Feb 28, 2018 5 min read

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Do you have reading glasses stashed everywhere? Do you squint while reading a menu or texting on your phone? Even if you never needed glasses and have had 20/20 vision your entire life, no one is immune to middle-age presbyopia, which is a normal part of aging and causes the gradual loss of vision up close. “The lens of our eye, when we are young, is soft and flexible,” explains Dr. Sean Pieramici, an ophthalmologist with Southwestern Pennsylvania Eye Center in Washington. “By changing the shape of the lens in our eye with muscle movement, we can focus from far to near. Presbyopia occurs because the lens of our eye begins to harden as we age, causing it to be more rigid.”

Because of the increasing stiffness, the lens can’t change shape as well as it used to, resulting in blurry vision up close. Onset usually starts in your mid 40’s and there’s no way to prevent it, but some exciting new procedures may allow you to ditch the readers once and for all.

The easiest way to treat presbyopia is by changing the lens that doesn’t function so well anymore. There are several ways to do this and which procedure you choose will depend on your age, eyesight and other conditions your eye doctor can check. Pieramici says there are two categories of treatment: intraocular lens treatments or corneal and surface treatments. “We can treat presbyopia with lens replacement surgery by replacing the natural lens with an artificial lens,” he says. “This treatment is usually reserved for patients who are older who already have cataracts or are beginning to develop cataracts.”

Cataracts are a gradual clouding of the eye’s lens as we age. Think of this as a 2-for-1 deal for older patients who need surgery for cataracts and who may also suffer from blurry vision up close due to presbyopia. “We can replace the natural lens with an artificial presbyopia-correcting lens,” Pieramici says. “There are several options for patients, including multifocal lenses, accommodating lenses and extended range of focus lenses which are the newest category of lenses. There are many lenses under FDA approval for presbyopia, some which may mimic the actions of our natural lens.”

If you’re younger and don’t require cataract surgery, another option to correct presbyopia is with a technique called monovision (mono meaning one). Doctors will test your vision then set the dominant eye for distance and the other for near vision. This can be done with contact lenses that patients usually wear for a few months as a test. Some patients are happy with just the contacts. If you adapt well to monovision using contact lenses but don’t want to wear them all of the time, you may ask about LASIK (laser eye) surgery to make the changes permanent. “If a person can tolerate the imbalance in the eyes, then they have both near and far vision,” Pieramici says. One downside of monovision LASIK is that it may not last forever. Presbyopia worsens with age, so the changes made with LASIK may not prevent your near vision from worsening through the years.

On the horizon, there is also a LASIK procedure called PresbyLASIK that was specifically designed to treat presbyopia. Unfortunately, you can’t get it yet in the United States. “The cornea is treated in a multifocal pattern resulting in both near and far vision,” Pieramici explains. “This is more popular in Europe, but not FDA approved in the U.S. Some promise, but more side effects.”

The newest procedures to treat presbyopia don’t involve changing your current lenses, but instead add implants to help them work better. They’re called corneal inlays and they’re quickly gaining popularity across the country while still being studied for their long-term effectiveness. “Corneal inlays are tiny lenses or optical devices that are inserted into the cornea to improve near vision,” Pieramici says. “The Kamra inlay is a tiny ring that is implanted in the center of the pupil in a pocket created by a laser. This creates a pinhole camera effect increasing the depth of focus and consequently improving near and intermediate visual acuity.”

He says the Kamra inlay is typically implanted only in the non-dominant eye allowing both eyes to see distance while the eye with the implant improves near vision. This differs from monovision laser correction which sets one eye to distance and the other to near vision. The U.S. Food and Drug Administration (FDA) approved Kamra inlays in 2015, however they are not in widespread use yet. In fact, the closest doctor offering these inlays is in Northeast Ohio.

The newest procedure is called the Raindrop inlay, which is a tiny, clear inlay similar to a contact lens. “The Raindrop inlay is also implanted in the non-dominant eye using a laser cut pocket in the cornea,” Pieramici says. “When in position, the Raindrop inlay changes the curvature of the cornea resulting in a multifocal cornea. This change in shape of the cornea gives improvement in near vision with little change in distant vision.”

This inlay was just approved by the FDA last March and doctors across the country are slowly adding it to their practices. While Southwestern Pennsylvania Eye Center does not offer either of these inlays yet, Pieramici says he is considering adding them to his practice and a few doctors around Pittsburgh have begun offering the Raindrop inlay.

Finally, one alternative showing promise are scleral implants, which are not yet FDA approved. A device called the VisAbility implant is in FDA trials. “VisAbility uses four small implants placed in the sclera of the eye,” Pieramici explains. “The placement gives the ciliary muscle more power to change the lens shape allowing for better near vision. This has the advantage of a more normal continuous range of focus from far to near.” Depending on the outcome of the FDA trials, scleral implants may gain FDA approval this year.