Presbyopia

{{short description|Medical condition associated with aging of the eye}}

{{Infobox medical condition (new)

| name = Presbyopia

| alt = Small print ingredients list

| caption = A person with presbyopia cannot easily read the small print of an ingredients list (top), which appear clearer to someone without presbyopia (bottom).

| field = Optometry, ophthalmology

| synonyms = The aging eye condition

| symptoms = Difficulty reading small print, having to hold reading material farther away, headaches, eyestrain

| complications =

| onset = Progressively worsening in those over 40 years old

| duration =

| types =

| causes = Aging-related hardening of the lens of the eye

| risks =

| diagnosis = Eye exam

| differential =

| prevention =

| treatment = Eyeglasses, contact lenses

| medication =

| prognosis =

| frequency = 25% currently; all eventually affected

| deaths =

}}

Presbyopia is a physiological insufficiency of optical accommodation associated with the aging of the eye; it results in progressively worsening ability to focus clearly on close objects.{{cite book |last1= Khurana |first1= AK |title= Theory and practice of optics and refraction |publisher= Elsevier |isbn= 978-81-312-1132-8 |pages= 100–107 |edition= 2nd |chapter= Asthenopia, anomalies of accommodation and convergence|date= September 2008 }} Also known as age-related farsightedness{{Cite web|title= 5 Facts About Age-Related Farsightedness You Probably Didn't Know|url= https://www.webmd.com/connect-to-care/lasik/facts-about-age-related-farsightedness|access-date= 2022-02-02|website= www.webmd.com|language= en}} (or as age-related long sight in the UK{{Cite web|title= Age-related Long Sight|url= https://patient.info/eye-care/long-sight-hypermetropia/age-related-long-sight-presbyopia|access-date= 2022-02-02|website= patient.info|language= en}}), it affects many adults over the age of 40. A common sign of presbyopia is difficulty in reading small print, which results in having to hold reading material farther away. Other symptoms associated can be headaches and eyestrain. Different people experience different degrees of problems. Other types of refractive errors may exist at the same time as presbyopia. This condition is similar to hypermetropia or far-sightedness, which starts in childhood and exhibits similar symptoms of blur in the vision for close objects.

Presbyopia is a typical part of the aging process. It occurs due to age-related changes in the lens (decreased elasticity and increased hardness) and ciliary muscle (decreased strength and ability to move the lens), causing the eye to focus right behind rather than on the retina when looking at close objects. It is a type of refractive error, along with nearsightedness, farsightedness, and astigmatism. Diagnosis is by an eye examination.

Presbyopia can be corrected using glasses, contact lenses, multifocal intraocular lenses, or LASIK (PresbyLASIK) surgery.{{cite journal |last1= Pérez-Prados |first1= Roque |last2= Piñero |first2= David P |last3= Pérez-Cambrodí |first3= Rafael J |last4= Madrid-Costa |first4= David |title= Soft multifocal simultaneous image contact lenses: a review |journal= Clinical and Experimental Optometry |date= March 2017 |volume= 100 |issue= 2 |pages= 107–127 |doi= 10.1111/cxo.12488|pmid= 27800638 |s2cid= 205049139 }}{{Cite web|title= PresbyLASIK - EyeWiki |url= https://eyewiki.aao.org/PresbyLASIK|access-date= 2020-08-27|website= eyewiki.aao.org|language= en}} The most common treatment is glass correction using appropriate convex lens. Glasses prescribed to correct presbyopia may be simple reading glasses, bifocals, trifocals, or progressive lenses.

