Presbyopia
Walter Huang, OD
Yuanpei University
Department of Optometry
Definition
Latin definition

Presbyopia = “old man’s eye”
Definition
Decrease in the amplitude of
accommodation or loss of accommodative
ability with age
Etiology
Natural part of the aging process
Onset at approximately 40 years of age
and over though may be earlier in low
hyperopes
Progression
Once presbyopia occurs, it increases over
a period of 10 to 12 years, after which it
stabilizes
Symptoms
Blurry vision at near
Difficult or impossible to accommodate
sufficiently for near work
Increasing Near Point of
Accommodation with Age
Age (years)
Distance (cm)
10
7
20
10
30
14
40
20
50
40
Amplitude of Accommodation and
Age (Donder’s Table)
Age (years) Amplitude (D) Age (years) Amplitude (D)
10
14.00
45
3.50
15
12.00
50
2.50
20
10.00
55
1.75
25
8.50
60
1.00
30
7.00
65
0.50
35
5.50
70
0.25
40
5.00
75
0.00
Near Work
Comfortable vision at near uses less than
or equal to half of the available amplitude
of accommodation
Near work becomes difficult when the
amplitude of accommodation is less than
5.00D
Example
Working distance at 40 cm requires 2.50D of
accommodation

Patient A has 5.00D of accommodation
He can use up to 2.50D of accommodation comfortably
Therefore, he has just enough accommodative power for
reading at 40 cm, and no reading glasses are required

Patient B has 3.00D of accommodation
He can use up to 1.50D of accommodation comfortably
Therefore, he needs an additional 1.00D of accommodative
power for reading at 40 cm, and +1.00D reading glasses are
required
Management
 Converging or plus lenses for near work
only in spectacles or contact lenses
Changes in prescriptions are required every two
to three years for presbyopia
 Surgery
Management
Spectacles


Single vision reading glasses
Multifocal lenses containing near Add
Bifocal lenses
Trifocal lenses
Progressive addition lenses
Management
Contact lenses




Single vision contact lenses with glasses
Monovision contact lenses
Bifocal and multifocal contact lenses
Modified monovision contact lenses
Management
Surgery

Laser in-situ keratomileusis (LASIK)
More for presbyopic hyperopia than presbyopia
myopia at the moment



Multifocal intraocular lens (IOL)
Conductive keratoplasty (monovision)
Scleral expansion