Presbyopia and our eyes as we age

Do you ever reach for your phone light when trying to read the menu in a dimly lit restaurant? Perhaps you stretch your arm further and further away when trying to focus on that book you’re reading? These could be the tell-tale signs of presbyopia, a common eye condition that quietly creeps in around our forties.

“It’s something we all experience,” says Michelle Phan, a Sydney based optometrist with Specsavers who has spent more than two decades helping Australians and their eye health. “Presbyopia is a completely normal part of ageing. It’s not a disease, and it’s not a sign your eyes are unhealthy. It’s just the focusing mechanism in our eyes becomes less flexible over time.”

So, what is presbyopia?

To understand presbyopia, Phan says it helps to think of the eye like a camera. “There’s a lens inside the eye that focuses light so we can see clearly at different distances,” she explains. “When we’re young, that lens is soft and flexible, it can focus in and out effortlessly. But as we get older, the lens becomes more rigid, and the muscles that hold it, called the ciliary muscles, start to weaken. The result is that we lose our ability to focus on near objects.”

Who does presbyopia affect?

In short, everyone, eventually. “You can be short-sighted, long-sighted or have perfect vision, it doesn’t matter,” Phan says. “Presbyopia affects all of us because it’s a natural part of the ageing process.” Typically however, it begins to surface around the age of 40, though for some it may arrive a little earlier or later. “It depends on your lifestyle too,” Phan says. “Someone who spends their day driving a bus or working outdoors might not notice it as soon as someone who works at a computer or does a lot of close-up work.”

What is surprising however, is how little we’ve heard of it. “Specsavers did a study that showed about 72 per cent of midlife Australians have never heard the term presbyopia,” she says. “Considering it’s something that every single one of us will experience, that’s a huge knowledge gap.”

This lack of awareness can lead people to brush off early symptoms. “They’ll say, ‘Oh my eyes are getting tired,’ or ‘I must need stronger lighting,’ but what’s really happening is that their eyes are struggling to focus,” she explains.

How do you know if you have presbyopia?

The early signs are often subtle and easy to shrug off. “People start increasing the text size on their phones or holding things further away to read,” Phan says. “One study found that about 43 per cent of people enlarge the font on screens and roughly 40 per cent start using their phone’s torch to read menus or labels.”

What causes it?

Presbyopia is driven by biology, not behaviour. “It’s really those two things I mentioned earlier, the stiffening of the lens and the weakening of the ciliary muscles,” Phan explains. “When we look into the distance, the lens relaxes. When we look at something close, it has to contract. Over time, that contracting motion becomes harder and harder.”

And there’s no magic exercise or vitamin that can reverse it. “Unfortunately, it’s just part of getting older,” she says. “You can’t prevent it, but you can definitely manage it.”

How is presbyopia treated?

“Glasses are the most straightforward solution,” says Phan. “We can prescribe single vision reading glasses for people who only need help up close, or multifocal or bifocal lenses for those who need clear vision at all distances.”
For those who prefer not to wear glasses, contact lenses are another option. “There are multifocal contact lenses and also something called monovision lenses, where one eye is corrected for distance and the other for near tasks,” she explains. “The right choice really depends on your daily visual needs and what you’re comfortable with.”

When should you see an optometrist?

Even if you don’t notice any vision problems, Phan stresses the importance of regular eye exams every two years, or annually if you’re over 65. “It’s like going to the dentist,” she says. “You don’t wait until you’re in pain to have a check-up.”

Routine testing isn’t just about reading letters off a chart. “At Specsavers, for example, we use a 3D digital scanner called an OCT,” she explains. “It’s hospital-grade technology that helps us to detect early signs of eye, conditions that might not cause symptoms.”

And if you do notice changes, blurry near vision, headaches or eyestrain, don’t wait for your next routine check. “Book in as soon as you can,” Phan advises. “Even small changes can tell us a lot.”

What happens if presbyopia goes untreated?

Ignoring the signs might not sound serious, it’s just a bit of blur, after all, but the consequences can go beyond squinting at menus. “People start avoiding near tasks altogether,” Phan says. “They make more mistakes at work, get headaches or just feel fatigued. It can really affect your quality of life.”

More importantly, regular eye tests can also help catch other problems early. “Because we have two eyes, one can compensate for the other,” she explains.

They look out for you, look after them.

Phan’s advice for helping to reduce the risk of eye problems as we age is relatively straightforward. “Wear sunglasses, especially polarised ones, to guard against UV damage,” she says. “Sun exposure can be linked to cataracts, macular degeneration and even eyelid cancers.”

She also recommends knowing your family history and maintaining a healthy lifestyle. “Things like diabetes and smoking can have a big impact on eye health,” she notes. “Your eyes are connected to your body, so what’s good for you is also good for your vision.”

And finally, she adds, “Don’t ignore the signs. If you’re finding yourself reaching for that phone torch a little too often, it’s time to get your eyes tested.”
 

Michelle Phan is an optometrist at Specsavers Australia and New Zealand.