease
Tests
- Near and distance visual acuity
- Refraction to measure the reading power needed
- Comprehensive dilated eye exam, mainly from age 40
- Intraocular pressure check
Treatment basics
- Over-the-counter reading glasses
- Prescription bifocal, trifocal or progressive lenses
- Multifocal or monovision contact lenses
- Pilocarpine eye drops for temporary near focus in selected adults
- Refractive surgery or lens implants in selected patients
Red flags
- Sudden vision loss or sudden blurring
- Eye pain, red eye or halos around lights
- New flashes, floaters or a curtain over the vision
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.