Presbyopia

Disease Description (Causes and Symptoms)

• Name: Presbyopia
• Definition and pathophysiology: This is a phenomenon in which the ability to focus on nearby objects decreases as the elasticity of the lens declines (lens hardening) with age and the accommodative ability of the ciliary muscle decreases. It occurs as part of the structural and physiological aging process, and in most people it begins in midlife (mid-40s to 50s) and tends not to progress significantly after the late 50s.
• Main causes: Decreased elasticity of the lens and reduced function of the ciliary muscle and related structures.
• Main symptoms: Nearby writing or small objects appear blurry (decreased near vision), eye fatigue (dryness or a stiff feeling in the eyes), headaches, stretching the arms out to read a book or look at a smartphone, and greater discomfort in dark environments.
• Related information: People with myopia may feel that they can see nearby objects relatively well even after developing presbyopia, but their reduced accommodative ability is the same. It is diagnosed through a vision examination (refraction test).

Treatment Methods

• Non-surgical correction
  • Reading glasses (single-vision near lenses) or glasses for reading: The most common method.
  • Multifocal (bifocal) glasses: Correct both near and distance vision.
  • Multifocal/specially differentiated contact lenses or monovision contact lenses (a near prescription for one eye and a distance prescription for the other eye).
  • Recent medication: Low-dose pilocarpine (e.g., topical eye drops) may be used to temporarily improve near vision by slightly constricting the pupil (the effect is temporary and side effects are possible).
• Surgical treatment
  • Lens-based surgery: Insertion of a multifocal or extended depth-of-focus (EDOF) intraocular lens during cataract surgery to correct near and distance vision.
  • Refractive surgery: A monovision design using LASIK/PRK (near focus in one eye) is possible.
  • Near-vision assistance techniques using the superficial corneal layer, such as corneal inlays (e.g., KAMRA), may be selected after considering indications and complications.
• Lifestyle management
  • Reading under sufficient lighting, enlarging the text, adjusting the working distance (not holding books too close to the eyes), and resting the eyes (looking at a distant object for about 20 seconds after 20 minutes of work) are recommended.
• Precautions (related to treatment)
  • Before surgery, a detailed examination should assess the condition of the cornea, the presence of dry eye, and occupation and lifestyle habits (such as driving).
  • Contact lenses carry a risk of infection and corneal damage, so proper hygiene is necessary.
  • Eye drops may cause side effects (such as headache, glare, and reduced night vision).

Outpatient Visit Checklist (Including Preparation and Example Questions)

• Items to prepare (bring with you)
  • Currently worn glasses/contact lenses (if any) and their prescription records
  • List of medications currently being taken (including systemic medications and eye drops)
  • Previous ophthalmic examination results (such as vision tests, intraocular pressure, and cataract examinations) and surgical records
  • When the symptoms began and how they have progressed (when they started and in which situations they are worse), and specific activities that cause discomfort (such as reading or work)
  • Occupation and whether you drive (whether night driving is required), and hobbies (whether they involve detailed work)
• Information to tell the doctor in advance during the outpatient visit
  • Whether you have existing eye diseases (such as dry eye, glaucoma, or retinal disease)
  • Whether you are pregnant or breastfeeding (when using certain medications)
  • Any eye allergies or records of previous adverse drug reactions

Examples of General Questions to Ask the Doctor

• "What is the most appropriate method for improving my near vision?"
• "What are the advantages, disadvantages, and side effects of each treatment (reading glasses, contact lenses, and surgery)?"
• "What tests are needed, and what options may differ depending on the results?"
• "Are there any lifestyle changes (such as lighting or working distance) that I should make right away?"
• "How might this medication (or surgery) affect my daily life, driving, or work?"

Examples of Condition-Specific Questions

• "If I receive a multifocal intraocular lens during cataract surgery, can it satisfactorily correct both distance and near vision? What is the risk of night glare (halos) or reduced contrast sensitivity?"
• "If I try monovision (near correction in only one eye), is it possible to adapt, and what options are available to reverse it if I fail to adapt?"

Additional note: Regular ophthalmic examinations are important to check for vision loss caused by other conditions, such as cataracts, glaucoma, and macular degeneration.