People over 40 are at risk for developing presbyopia and all people become affected to some degree.{{cite web|title= Facts About Presbyopia|url= https://nei.nih.gov/health/errors/presbyopia|website= National Eye Institute|access-date=11 September 2016|date=October 2010|archive-url= https://web.archive.org/web/20161004195255/https://www.nei.nih.gov/health/errors/presbyopia|archive-date= 4 October 2016|url-status= dead}} An estimated 25% of people (1.8 billion globally) had presbyopia {{as of | 2015 | lc = on}}.{{cite journal |last1= Fricke |first1= Timothy R. |last2= Tahhan |first2= Nina |last3= Resnikoff |first3= Serge |last4= Papas |first4= Eric |last5= Burnett |first5= Anthea |last6= Ho |first6= Suit May |last7= Naduvilath |first7= Thomas |last8= Naidoo |first8= Kovin S. |title= Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia |journal= Ophthalmology |date= October 2018 |volume= 125 |issue= 10 |pages= 1492–1499 |doi= 10.1016/j.ophtha.2018.04.013|pmid= 29753495 |doi-access= free |hdl= 1959.4/unsworks_79548 |hdl-access= free | quote = We estimate there were 1.8 billion people (prevalence, 25%; 95% confidence interval [CI], 1.7–2.0 billion [23%–27%]) globally with presbyopia in 2015 [...].}}

Signs and symptoms

The first symptoms most people notice are difficulty reading fine print, particularly in low light conditions, eyestrain when reading for long periods, blurring of near objects or temporarily blurred vision when changing the viewing distance. Many extreme presbyopes complain that their arms have become "too short" to hold reading material at a comfortable distance.{{cn|date=July 2022}}

Presbyopia, like other focal imperfections, becomes less noticeable in bright sunlight when the pupil becomes smaller.{{cite web|url=http://www.marquetteeye.com/patientinfo/presbyopia.html|title=Presbyopia: Patient Information|publisher=Eye Associates of Marquette|location=Marquette, MI|year=2008|access-date=2010-10-31|url-status=dead|archive-url=https://web.archive.org/web/20081202175115/http://www.marquetteeye.com/patientinfo/presbyopia.html|archive-date=2 December 2008}} As with any lens, increasing the focal ratio of the lens increases depth of field by reducing the level of blur of out-of-focus objects (compare the effect of aperture on depth of field in photography).

The onset of presbyopia varies among those with certain professions and those with miotic pupils.{{cite journal |pmid=12410405 |date=Nov 2002 |last1=García Serrano |first1=JL |last2=López Raya |last3=Mylonopoulos Caripidis |title=Variables related to the first presbyopia correction |volume=77 |issue=11 |pages=597–604 |issn=0365-6691 |journal=Archivos de la Sociedad Española de Oftalmología |url=http://www.oftalmo.com/seo/2002/11nov02/03.htm |format=Free full text |first2=R |first3=T |url-status=live |archive-url=https://web.archive.org/web/20111007032318/http://www.oftalmo.com/seo/2002/11nov02/03.htm |archive-date=7 October 2011}} In particular, farmers and homemakers seek correction later, whereas service workers and construction workers seek correction earlier. Scuba divers with interest in underwater photography may notice presbyopic changes while diving before they recognize the symptoms in their normal routines due to the near focus in low light conditions.{{cite journal |author=Bennett QM |title=New thoughts on the correction of presbyopia for divers |journal=Diving Hyperb Med |volume=38 |issue=2 |pages=163–164 |date=June 2008 |pmid=22692711 |url=http://archive.rubicon-foundation.org/10206 |access-date=2013-04-19 |url-status=usurped |archive-url=http://archive.wikiwix.com/cache/20130419204149/http://archive.rubicon-foundation.org/10206 |archive-date=19 April 2013}}

=Interaction with myopia=

People with low near-sightedness can read comfortably without eyeglasses or contact lenses even after age forty, but higher myopes might require two pairs of glasses (one for distance, one for near), bifocal, or progressive lenses. However, their myopia does not disappear and the long-distance visual challenges remain. Myopes considering refractive surgery are advised that surgically correcting their nearsightedness may be a disadvantage after age forty, when the eyes become presbyopic and lose their ability to accommodate or change focus, because they will then need to use glasses for reading. Myopes with low astigmatism find near vision better, though not perfect, without glasses or contact lenses when presbyopia sets in, but the more astigmatism, the poorer the uncorrected near vision.{{cn|date=July 2022}}

A surgical technique offered is to create a "reading eye" and a "distance vision eye", a technique commonly used in contact lens practice, known as monovision. Monovision can be created with contact lenses, so candidates for this procedure can determine if they are prepared to have their corneas reshaped by surgery to cause this effect permanently.{{cn|date=July 2022}}

