Written by Kerry R. McGee, MD, FAAP | Reviewed by Sophie Vergnaud, MD Published on August 27, 2021
Key takeaways:
- Presbyopia is the natural aging of the lenses inside our eyes that makes it more difficult to focus on things that are up close.
- Presbyopia happens to everyone. Most people start to notice it when they reach their mid-40s.
- Occasionally, presbyopia causes problems before age 40. This is sometimes called premature presbyopia.
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Picking out your first pair of reading glasses isn’t a milestone most people look forward to. But, like taking the test for your driver’s license or figuring out how to file your tax return, presbyopia is something most of us have to face eventually.
As we get older, it becomes more difficult for our eyes to focus. This gradual change is called presbyopia, and it often shows up as a problem seeing objects up close. The need to hold a menu or newspaper at arm’s length is the first sign of presbyopia for many people.
What is presbyopia?
As we get older, the lenses inside our eyes change, making it more difficult to focus on things that are up close. This is presbyopia, and it’s a natural part of the aging process.
When does presbyopia happen?
Our eyes change throughout our lives. Most people begin to notice presbyopia when they reach their mid-40s.
What are the symptoms of presbyopia?
Presbyopia will first affect your ability to see things that are near to you. The most common symptoms are:
- Difficulty reading a newspaper or threading a needle
- Squinting to see something right in front of your nose
- Holding objects farther away in order to see them clearly
- Eye strain and fatigue during reading or other close work
- Needing brighter light than usual for up-close tasks
- Headaches, especially after reading or working on something close at hand
What causes presbyopia?
Presbyopia happens because the lenses inside our eyes stiffen over time. As the lenses get stiff, it takes more work to focus them tightly.
Our lenses are tucked deep inside our eyes, behind the colored part. They’re shaped like M&M’s, and they start out clear and soft when we’re young. Tiny muscles in our eyes pull our lenses into focus when we need to see up close.
As our lenses get stiffer, those muscles have to work harder. At some point, we’ll start to notice eyestrain, fatigue, and headaches. Eventually, focusing on near objects will become exhausting. Reading glasses, bifocals, and special contact lenses can be used to correct for presbyopia.
Can I stop presbyopia from happening?
Strictly speaking, presbyopia is caused by age — which, unfortunately, is not something anyone can change.
What is premature presbyopia?
If you notice the symptoms of presbyopia before age 40, you could be dealing with premature presbyopia.
Premature presbyopia is important to pay attention to, because it could be a clue to other problems affecting your health. That said, some people just start to notice the changes caused by presbyopia a bit earlier than others do.
What could cause premature presbyopia?
A number of factors can make presbyopia a problem earlier than expected. Although there are a handful of things that could cause presbyopia to speed up, premature presbyopia can also be the result of noticing it earlier than usual.
Genetic factors
If your parents and grandparents needed reading glasses at a young age, that could mean you will, too. There are genetic factors involved in how quickly your eyes change over time.
Your eye shape matters, too. Eye shape determines how nearsighted (myopic) or farsighted (hyperopic) you are. If you were a bit farsighted to begin with, you’ve always had to work a bit harder than others to see up close. Maybe you never needed glasses or contacts as a youngster, but as you get older, presbyopia will make focusing even more difficult. You’ll likely end up with reading glasses earlier than others.
Health factors
Your health affects your vision in many ways. A number of medical conditions can cause the lenses in your eyes to age faster than usual. These include:
- Being born prematurely
- Needing to have eye surgery at some point
- Having diabetes, even if it’s well-controlled
- Having multiple sclerosis
Certain medications can affect your lenses, and they could have an impact on how quickly presbyopia develops. These include:
- Some cholesterol medications, such as atorvastatin (Lipitor)
- Some antihistamines, such as cetirizine (Zyrtec) or hydroxyzine (Atarax)
- Some antipsychotics, such as chlorpromazine (Thorazine)
- Some antidepressants, such as sertraline (Zoloft) or amitriptyline (Elavil)
- Some antispasmodics, such as tolterodine (Detrol) or oxybutynin (Ditropan)
Lifestyle factors
Smoking cannabis regularly can contribute to early-onset presbyopia. The effects of other lifestyle factors, like diet or sun exposure, are not so clear.
It’s also not clear if using a smartphone, tablet, or computer for long periods of time will make presbyopia develop faster. What seems likely is that people who try to focus on their smartphone screens often will be bothered by presbyopia sooner than people who don’t. This could make smartphone users reach for reading glasses at a younger age.
The same is likely true for people who read frequently, or who work up close every day. Although these activities probably don’t make aging lenses harden faster, they could make presbyopia a problem earlier in life.
Can young children have presbyopia?
Young children naturally have soft lenses, but there are medical conditions that can make it difficult for them to pull those lenses into focus. Like presbyopia, this often shows up as trouble seeing up close. In children and young people, this is called accommodative insufficiency.
Accommodative insufficiency is different from premature presbyopia. In young people, it’s usually the muscles, or the nerves leading to the muscles, that are the problem — not the stiffness of the lenses themselves. A number of treatments are available for this condition.
Although they are two different things, young people who suffer from accommodative insufficiency will already be at a disadvantage when presbyopia kicks in. Chances are, they will be bothered by presbyopia earlier in life than others will.
The relationship between presbyopia and cataracts
Presbyopia and cataracts cause very similar symptoms. And both happen to nearly everyone as we get older.
Presbyopia happens because our lenses get stiff over time. Cataracts happen because our lenses get cloudy over time. Both things change gradually — but they don’t change at the same speed for everyone.
For many people, presbyopia shows up first. But for others, cataracts cause problems earlier in life. Cataract surgery (which involves removing the lens completely) stops presbyopia because it involves replacing your lens with one that can’t change focus at all.
What else could it be?
Trouble reading up close is often the first sign of presbyopia. But presbyopia isn’t the only thing that can cause it. Other problems — including a number of health conditions that tend to get worse with age — can cause the same symptoms as presbyopia. These include:
- Cataracts
- Dry eyes
- Diabetes
- Retinal problems, like macular degeneration
- Convergence insufficiency (difficulty turning the eyes in towards each other) due to muscle or nerve problems
The bottom line
Presbyopia is the gradual change in our focusing ability that happens naturally as we age. Most people begin to notice it after age 40. When it occurs earlier than expected, it can be called premature presbyopia.
Genetic, health, and lifestyle factors can impact when presbyopia will start to affect you. If your up-close vision is becoming a problem, make an appointment with your eye health provider. A professional eye exam is the first step to finding solutions.
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