Distinguishing presbyopia from senile eye disease: myths and facts

Many people have misconceptions about presbyopia. They don't distinguish it from “senile eye disease.”

Presbyopia is a condition in which the lens in the eye, the lens, loses control, making it difficult to see at close range. Still, it doesn't cause blurred vision or decreased vision like” cataracts,” the most common senile eye disease.

So, when does presbyopia start, and what is its course?

“In the mid-40s, a certain degree of loss of control begins, and most people lose control by the time they reach their 60s and 70s,” explained Professor Hyon Joon-young of the Department of Ophthalmology at Seoul National University Bundang Hospital (SNUBH) on the hospital’s YouTube channel.

While presbyopia is age-related, the condition varies from person to person. Why is this the case?

“Presbyopia can cause a lot of discomfort for some people and less discomfort for others,” Professor Hyon said. “If you have myopia, you don't need to adjust when you look up close, so you can see well up close even as you get older.”

“If you have mild astigmatism, the astigmatism acts to deepen the depth of focus a little bit, so you can see up close without using a magnifying glass, but your actual adjusting ability might have fallen much,” he said. “You have presbyopia. Still, other mechanisms at work allow you to see up close.”

There is also a myth that presbyopia is caused by the liver, but is this true?

“It is true that we are affected by various body conditions depending on our systemic condition, and it is also true that if our systemic nutrition is poor or our body is tired, it is more difficult to control. However, there is no medical evidence that the liver is the cause of presbyopia,” Professor Hyon said.

There is also a myth that sunglasses can help with presbyopia, but this is not yet objectively proven. In general, UV protection can help prevent the development of cataracts or retinal diseases, including macular degeneration. Still, it has not been shown to prevent the progression of presbyopia in general, according to the eye specialist.

Can eye-healthy behaviors, such as not looking at smartphones for long periods, help slow the progression of presbyopia?

“While there is no way to prevent the loss of eye control, many behaviors that support overall eye health, including UV protection and reducing eye strain, can help maintain healthy visual function in everyday life,” Hyon said.

Many foods and nutritional supplements are also said to be good for presbyopia, but do these myths actually help prevent it?

“There are no reports that any food or nutritional supplement helps prevent presbyopia. Some reports say that nutritional supplements and vitamins have antioxidant and anti-inflammatory effects that improve various eye diseases related to presbyopia. However, none has a direct link to presbyopia,” Hyon said.

Lutein, zeaxanthin, and omega-3s, known for their eye health benefits, have not been shown to benefit presbyopia directly. “Studies have shown that antioxidants, including lutein and zeaxanthin, can help slow the progression of macular degeneration, and some studies have even shown that certain concentrations of these compounds are beneficial,” Professor Hyon said, drawing the line at presbyopia.

The same goes for omega-3s. “There are many studies that show omega-3s can be helpful in conditions like dry eye, especially the inflammation of the eyelids that often accompanies dry eye,” Hyon said. “While they help maintain overall eye health and have antioxidant and anti-inflammatory properties, I wouldn't say that they suppress the progression of presbyopia.

According to Hyon, another myth is that pinhole glasses help presbyopia, which is invalid.

“When you look through a small hole through pinhole glasses, the depth of focus is deepened, and a small amount of refractive error is corrected, so you can feel that you can see clearly,” he said. “It does not correct presbyopia but can subjectively improve the discomfort.”

One known method that can slow the progression of presbyopia is an eye exercise from a medical textbook. “If you hold your thumb up and extend it at arm's length, and then slowly pull it forward while looking at the tip of your thumb, and then pull it back again when it goes out of focus, it can help you maintain control because you're constantly training your self-regulation,” Hyon tipped.

While there's no way to prevent presbyopia, there are ways to deal with it when it happens. “The most common recommendation is to use reading glasses,” Hyon explained. “You can use reading glasses separately or multifocal glasses, but they have no advantages or disadvantages, and it's important to find what works for you.”

One thing is important when using reading glasses: customize them according to your coordination. If you don't use them well, you can quickly lose control.

“You use a magnifier because you don't have enough accommodation to see up close, so the magnifier compensates for the lack of accommodation,” Hyon noted. ”If you have some accommodation left but use a magnifier with too much power, you can't use the remaining accommodation and rely on the magnifier. So, when you remove the magnifier, it becomes more difficult to see up close, and you lose accommodation faster.”

“When using reading glasses, wearing only as much as you can handle is important. It's important to start with lower power and increase the power as you get older and lose more control, so it's important to have your eye doctor examine you and prescribe the right power for you,” he cautioned.

Presbyopia surgery is also considered, but it is generally not recommended for presbyopia alone.

“If you have a cataract and need cataract surgery, you can have one, and recently, there are methods that can improve presbyopia as well, but I still don't recommend surgery just to correct presbyopia,” Hyon said. “It's very rare to have surgery on the eye, but it's not impossible to lose vision if there are complications. It's a bit excessive to have surgery that goes into the eye to make it more comfortable.”

What is the smartest way to deal with presbyopia?

“Presbyopia is a physical change that occurs with increasing age,” Professor Hyon said. “It is difficult to prevent presbyopia fundamentally. However, suppose we focus on general eye health and take good care of our eyes with regular eye examinations. In that case, even if we have a slightly less controllable presbyopia, I think it will help us overcome these things and live without discomfort.”