Management of Presbyopia in Older People

Introduction

As age increases, it is normal for the body to undergo certain changes. Elderly people usually face difficulties distinguishing colors, need more time to adjust to the changing light intensities, may lose the ability to see close things, or may have blurred vision. Age-related eye changes can also occur due to underlying disorders such as macular degeneration (an eye disorder that causes blurry vision), diabetes (a metabolic condition that causes elevated blood sugar levels), cataracts (the lens in the eyes appear cloudy), glaucoma (a set of eye disease that leads to blindness), etc. Many people may not notice the symptoms or neglect these changes at an early stage. Regular eye check-ups and maintaining eye health help protect vision and prevent vision loss.

What Is Presbyopia?

Presbyopia in the Greek language means old eyes. It is a gradual loss of the ability of the eyes to focus on any nearby objects. It is a common age-related disorder seen in adults around mid-40 years and may worsen as age increases. Presbyopia is usually seen in women more than men. Up to 85 percent of adults above 40 years old may develop presbyopia. It is usually noticed when elderly people start holding mobile phones, books, or newspapers at a distance (about arm’s length) to read. Untreated presbyopia can affect the quality of life of individuals by requiring dependency on spectacles, increased light, frequent headaches, problems with reading, and others.

What Are the Causes of Presbyopia?

The lens of the eyes changes shape to focus the light onto the retina to see. At young ages, the lens is soft and flexible and changes shape easily to focus on near and far objects. Presbyopia can be caused due to loss of elasticity or hardening of the lens as a result of aging. It may also be due to the weakening of the ciliary muscles. It occurs due to loss of accommodation as the lens changes with age, and the ability to expand reduces, resulting in the loss of refractive power. According to Helmholtz’s theory, presbyopia can occur due to sclerosis of the crystalline lens, but Schachar suggested that an increase in the equatorial diameter of the lens due to aging can cause presbyopia.

What Are the Signs and Symptoms of Presbyopia?

Signs and symptoms of presbyopia include:

• Holding the reading device, books, or newspapers far away to make letters clearly visible.

• Headache, eye pain, or strained eyes after reading.

• Blurring of the vision at a normal reading distance.

• Requirement of more light while reading.

• Difficulty in reading small letters.

• Some symptoms which require immediate attention include; sudden hazy or blurred vision, double vision or loss of vision in one eye, experiencing flashes of light or black spots around lights.

What Are the Risk Factors Associated With Presbyopia?

Risk factors associated with presbyopia include:

• Increase in age.

• History of head injury.

• Hyperopia or farsightedness.

• Medical conditions such as diabetes, anemia, multiple sclerosis (a disease that causes damage to the layers covering the nerves due to immune disorders), and cardiovascular diseases.

• Drugs such as antidepressants, diuretics, antihistamines, and others.

How Is Presbyopia Managed in Older People?

Presbyopia can be diagnosed during routine eye examinations when the doctor uses various instruments and eye drops to check the lens and inner parts of the eyes to test the distance and closed vision. A refraction assessment is then performed to determine the far-sightedness, near-sightedness, or myopia. Treatment of presbyopia is based on the severity of the condition, which includes wearing corrective spectacles, contact lenses, or undergoing refractive surgery.

Corrective Spectacles: These are a simple and safe way to correct vision problems, especially in elderly people. Under the doctor's advice, different reading glasses can be tried. A suitable one can be selected based on the appropriate magnification, which is comfortable for reading or viewing things nearby. These prescription spectacles can be removed when not reading. Bifocal eyeglasses are often prescribed for presbyopia, as it has two parts, the upper portion of the lens focuses on distance prescriptions and the lower portion on closeby objects. Trifocal spectacles have three lenses, which include; closeby, far-off, and in-between vision.

Contact Lenses: Monovision contact lenses are available; in which one eye can view the objects that are far and the other eye, the objects that are near. The individual might take a few weeks to adjust to these lenses. Modified monovision lenses were developed, which include one lens for far or near vision and another multifocal lens to view all distances. A bifocal lens is available in soft and hard materials, and these can be helpful in two focal points, near and far. Multifocal contact lenses are available in soft and gas-permeable options and are similar to bifocal ones, but it includes two focal points and an intermediate zone.

Refractive Lens Exchange: A lens replacement procedure can be performed in some patients, which is similar to a cataract surgery, during which all deformities, such as far or near-sightedness, presbyopia can be corrected depending on the type of implant used.

Corneal Inlays: It is a recent technique that works similarly to a pinhole camera effect but is less commonly preferred. During this surgical procedure, a tiny plastic ring is inserted into the cornea of one eye, allowing the eye to view far and near objects, and it also reduces blurred vision.

Refractive Surgery: It is a minimally invasive surgery, usually done on an outpatient basis by a trained ophthalmologist (eye specialist). The surgeries recommended for presbyopia include:

• LASIK Surgery: It is a popular surgical treatment, also known as laser in-situ keratomileusis, which is used to correct far-sightedness, near-sightedness, and astigmatism (an eye condition, where the lens curvature appears abnormal).

• Small Incision Lenticule Extraction (SMILE) Surgery: It is a small incision lenticule extraction (SMILE) surgical procedure in which a precise laser is used to create disc-shaped tissue inside the cornea (reshaping the cornea).

• Photorefractive Keratectomy (PRK) Surgery: In case of near and farsightedness, and astigmatism, photorefractive keratectomy surgery is performed.

Can Presbyopia Be Prevented?

Presbyopia cannot be prevented; however, certain measures can be taken to protect vision and eye health, such as;

• Maintaining a healthy lifestyle by consumption of a balanced diet that includes plenty of vegetables, fruits, and green vegetables as they contain antioxidants, especially foods containing vitamins A, C, E, and beta-carotene, which are known to be beneficial to the eyes.

• Regular eye check-ups every year to diagnose the conditions at an early stage.

• Regular health check-ups to control chronic health conditions as they affect vision.

• Protecting the eyes with sunglasses when spending long hours outside during the day.

• Reading only under adequate light and using appropriate reading glasses, which are recommended by the doctor.

Conclusion

Presbyopia is a common age-related disorder characterized by loss of ability to view nearby objects, mostly beginning in the mid-40s and may progress as age increases. It may be caused due to loss of elasticity of the lens or weakened ciliary muscles. Presbyopia can be managed by corrective spectacles, contact lenses, or refractive surgery. Regular eye check-ups and following a healthy diet may help improve the condition.