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Presbyopia

Presbyopia is different from astigmatism, nearsightedness and farsightedness, in that the eyeball retains its normal circular shape. Instead, the naturally flexible crystalline lenses of the eye become stiffer with age, interfering with near vision focus in particular. This is of course different than the clouding of the lens that occurs in cataracts, though both are due to changes in the proteins making up the lens. There may also be a weakening of the ciliary muscles controlling the shape of the lens, leading to the same loss of clarity when looking at nearby objects and words. This is because seeing nearby objects requires the most "accommodation" by the lens, meaning a greater change in shape, than far away things.

Presbyopia is diagnosed by a standard eye examination. Even in people with completely normal vision, the effects of presbyopia begin to hit virtually everyone sometime at about forty to fifty years of age. The farsighted will continue to need adjustment to see close up, just a bit moreso. Yet even the nearsighted will notice a diminishing ability to focus up close, particularly when wearing glasses or contact lenses correcting uniformly for better distance vision. This leads to the need for two different corrections in the same lens, traditionally accomplished through bifocal lenses. The same basic idea is involved in progressive adjustment lenses, but instead of a sudden visible change in thickness of the lens, the change is made more gradually, with multiple transition zones of thickness in the lenses.

One of the first signs of presbyopia is the need to hold reading material at increasing distance away in order to see it properly. Those doing a lot of fine detail work may find themselves getting headaches more frequently than they used to. Corrective eyeglasses or contact lenses are a simple solution for presbyopia - except for those in many developing countries where the availability of such items cannot be taken for granted. Those without other eye problems or focusing issues can often get by with a simple pair of "reading glasses," at least for a number of years.

Some patients who wear contact lenses can experiment with a treatment option known as monovision. In this approach, the contact lens for one eye is for distant vision while the other is for near vision. Usually people have a ‘dominant' eye and that one is used for distance vision. The brain learns fairly quickly which eye to "pay attention to" depending on the context. This works better for some people than others. Because depth perception relies on the ‘binocular' vision of two eyes, those using monovision contacts can experience some loss in this part of visual judgment.

There are also surgical solutions to presbyopia. The one involving the LASIK approach (laser-assisted in situ keratomileusis) is a surgical version of monovision. Before having this, one should experiment with monovision using contact lenses, in case they find it not personally desirable. In cases where cataracts occur to a person having presbyopia, it is possible for the new, artificial lenses ("intra-ocular lenses") to also have correction for seeing nearby objects and letters better. Like graying hair and a few more freckles, presbyopia is a very "equal opportunity" condition for mature people from all walks of life!

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