Most people need reading glasses after the age of about 45 to see near objects clearly. The technical term for this is presbyopia. Reading glasses may be worn on their own or glasses worn also for distance vision can be modified to make them bifocal or varifocal. Alternatively some people wear multifocal contact lenses.

Presbyopia is one of the reasons that glasses or contact lenses are required to see clearly. Others are short sight (myopia), long sight (hyperopia) and astigmatism.

The problem in presbyopia is that the lens inside the eye can no longer change its shape to focus on close objects. (Read normal sight & vision defects). Whilst presbyopia is not a disease but simply a manifestation of getting older like grey hair, it is a change that often causes great inconvenience.

In presbyopia the image of close
objects is focused behind the retina

Presbyopia is more difficult to correct that short or long sight. However treatment for presbyopia has advanced greatly over the past few years and is now possible to reduce dependence on reading glasses or sometimes even cure it altogether. If you are short or long sighted or have astigmatism, these can be treated at the same time.

The method used to treat presbyopia depends on the patient’s age, personal preference and the characteristics of the patients’ eyes.

Glasses and contact lenses will satisfy many patients.

Lensectomy using multifocal or accommodating intraocular lenses

This procedure corrects presbyopia and also short or long sight and astigmatism. Lensectomy is the removal of the natural lens of the eye and its replacement by a new, artificial focusing lens. The new lens is smaller than a fingertip and is inserted through a keyhole incision into the space previously occupied by the natural lens. Two types of artificial lenses are available, multifocal and accommodating.

An ‘accommodating’ intraocular lens

Lensectomy is similar to cataract surgery. It may be done under local or general anaesthetic. No aftercare or cleaning is needed other than medicated eyedrops for a few weeks after insertion. The correction is permanent. The new lens is invisible inside the eye.

As with all vision correction procedures there is a small risk. This subject will be discussed in detail before you decide to have treatment.

In presbyopia the image of close
objects is focused behind the retina

In Lensectomy the natural (grey) lens of the eye is removed
and replaced by an artificial (blue in this drawing) intraocular lens.
The image is now focused onto the retina

Phakic intraocular lens

This is a tiny focusing lens which is inserted into the eye through a keyhole incision. Once inserted it is held permanently in place inside the eye by special attachments. It works together with the eye’s natural lens which is not removed. The new lens is multifocal and so focuses near objects without the need for reading glasses. If necessary short or long sight and astigmatism can be corrected at the same time when the new lens is inserted.

Medicated eyedrops are required for a few weeks after insertion. The correction is permanent. The new lens is normally invisible inside the eye. The procedure may be done under local or general anaesthetic. Long term follow up by a suitable qualified person is required afterwards.

As with all vision correction procedures there is a small risk. This subject will be discussed in detail before you decide to have treatment.

A MULTIFOCAL PHAKIC INTRAOCULAR LENS

After cataract surgery

Many patients become dependent on reading glasses after cataract surgery. It is now possible to alleviate and sometimes fully correct this problem. This is done by placing an additional artificial focusing lens inside the eye. The new lens is multifocal and rests on top of the lens that was originally inserted into the eye during cataract surgery.

LASIK and LASEK

Laser treatment can sometimes be done in a way which reduces dependence on reading glasses. The method used is called ‘monovision’. This works best if it is done at the same time as correcting short or long sight and astigmatism. You should be aware that it works in only a minority of persons.