Which therapies help with presbyopia, from glasses to contact lenses to lasers - and why the term "presbyopia" is wrong

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Presbyopia - briefly explained

  • Presbyopia is caused by the normal aging process of the lens of the eye. As a result, the eye can no longer focus so well at close range.
  • The first symptoms usually appear from the age of 40. Reading at a normal reading distance becomes more difficult.
  • The area on which the eye can focus shifts further and further into the distance over the years - until it is around two meters at the age of 65.
  • The vision problems can be corrected with glasses, contact lenses, surgery or laser procedures. The statutory health insurance companies usually do not pay for this.

Background: Because the lens of the eye ages in all people, presbyopia is neither a disease nor an ametropia. It would therefore be wrong to translate presbyopia as "presbyopia". Because with farsightedness there is a refractive error of the eye.

What are the causes of presbyopia?

In the case of presbyopia, the so-called accommodation no longer works properly. Accommodation describes the ability of the eye to adjust flexibly to different distances.

In order to be able to see clearly at close range, the eye lens must become more spherical. It works like this:

  • A specific eye muscle, the ciliary muscle, contracts.
  • This will relax the suspension straps of the lens.
  • The lens becomes more spherical.

The lens of the eye ages in the course of life. When we are born it is very elastic. Over the years it becomes thicker and harder as the tissue thickens. The result: the lens can no longer deform sufficiently.

The eye no longer bundles the incident light rays from nearby objects correctly. The so-called refractive power of the lens decreases. Objects in the close range are only shown blurred on the retina at the fundus of the eye. The eye is still normally sighted at a distance because it can continue to focus on a distant object on the retina. But near vision deteriorates.

While a two-year-old child can see clearly at a distance of five centimeters, a seven-year-old can focus at seven centimeters. At the age of 20 it only works at a distance of ten centimeters, at 40 it is already 25 centimeters, for a 50-year-old even 50 centimeters, at 65 the close-up only works to two meters - at this age the changes are visible but then also completed.

Is there presbyopia also in nearsighted and farsighted people?

Presbyopia and myopia

Myopia is usually caused by an eyeball that is too long or because of an error in the refraction of incident light.The result: the light rays are bundled too much so that the focal point is not on the retina at the fundus of the eye, but in front of it. So it happens that nearsighted people cannot see clearly in the distance.

An additional presbyopia, which starts from the age of 40, is not a problem for many shortsighted people, as the myopia compensates for the presbyopia that develops.

Presbyopia and farsightedness

Farsightedness is caused by an eyeball that is too short or a change in the refraction of the cornea or lens. The result: the focal point of the incident light is not on the retina, but behind it. In young people, the eye can largely compensate for this refractive error through the activity of the ciliary muscle in the eye, so that many people do not even notice that they are farsighted.

When presbyopia sets in, farsighted people can no longer see clearly at close range and later also in the distance. The process becomes noticeable a little earlier than in people with normal vision - namely between the ages of 35 and 45.

Symptoms of presbyopia

The symptoms of presbyopia usually appear for the first time from the age of 40. They are first noticeable in dim light or when you are tired.

The first signs can be:

  • reading becomes exhausting
  • the picture becomes blurred
  • there is a dull feeling of pressure in the forehead or eyes

As it progresses, near vision causes more and more problems, text and contours appear blurred. Those affected usually instinctively hold the book or the price tag further away in order to be able to read letters and numbers. At some point the length of the arms is no longer sufficient. Reading is hardly possible anymore.

How is presbyopia diagnosed?

Anyone who notices visual problems should be examined by an ophthalmologist - if only to rule out other eye diseases. Various tests show whether the eyes need support:

Vision test boards: The visual acuity of the eye can easily be determined with the help of vision test boards. Ask the patient to read out numbers or letters that are shown in different sizes in black on a white background. Each eye is tested individually.

Test with phoropter: In order to be able to determine the best possible visual acuity for the distance and near, a similar test follows. The person concerned looks through a device and indicates which letters and numbers he can recognize. Corrective lenses of different strengths can be set. An alternative to such a phoropter is a pair of measuring glasses, which can also be provided with lenses of different thicknesses. In this way, the right lens can be determined for near and far.

Test with a refractometer: With the help of a refractometer, the refraction of light in the eye can be measured without the patient having to do anything. He just sits in front of the device and looks through an optical system. The refractometer sends light rays into the eye, which are bundled by the cornea and the lens and finally hit the retina. The device controls the refraction of light and calculates which glasses strength would be optimal to be able to see well again in the far and near range.

Can presbyopia be prevented?

The natural process of hardening of the lens occurs in all people and is not hereditary. He cannot be stopped by special eye training or other measures. Whether and when you start to wear glasses also has no influence on the course.

Other eye problems can be partially prevented: