What is presbyopia? Symptoms and correction of presbyopia / presbyopia

Presbyopia, also known as presbyopia, affects almost everyone over a certain age. If reading suddenly becomes more strenuous, your arms appear “too short” and the writing on your smartphone or in books becomes increasingly blurred, this is usually due to this natural ageing process of the eye. But what exactly is presbyopia? How does it differ from other visual defects such as short-sightedness, long-sightedness and astigmatism? And above all, what treatment options are available to restore sharp vision?

What is presbyopia?

Presbyopia, also known as presbyopia or presbyopia, is a natural change in the eye that occurs with increasing age. From around the age of 40 to 45, many people notice that they find it difficult to see nearby objects clearly and sharply. This visual impairment is particularly noticeable when reading, when text suddenly becomes blurred or out of focus.

The cause lies in the elasticity of the lens of the eye. With increasing age, the lens loses its natural flexibility and therefore also its ability to adjust to different distances. This loss of the eye’s refractive power means that the so-called “near point”, i.e. the point at which an object is still perceived in focus, moves further and further away from the eye. This explains why many people of a certain age need reading glasses to be able to see clearly at close range again.

Presbyopia affects almost everyone in the course of their lives and is not a disease, but a normal part of the ageing process of the eye. As presbyopia is caused by a decrease in lens flexibility, it cannot be completely corrected by simple corrections such as those for short-sightedness or long-sightedness. Instead, it requires special visual aids such as glasses or contact lenses to restore sharp near vision.

It is important to understand that presbyopia, which is often mistakenly equated with long-sightedness (medically known as hyperopia), is a separate form of defective vision. While long-sightedness is usually present from birth and is based on the eye’s refractive power being too low, presbyopia only develops with increasing age and mainly affects near vision.

Differentiation from other visual defects such as short-sightedness, long-sightedness & astigmatism

Short-sightedness (myopia)

With short-sightedness or myopia, those affected can see close objects clearly, while distant objects appear blurred. This visual defect occurs when the eyeball is too long or the refractive power of the eye is too strong, so that light is focused in front of the retina. In contrast to presbyopia, which is caused by the natural ageing process of the lens, short-sightedness often occurs in childhood or adolescence and persists throughout life.

Farsightedness (hyperopia)

Farsightedness, medically known as hyperopia, is a condition in which distant objects appear sharp but close objects appear blurred. This visual defect is caused by the eyeball being too short or the refractive power of the eye lens being too low, causing light to focus behind the retina. Although farsightedness and presbyopia bothaffect near vision, they differ in their origin: farsightedness is often congenital or develops early in life, while presbyopia is almost exclusively caused by the loss of lens flexibility with age.

Astigmatism (curvature of the cornea)

Astigmatism, also known as corneal curvature, occurs when the cornea or lens is unevenlycurved, resulting in distorted or blurred vision at all distances. Instead of focusing light evenly on the retina, astigmatism causes irregular refraction of light, making it difficult to see clearly. This visual defect can occurin combination with short-sightedness, long-sightedness or presbyopia.

Causes of presbyopia (presbyopia)

Loss of lens elasticity

The main factor in the development of presbyopia is the loss of elasticity in the lens of the eye. At a young age, the lens is flexible and can easily change its shape to focus on objects at different distances. This process, known as accommodation, allows us to see both near and far objects clearly.

However, as we age, the lens loses its flexibility and can no longer curve as much as it needs to for sharp near vision. This loss of adaptability means that the eyehas difficultyfocusing on close objects, causing them to appear blurred or out of focus.

Changes in the lens structure

In addition to the loss of elasticity, there is also a thickening and hardening of the lens itself. Over the years, protein molecules are deposited in the lens, making it more rigid. These changes also contribute to the lens losing its ability to accommodate. As a result of this increasing hardening and thickening, the point at which the eye can still focus clearly on close objects shifts further and further into the distance.

Decrease in muscle strength

Another factor that contributes to presbyopia is the decrease in muscle strength of the ciliary muscles that control the lens in the eye. These muscles are responsible for curving the lens, changing the refractive power of the eye to see near objects in focus. As we age, these muscles lose strength, which makes it more difficult for them to deform the lens sufficiently. This also causes close objects to appear blurred.