Mechanism

File:Presbyopia.png

The cause of presbyopia is lens stiffening by decreasing levels of Crystallin#Alpha-crystallin, a process which may be sped up by higher temperatures.{{cite journal|last1=Pathai|first1=S|last2=Shiels|first2=PG|last3=Lawn|first3=SD|last4=Cook|first4=C|last5=Gilbert|first5=C|title=The eye as a model of ageing in translational research--molecular, epigenetic and clinical aspects.|journal=Ageing Research Reviews|date=March 2013|volume=12|issue=2|pages=490–508|pmid=23274270|doi=10.1016/j.arr.2012.11.002|s2cid=26015190}} It results in a near point greater than {{val|25|u=cm}}{{cite book |last1=Katz |first1=Debora M. |title=Physics for Scientists and Engineers: Foundations and Connections, Advance Edition |date=2015 |publisher=Cengage Learning |isbn=978-1-305-53720-0 |url=https://books.google.com/books?id=Z41vCgAAQBAJ&pg=PA1246 |language=en}} (or equivalently, less than 4 diopters).

In optics, the closest point at which an object can be brought into focus by the eye is called the eye's near point. A standard near point distance of {{val|25|u=cm}} is typically assumed in the design of optical instruments, and in characterizing optical devices such as magnifying glasses.{{cn|date=July 2022}}

There is some confusion over how the focusing mechanism of the eye works.{{clarify |date=February 2019 |reason=What is the confusion? Is the example given wrong in some way? }} In the 1977 book, Eye and Brain,{{cite book|last=Gregory|first=Richard Langton|title=Eye and brain : the psychology of seeing.|year=1977|publisher=McGraw-Hill|location=New York; Toronto|isbn=978-0070246652|edition=3rd ed. rev. and update.|url-access=registration|url=https://archive.org/details/eyebrainpsych00greg}} for example, the lens is said to be suspended by a membrane, the 'zonula', which holds it under tension. The tension is released, by contraction of the ciliary muscle, to allow the lens to become more round, for close vision. This implies the ciliary muscle, which is outside the zonula, must be circumferential, contracting like a sphincter, to slacken the tension of the zonula pulling outwards on the lens. This is consistent with the fact that our eyes seem to be in the 'relaxed' state when focusing at infinity, and also explains why no amount of effort seems to enable a myopic person to see farther away.{{cn|date=March 2023}}

The ability to focus on near objects declines throughout life, from an accommodation of about 20 dioptres (ability to focus at {{val|50|u=mm}} away) in a child, to 10 dioptres at age 25 ({{val|100|u=mm}}), and levels off at 0.5 to 1 dioptre at age 60 (ability to focus down to {{val|1|–|2|u=metres}} only). The expected, maximum, and minimum amplitudes of accommodation in diopters (D) for a corrected patient of a given age can be estimated using Hofstetter's formulas: expected amplitude {{nowrap|1=(D) = 18.5 − 0.3 ×}} (age in years); maximum amplitude {{nowrap|1=(D) = 25 − 0.4 ×}} (age in years); minimum amplitude {{nowrap|1=(D) = 15 − 0.25 ×}} (age in years).Robert P. Rutstein, Kent M. Daum, Anomalies of Binocular Vision: Diagnosis & Management, Mosby, 1998.

Diagnosis

A basic eye exam, which includes a refraction assessment and an eye health exam, is used to diagnose presbyopia.

Treatment

In the visual system, images captured by the eye are translated into electric signals that are transmitted to the brain where they are interpreted. As such, in order to overcome presbyopia, two main components of the visual system can be addressed: image capturing by the optical system of the eye and image processing in the brain.

=Image capturing in the eye=

Solutions for presbyopia have advanced significantly in recent years due to widened availability of optometry care and over-the-counter vision correction options.

