By Dr. Avinash Gurbaxani, Consultant Ophthalmologist, Medical Retina & Uveitis Specialist, Moorfields Eye Hospital Dubai

United Arab Emirates -  November 02, 2020:    Having trouble focusing on near objects, especially as you head into your 40s and 50s, could be a key sign that you are developing presbyopia. Presbyopia is a condition that affects many people, worsening as they age. 

When we are young, our crystalline lens, the part of the eye that is responsible for a large amount of the eyes focusing power, is flexible, which allows the muscles within the eye to manipulate it. As the muscles manipulate the lens, a reflex occurs that allows the lens to alter its thickness, which adjusts the lens power so that it can focus in on a range of distances. 

As we grow older, the lens becomes stiffer and more rigid, thus, it becomes harder for the muscles to manipulate the lens. When this occurs, the eyes lose their ability to focus light into the retina efficiently. In result, the eyes have trouble focusing, which leads to blurred near vision. 

Globally, the prevalence of presbyopia continues to rise, in fact according to Jama Ophthalmology, about 1.04 billion people suffered from presbyopia globally in 2015 and this number was predicted by the National Eye Institute to rise to 1.37 billion in this year  .

How does Presbyopia occur?
Presbyopia develops over time. One of the first signs of the condition, is the need to place objects farther away or increase the size of digital screens to view them. While this may be a short-term solution, eventually, the need for glasses to perform day to day activities becomes evident. 

The glass lens will act as a magnifier that can be used for near vision when a patient has strong farsightedness. Alternatively, the magnifiers may be added to far vision correction glasses to provide dual vision correction. 

Presbyopia has been corrected with glasses for a long time, but those who do not want to wear glasses can opt for surgical remedies:

1 – Monovision Surgery 
Monovision surgery performed via laser or intraocular lenses, has a remarkably high success rate of 92.5% in rectifying presbyopia . This technique uses binocularity, the brain’s ability to process images from each eye individually to create one picture, to adjust the patients’ vision.  During the operation, the surgeon sets one eye for distance vision and the other eye for near vision. When the patient’s visual system copes with this change, the eyes merge both images together to provide the patient with corrected vision.

2 – Multifocal Intraocular Lenses 

Multifocal intraocular lenses are implanted after removing the natural lens through a procedure known as refractive lens exchange. The multifocal intraocular lenses have different gradients which allows patients to see for far, intermediate and near without glasses thus giving you spectacle independence for driving, mobile phone, books or computer screen. This procedure is usually performed in both eyes. Multifocal lenses can be implanted in cataract patients as well.

In all cases, the treatment option that the patients select depends on their age, current eye health, and visual power.  Therefore, we advise that each patient consult with their ophthalmologist to find out which option is best for them. During the consultation, the doctor will conduct a thorough eye test to identify any challenges or risks that might occur during the surgery which will ensure that the patient undergoes the surgery that is best for them.