Presbyopia
By The Treatment Registry editors
Age-related loss of the lens's ability to focus on near objects, typically presenting in the 40-50 age range. Distinct from refractive errors of childhood and young adulthood (myopia, hyperopia, astigmatism). Treatment options range from reading glasses and contact lenses through to refractive lens exchange (RLE) and corneal procedures.
Treatment ladder
Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.
Conservative
- Reading glasses or progressive lenses
Optical correction for near vision. Lowest cost, reversible, no surgical risk. The default choice unless the patient has a specific reason to seek a surgical solution.
- Monovision contact lenses
One eye corrected for distance, the other for near. Most patients adapt but some experience reduced depth perception. Trial with contact lenses is the standard pre-surgical assessment.
Procedural
- Multifocal contact lenses
Contact lenses incorporating multiple focal zones. Higher cost than monofocal lenses; not all patients tolerate the optical compromise.
Surgical
- Refractive Lens Exchange · View procedure page
Clear lens extraction with implantation of a monofocal, multifocal, or extended depth-of-focus IOL. Permanent and prevents future cataract. Carries the small risks of any intraocular surgery and the optical compromises of any multifocal IOL.
- Premium intraocular lens at cataract surgery · View procedure page
If presbyopia coexists with early cataract, treating both at once with a multifocal or extended depth-of-focus IOL can address both conditions in one operation. Patient suitability is the gating question.