==Corrective lenses==

Corrective lenses provide vision correction over a range as high as +4.0 diopters. People with presbyopia require a convex lens for reading glasses; specialized preparations of convex lenses usually require the services of an optometrist.{{cite journal |pmid=16597675 |date=Apr 2006 |last1=Li |first1=G |last2=Mathine |last3=Valley |last4=Ayräs |last5=Haddock |last6=Giridhar |last7=Williby |last8=Schwiegerling |last9=Meredith |title=Switchable electro-optic diffractive lens with high efficiency for ophthalmic applications |volume=103 |issue=16 |pages=6100–4 |issn=0027-8424 |doi=10.1073/pnas.0600850103 |journal=Proceedings of the National Academy of Sciences of the United States of America |first2=DL |first3=P |first4=P |first5=JN |first6=MS |first7=G |first8=J |first9=GR |last10=Kippelen |first10=B. |last11=Honkanen |first11=S. |last12=Peyghambarian |first12=N. |pmc=1458838|display-authors=8 |bibcode=2006PNAS..103.6100L |doi-access=free }}

Contact lenses can also be used to correct the focusing loss that comes along with presbyopia. Multifocal contact lenses can be used to correct vision for both the near and the far. Some people choose contact lenses to correct one eye for near and one eye for far with a method called monovision.

==Surgery==

Refractive surgery has been done to create multifocal corneas. PresbyLASIK, a type of multifocal corneal ablation LASIK procedure may be used to correct presbyopia. Results are, however, more variable and some people have a decrease in visual acuity.{{cite journal | vauthors = Pallikaris IG, Panagopoulou SI | title = PresbyLASIK approach for the correction of presbyopia | journal = Current Opinion in Ophthalmology | volume = 26 | issue = 4 | pages = 265–72 | date = July 2015 | pmid = 26058023 | doi = 10.1097/icu.0000000000000162 | s2cid = 35434343 }} Concerns with refractive surgeries for presbyopia include people's eyes changing with time.{{cite journal |last1=Kim |first1=Tae-im |last2=del Barrio |first2=Jorge L Alió |last3=Wilkins |first3=Mark |last4=Cochener |first4=Beatrice |last5=Ang |first5=Marcus |title=Refractive surgery |journal=The Lancet |date=May 2019 |volume=393 |issue=10185 |pages=2085–2098 |doi=10.1016/S0140-6736(18)33209-4 |pmid=31106754|s2cid=4474834 }} Other side effects of multifocal corneal ablation include postoperative glare, halos, ghost images, and monocular diplopia.{{Cite book|last=Azar|first=Dimitri T.|title=Refractive surgery|publisher=Mosby / Elsevier|year=2007|isbn=978-0-323-03599-6|edition=2nd|location=Philadelphia|chapter=Terminology, classification, and history of refractive surgery| oclc=853286620}}

=Image processing in the brain=

A number of studies have claimed improvements in near visual acuity by the use of training protocols based on perceptual learning and requiring the detection of briefly presented low-contrast Gabor stimuli; study participants with presbyopia were enabled to read smaller font sizes and to increase their reading speed.{{cite journal | vauthors = Lev M, Ludwig K, Gilaie-Dotan S, et al | date = 28 November 2014 | title = Training improves visual processing speed and generalizes to untrained functions | journal = Scientific Reports | volume = 4 | issue = 1 | page = 7251 | doi = 10.1038/srep07251 | pmid = 25431233 | pmc = 4246693 | bibcode = 2014NatSR...4.7251L }}{{cite journal |vauthors = Polat U, Schor C, Tong J, Zomet A, Lev M, Yehezkel O, Sterkin A, Levi DM | date = 23 February 2012 | title = Training the brain to overcome the effect of aging on the human eye | journal = Scientific Reports | volume = 2 | page = 278 | doi = 10.1038/srep00278 | pmid = 22363834 | pmc = 3284862 | bibcode = 2012NatSR...2..278P}}{{cite journal | vauthors = DeLoss DJ, Watanabe T, Andersen GJ | year = 2014 | title = Optimization of perceptual learning: Effects of task difficulty and external noise in older adults | journal = Vision Research | volume = 99 | pages = 37–45 | doi = 10.1016/j.visres.2013.11.003 | pmid = 24269381 | pmc = 4029927}}{{cite journal | vauthors = Sterkin A, Levy Y, Pokroy R, Lev M, Levian L, Doron R, Yehezkel O, Fried M, Frenkel-Nir Y, Gordon B, Polat U | year = 2018 | title = Vision improvement in pilots with presbyopia following perceptual learning | journal = Vision Research | volume = 152 | issue = 152 | pages = 61–73 | doi = 10.1016/j.visres.2017.09.003 | pmid = 29154795 | s2cid = 20260936 | doi-access = free }}

