Many people are under the impression that wearing reading glasses is an inevitable part of getting older. While it’s true that everyone’s near vision will deteriorate because of a condition called presbyopia, it’s not actually true that you must wear reading glasses – vision correction procedures exist that can correct presbyopia permanently and give you clear vision.
Presbyopia is caused by the lens inside the eye becoming stiffer and less able to focus on close-up objects. The appropriate surgical treatment for presbyopia generally depends on the age of the person and the health of their lens.
If the lens has lost its flexibility, but is otherwise clear and healthy, a cornea-based procedure is often the treatment of choice. This is normally the situation for patients between the ages of 40 and 55.
Laser blended vision: In this type of laser eye surgery, the surgeon intentionally makes one eye more near-sighted, to compensate for the lens not being able to focus up-close. You won’t notice that one eye is better at seeing near objects and the other is better at seeing intermediate or distant objects because your brain blends the images together.
Corneal inlays (e.g. KAMRA, Raindrop or Presbia): These tiny, flexible lenses are placed within the cornea of the non-dominant eye to correct vision, and they can be removed at a later stage should another lens procedure (such as cataract surgery) be required.
Cataract surgery or refractive lens exchange: If the lens of the eye is clouded (e.g. showing signs of cataract) or if the patient is older (60+), then a lens-based procedure is generally more suitable. In this procedure, the eye’s natural lens is removed and replaced with an artificial lens – many of which can correct presbyopia. The procedure is referred to as cataract surgery when a cataract is removed or refractive lens exchange when a clear lens is removed.
Lens replacement is not normally recommended for younger patients because the currently available artificial lenses are not as good as a younger person’s natural lens. In saying that, the lens technology available today is pretty remarkable and in many cases lenses can offer patients much better vision than they have had in years. This is especially true for patients who have had their cataracts removed.
When helping you choose an intraocular (IOL) replacement lens, the surgeon has to identify which lens will optimise your quality of vision while minimising any unwanted effects, such as glare or halos. This depends on your vision (i.e. if you have short-sightedness, long-sightedness and/or astigmatism in addition to presbyopia), your lifestyle preferences and whether you are willing to accept some visual compromise. Lens selection is a crucial part of ensuring my patients achieve good visual outcomes after their refractive lens exchange or cataract surgery procedure.
Multifocal lenses give clear vision at multiple distances and can correct presbyopia as well as other refractive errors. Bifocal lenses correct vision at two distances (near and far), while trifocal lenses correct vision at three distances (near, intermediate and far). While there can be some visual compromise with these lenses, many patients are able to gain spectacle independence after their procedure. I have been doing multifocal lens implants for over 15 years and these are the lenses of choice for the vast majority of my patients.
Extended-depth-of-focus lenses are a newer type of presbyopia-correcting IOL. These lenses offer good vision over varying distances to provide an extended range of vision. Generally, patients no longer need glasses for driving, watching TV and looking at a computer or phone but, unlike multifocal IOLs, they may still require low-power reading glasses. A key benefit of these lenses is that they have less visual compromise than traditional multifocal IOLs, with better contrast sensitivity and a lower likelihood of glare or halos.
Blended vision can also be achieved with replacement lenses. The lens implanted in one eye will correct for reading/near vision and the lens in the other eye will correct distance vision.
We are constantly striving to improve visual outcomes for patients with presbyopia. In my opinion, the most exciting developments on the horizon are in the optical design of replacement lenses. The ultimate goal is to develop dynamic lenses that act like the eye’s natural lens – artificial lenses that can change the focusing power in the eye effortlessly. I’m feeling optimistic that these will be here in the not-too-distant future.
Whether you’ve recently noticed changes in your reading vision or you have been relying on glasses for many years, it’s never too late to explore your options for treating presbyopia.
If you would like to free yourself from the constraints of reading glasses, book a consultation today for a full assessment and discussion of your treatment options.
Dr Patrick Versace is a highly regarded refractive and cataract surgeon who specialises in presbyopia correction. He has expertise in corneal inlays, multifocal lenses and laser eye surgery. He practices at Vision Eye Institute Bondi Junction and Vision Eye Institute Hurstville.
All medical and surgical procedures have potential complications. Check with your doctor before proceeding.
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