Why can’t I see to read anymore?
Everyone in their 40s develops presbyopia, the age-related loss of near vision, whereby, if you previously had great distance and near vision without specs, you now need them for near. The word presbyopia is derived from ancient greek and means “old eye.” It affects everyone in their 40s, and like greying hair and wrinkles, is unavoidable.
For those who are yet to develop it, it is hard to understand as the eye is still able to change focus instantaneously between far and near, seamlessly and without thought. For those who have it, it is frustrating and means reading glasses are needed. Even those who are short-sighted will either need reading glasses when wearing their contact lenses, or to take their glasses off to see near. Its onset is insidious and typically first noticed when you have trouble reading in bed or seeing your phone on waking.
What causes presbyopia?
The biology behind presbyopia is complex with a number of interacting mechanisms, but in brief, when you are young, the natural lens in the eye is soft and flexible, easily changing shape; as you age, it stiffens, losing the ability to change focus.
To date, there is no treatment to prevent or reverse presbyopia. All of the options are essentially work-arounds.
Reading glasses- what are my options?
These are the simplest options, and this is what makes them so commonly used. They are low cost, zero risk (except when you lose them before an important meeting!) and some even wear them as a style statement. However their simplicity is also their main cause of frustration: they have to travel wherever you go, forgetting them means you can’t see close and you also have to deal with smudges or scratches. Some patients have pairs in almost every room of their house or coat pockets.
Reading glasses can be bought as prescription, or over-the-counter. The latter are cheaper but don’t work as well as they are not tailored to each of your eye’s individual focus.
If you already wear glasses, you can consider bifocals, or trifocals, or progressive lenses. Bifocals correct for close-up and far vision and have a line that may be noticeable that divides the lens into two parts with the bottom of the lens refracts light for near vision and the top part refracting light to allow you to see distant objects. Trifocals work on a similar principle but with an additional middle section for intermediate vision. Progressive lenses, or “varifocals” correct vision like bifocals and trifocals, but instead of a marked graduation or line between the refracting areas, the refraction changes gradually in the lens from top to bottom.
Contact lens options
With contact lenses, the options are to consider multifocal contact lenses (that have different rings or zones for vision at different distances), or to consider monovision contact lenses. With the latter, one eye is focussed for near and the other for far.
Both multifocal contact lenses and monovision contact lenses take time to adjust to, you may notice some overall loss of sharpness with multifocal contact lenses or increased glare/ halo at night; and with monovision contact lenses you have to relearn a little to judge distances or object speeds as the eyes are no longer working fully together.
Eye drops
More recently, eye drops have become available for presbyopia. However rather than preventing or reversing it, they work by constricting the pupil, so helping the eye see more closely. This means that vision in dim light can be impaired, and other side effects can include headaches, eye irritation and retinal problems. These drops are prescription only and are currently only available in the US. Both Vuity™ and Qlosi™ have the same active ingredient, pilocarpine, but differ in strength and dosing frequency: Vuity (1.25%) is once a day, while Qlosi (0.4%) is up to twice a day. Qlosi is also preservative-free to help prevent eye irritation.
Surgical solutions.
There are a number of surgical solutions for presbyopia and these, whilst providing good distance and near vision without needed glasses, is a different type of vision to that you had in your 20s and 30s.
- LASIK and other methods of laser eye surgery can be used to create a type of monovision, creating a small disparity in the focus between the eyes. One eye is focussed for optimal distance and the other for optimal near, the brain seamlessly marries and blends the images together.
- ICL (implantable contact lens) can also be used for monovision for those unsuitable for laser eye surgery.
- Refractive lens exchange (RLE) is where the natural lens is removed and replaced with an artificial lens implant, taking only 10-15 minutes per eye to be completed. Multifocal lens implants aim to give a full range of focus in each eye and almost all patients with these are spectacle free. Alternatively, extended depth of focus lenses can be used with a small offset each eye, meaning one eye covers distance, intermediate and some near, and the other covering more intermediate and near.
Laser Eye Surgery for Reading Glasses or Refractive Lens Exchange- Which is Right for You?
If you are over 45, tired of needing reading glasses, and want a long term vision solution, a personalised assessment is the next step.
Book a consultation with Mr Alex Day at Moorfields Private West London to explore the options for you.
Call: 020 7100 5468
WhatsApp: https://api.whatsapp.com/send/?phone=447999932020
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FAQs
Is refractive lens exchange the same as cataract surgery?
The surgical technique is similar, with RLE being performed to improve vision without the need for glasses, whilst cataract surgery is performed to improve vision as the natural lens in the eye has become cloudy. If you have RLE, you will not need to have cataract surgery later in life.
Can you have laser eye surgery after 50?
Yes, if the natural lens is clear and presbyopia symptoms are mild. A consultation determines suitability.
Will I still need glasses after RLE?
Many patients achieve full spectacle independence, depending on lens choice and visual goals.
Is RLE permanent?
Yes. Once the lens is replaced, it does not age or cloud.
How do I know which option is right for me?
A detailed, consultation-led assessment is essential. No single treatment suits everyone.