Symptoms of presbyopia / presbyopia

• Difficulty reading nearby: Books, smartphones or restaurant menus suddenly appear blurred. Many people have to hold the text further away from their eyes to be able to recognize the letters better.
• Eye strain during close work: Activities such as sewing, reading or working on the computer require more concentration and lead to tired or strained eyes more quickly.
• Headaches and eye pain: The constant effort to see close objects clearly can lead to headaches and a feeling of pressure in the eyes, especially after prolonged work at close range.
• Blurred vision at close range: Seeing objects close up becomes increasingly difficult and blurred, especially in low light or after a long day.
• Increased need for light: Many people find that they need more light to see well at close range. Reading in dim light becomes increasingly tiring.
• Avoidance of close work: Due to the symptoms, many people tend to avoid close work, which can have a negative impact on their quality of life.
• Need for reading glasses: At a certain point, most people need reading glasses to see clearly and sharply again. This often happens from the age of 45, when presbyopia becomes more pronounced.
• Change in visual habits: Reading up close can become uncomfortable, and many people are starting to hold text or objects further away from their eyes to make them easier to see.

How does presbyopia affect everyday life?

• Difficulties with reading: Books, magazines, and especially small print on packaging or smartphones are becoming increasingly difficult to read. Many people find that they have to hold the text further away in order to read it clearly, which is known as the “arms getting too short” phenomenon.
• Difficulty working on the computer: Working on a computer or laptop can become more strenuous, as constantly switching between looking at the screen and other objects at close range can lead to eye pain and fatigue.
• Problems when cooking: Reading recipes or deciphering ingredient lists on packaging can be challenging, especially if the lighting in the kitchen is not optimal.
• Shopping: When shopping, it can be difficult to recognize price tags or ingredients on products, which can slow down the shopping process and make it frustrating.
• Use of smartphones and tablets: Reading messages, emails or browsing social media on small screens often requires the text to be enlarged or reading glasses to be worn.
• Problems with manual work: Fine motor activities such as sewing, handicrafts or DIY often require sharp close-up vision, which is impaired by presbyopia. Threading a thread through a needle or precise cutting can become much more difficult.
• Driving a car: When driving, especially in poor lighting conditions, presbyopia can make it more difficult to read maps, navigation devices or the dashboard, as these are often at close range.
• Increased effort at work: People who have to do a lot of close work in their profession, such as jewelers, watchmakers or dentists, may find that they have to exert more effort to perform their tasks. This can lead to faster fatigue and a drop in performance.
• Restrictions on leisure activities: Hobbies such as reading, crafting, or playing musical instruments that require good near vision can be affected by presbyopia. This can reduce the enjoyment of these activities and limit the quality of life.
• Social situations: In social situations, such as reading a menu in a restaurant or using a smartphone in public, presbyopia can lead to frustration if you can no longer see well without aids.

Correction of presbyopia: treatment options for presbyopia

Glasses and contact lenses

Glasses as a correction for presbyopia

• Reading glasses: The simplest and most frequently used solution is reading glasses. They are specially adapted for near vision and help to restore focus when reading, working at the computer or performing other close-up activities. Reading glasses are particularly practical as they are easy to put on and take off when they are not needed.
• Progressive spectacles: Progressive spectacles offer seamless correction for both near and distance vision. Unlike reading glasses, which only correct a single distance of vision, varifocals have multiple strengths that run from top to bottom of the lens. This makes it possible to see clearly at different distances without changing glasses, which is particularly convenient in everyday life.
• Special workplace glasses: Special workplace glasses are available for people who work a lot at a computer. These glasses are designed to optimally correct both the close-up range and medium distances that occur when working at a desk. They are particularly suitable for those who spend long periods of time in front of a screen and need a clear view.

Contact lenses for the correction of presbyopia

• Multifocal contact lenses: Multifocal contact lenses are a popular option for correcting presbyopia. These lenses offer multiple zones of vision in a single lens, similar to varifocals. The wearer can see both near and far objects clearly without having to wear glasses. Multifocal contact lenses are particularly suitable for people who find glasses annoying or lead an active lifestyle.
• Monovision contact lenses: Another method used for presbyopia is monovision. One eye is corrected for distance vision and the other for near vision. This solution requires a certain period of adaptation, as the brain has to learn to process the two different visual acuities. Monovision can be achievedwith disposable contact lenses as well as with hard or soft lenses.
• Hybrid contact lenses: These combine the advantages of hard and soft contact lenses and offer both high wearing comfort and clear visual acuity for different distances. They are a good choice for people who are looking for a flexible and comfortable solution.