= Eye drops =

Pilocarpine, eye drops that constrict the pupil, has been approved by the FDA for presbyopia.{{Cite news|last=Moyer|first=Melinda Wenner|date=2021-12-14|

title=New Eye Drops Offer an Alternative to Reading Glasses|language=en-US|

work=The New York Times|url=https://www.nytimes.com/2021/12/14/well/live/eye-drops-reading-glasses-fda.html|access-date=2021-12-15|issn=0362-4331}}{{cite web|title=Vuity |publisher=drugs.com |url= https://www.drugs.com/mtm/vuity.html|access-date=2022-02-09}} Research on other drugs is in progress.{{cite journal|last1=Dick|first1=HB|date=July 2019|title=Small-aperture strategies for the correction of presbyopia.|journal=Current Opinion in Ophthalmology|volume=30|issue=4|pages=236–242|doi=10.1097/ICU.0000000000000576|pmid=31033734|s2cid=139101960}} Eye drops intended to restore lens elasticity are also being investigated.{{cite journal|last1=Korenfeld|first1=Michael S.|last2=Robertson|first2=Stella M.|last3=Stein|first3=Jerry M.|last4=Evans|first4=David G.|last5=Rauchman|first5=Steven H.|last6=Sall|first6=Kenneth N.|last7=Venkataraman|first7=Subha|last8=Chen|first8=Bee-Lian|last9=Wuttke|first9=Mark|last10=Burns|first10=William|date=29 January 2021|title=Topical lipoic acid choline ester eye drop for improvement of near visual acuity in subjects with presbyopia: a safety and preliminary efficacy trial|journal=Eye|volume=35|issue=12|pages=3292–3301|doi=10.1038/s41433-020-01391-z|pmc=8602643|pmid=33514891|doi-access=free}}

Etymology

The term is from {{langx|grc|πρέσβυς|presbys|old}} and {{langx|grc|ὤψ|ōps|sight|label=none}} (GEN {{langx|grc|ὠπός|ōpos|label=none}}).{{cite web|url=http://dictionary.reference.com/browse/presbyopia|title=Presbyopia|publisher=Dictionary.reference.com|access-date=2013-04-19|url-status=live|archive-url=https://web.archive.org/web/20130412155607/http://dictionary.reference.com/browse/presbyopia|archive-date=12 April 2013}}{{cite web|url=http://www.etymonline.com/index.php?term=presbyopia|title=Presbyopia|publisher=Etymonline.com|access-date=2017-05-04|url-status=live|archive-url=https://web.archive.org/web/20170818173811/http://www.etymonline.com/index.php?term=presbyopia|archive-date=18 August 2017}}

History

The condition was mentioned as early as the writings of Aristotle in the 4th century BC. Glass lenses first came into use for the problem in the late 13th century.{{cite book|last1=Wade|first1=Nicholas J.|last2=Wade|first2=Nicholas|title=A Natural History of Vision|date=2000|publisher=MIT Press|isbn=9780262731294|page=50|url=https://books.google.com/books?id=aLiyFCm5ylMC&pg=PA50|language=en|url-status=live|archive-url=https://web.archive.org/web/20170908180959/https://books.google.com/books?id=aLiyFCm5ylMC&pg=PA50|archive-date=8 September 2017}}

References

External links

[https://www.nlm.nih.gov/medlineplus/ency/article/001026.htm "Presbyopia"] at MedLinePlus Medical Encyclopedia

{{Medical resources

| DiseasesDB=29647

| ICD10={{ICD10|H|52|4}}

| ICD9={{ICD9|367.4}}

| OMIM=

| MedlinePlus=001026

| eMedicineSubj=article

| eMedicineTopic=1219573

| MeSH=D011305

| GeneReviewsNBK=

| GeneReviewsName=

}}

Category:Disorders of ocular muscles, binocular movement, accommodation and refraction

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