Laser eye surgery with PresbyMAX

Laser eye surgery with PresbyMAX is a modern and effective method for correcting presbyopia. It offers a way of regaining sharp vision and largely eliminating the need for glasses or contact lenses. PresbyMAX has been specially developed for people who suffer from presbyopia and are looking for a long-term solution to improve their near vision.

How PresbyMAX works

PresbyMAX is a variant of laser treatment that is based on the proven LASIK technology and was developed specifically for the treatment of presbyopia. The essence of this procedure is to adjust the refractive power of the eye sothat vision is improved at near, far and medium distances. Here is how the process works:

1. Preliminary examination: A comprehensive eye examination is carried out before the procedure to determine whether the patient is suitable for PresbyMAX treatment. The cornea and other important parameters of the eye are measured precisely.
2. Adaptation of the cornea: During the procedure, the laser reshapes the cornea to give it a multifocal refractive power. This means that different areas of the cornea are optimized for sharp vision at different distances. The central area of the cornea is usually corrected for near vision, while the outer area is optimized for distance vision.
3. Combination of near and far vision: The precise modification of the cornea creates a kind of “multi-focal effect” that enables the eye to see objects sharply at different distances. This adaptation enables the brain to make optimum use of the relevant visual zones depending on the visual task.
4. Rapid recovery: After the procedure, most patients can resume their usual activities after a short time. Vision usually stabilizes within a few days to weeks, with the full corrective effect being achieved after a few months.

Limit values and suitability

Although PresbyMAX is an effective solution for many patients, there are certain limits and requirements that must be observed:

• Age: PresbyMAX treatment is generally recommended for people aged 40 and over if presbyopia is clearly noticeable. This method is not usually necessary for younger patients, as the lens still has sufficient elasticity.
• Refractive power of the eye: PresbyMAX can be used for patients with short-sightedness(myopia), long-sightedness(hyperopia) and a slightastigmatism. However, there are limits up to which the laser can work effectively. Typically, the limit is around -8 diopters for short-sightedness and +4 diopters for long-sightedness. The cornea must also be of sufficient thickness for the treatment to be carried out safely.

Lens implantation or lens exchange as a solution for presbyopia

The aim of lens implantation is to replace the eye‘s natural lens, which has lost its elasticity and therefore its ability to accommodate, with an artificial intraocular lens (IOL). This artificial lens isspecifically designed to adjust the refractive power of the eye to correct presbyopia. There are different types of intraocular lenses, which are selected according to the patient’s needs and individual requirements:

• Monofocal lenses: These lenses provide sharp vision at a specific distance – either near or far. Patients who opt for monofocal lenses usually need reading glasses for near vision.
• Multifocal lenses: These lenses offer multiple focal points and enable sharp vision at different distances. They are designed to improveboth near and distance vision. Multifocal lenses are a common choice for people who want to be as independent as possible from glasses or contact lenses after surgery.
• Trifocal lenses: A further development of multifocal lenses which, in addition to near and distance vision, also offer improved intermediate vision (for medium distances, e.g. at the computer). These lenses are ideal for people who want comprehensive correction.
• EDOF lenses (Extended Depth of Focus): These lenses provide extended depth of focus and allow for more uniform vision at various distances. They are particularly beneficial for patients who prefer very good visual acuity and minimal optical side effects.

The operational process

Lens implantation is a comparatively quick and safe procedure that is performed on an outpatient basis under local anesthesia:

1. Removal of the natural lens: First, the natural, aged lens of the eye is removed. This step is similar to cataract surgery, in which the clouded lens is replacedwith an artificial lens.
2. Insertion of the artificial lens: The selected intraocular lens is inserted into the eye. The lens is positioned in the capsular bag that surrounds the natural lens and remains permanently anchored there.
3. Healing process: After the operation, the eye needs a few weeks to heal completely and adapt to the new lens. Most patients experience a significant improvement in their vision just a few days after the operation.

Limits and risks

As with any surgical treatment, there are certain limits and risks associated with lens implantation:

• Age: Lens implantation is generally advisable from the age of around 50, when presbyopia is more pronouncedand other age-related changes such as cataracts may also need to be treated.
• Eye health: Before the procedure, the eyes must be thoroughly examined to ensure that there are no other eye diseases that could affect the success of the operation.
• Risks: As with any surgical procedure, there are risks such as infection, inflammation or visual impairment, but these are rare and can be treated well in most cases.