Treatment Options for Presbyopia
Presbyopia sounds like an alarming eye disease, but it is simply a term which describes a common change which occurs in our eyesight around the age of 40+. At this age we hate to be reminded that our youth is behind us, but our eyes are aware of the wear and tear over time. The lens of the eye begins to lose its flexibility to focus and restricts the ability to focus clearly on close objects. You will notice your vision blurring when reading, sewing, using the computer or doing close work. You may have seen others holding objects at arm’s length to read the small print. That’s presbyopia!
Even if your eyesight was perfect before, this age related condition affects everyone to a greater or lesser degree. Unfortunately it is not a one-off change. Your eyes will continue to get more farsighted over time, so corrective eyewear will also need to be changed over time.
Those who wear eyeglasses will need to change the prescription to accommodate this new more limited range of vision. Bifocal lenses or progressive lenses are the usual weapon of choice for those who already wear eyeglasses for distance vision. With these multifocal glasses, both near and far vision can be improved by looking through different parts of the lens. Those who do not wear eyeglasses may simply need reading glasses for close work.
If you wear contact lenses, the simplest solution for presbyopia is a pair of reading glasses that you can wear with your contacts when you are doing close work. Multifocal contact lenses, which work similarly to multifocal eyeglasses, are also available as rigid gas permeable or soft lenses.
Your eye doctor also may suggest contact lens correction with monovision. With this technique, one eye is given a contact lens for near sight and the other eye is given a lens for far sight. The brain balances the images, favoring one or other eye for clarity at all ranges. Monovision takes some getting used to, but can be a great solution for some people.
Presbyopia can also be corrected by LASIK surgery. One procedure gaining popularity is called PresbyLASIK. This is when an excimer laser is used to create a multifocal ablation on the cornea of the eye, which corrects vision at multiple distances much like multifocal glasses or contacts would.
LASIK surgery can also be performed on one eye to create monovision. One eye is corrected for near vision while the other eye is used for distance.
Intraocular lens (IOL) surgery
Those who are undergoing cataract surgery can choose presbyopia-correcting intraocular lens implants to achieve clear vision at all distances. During traditional cataract surgery, a monofocal lens is implanted in the eye. These monofocal intraocular lenses offer fixed vision at one distance only, which may be far, intermediate or near. These are the cheapest implants available and generally eyeglasses or contact lenses are also necessary to read, use a computer or view mid-range objects clearly, especially if you suffered from presbyopia causing farsightedness before the cataract surgery.
Premium lenses include multifocal IOLs which have different zones to give sharp vision at multiple distances. They work in a similar way to progressive lenses in eyeglasses. The brain learns how to select the appropriate zone to look through to provide clear vision at near, intermediate or far ranges. The disadvantage of these lenses is that the limited space on multifocal IOLs must be divided into zones. Some advantages of seeing through just one zone in single vision monofocal lenses are lost, such as contrast sensitivity. This determines how well the eye can see in low light and how well it can distinguish objects from similarly colored backgrounds. All types of premium IOL incur additional costs which are not covered by Medicare or private health insurance as the benefits are considered optional.
Accommodating IOLs are so-called as they move to accommodate different ranges of vision. The ciliary muscle of the eye allows the lens to move forward and focus on images that are near which counters the presbyopia. When the muscle relaxes, it allows the lens to reshape and focus on intermediate objects. Reading glasses may still be required as an accommodating IOL does not provide as wide a range of focus as a multifocal lens. Presbyopia-correcting lenses are considered to be premium lenses.
For the treatment of presbyopia, a simple pair of reading glasses is the cheapest option. You can normally get a pair from around $150, depending on the type of frame you choose. Even cheaper options can be found by buying ready-made reading glasses from the drugstore for around $20, but they are not as accurate as made-to-measure lenses.
Progressive lens glasses and contact lenses will be more costly as they are more specialized. They can cost several hundred dollars, again depending upon how lightweight or fancy the frames are.
LASIK surgery starts at around $2500 for treatment on one eye. You may still need reading glasses after surgery as well.
Intraocular lens surgery to correct presbyopia is not currently available through Medicare or a general medical insurance policy. If you want a high-tech, presbyopia-correcting intraocular lens then costs would start at around $4000 per eye. Costs vary between states and between surgeons so it may be worth getting several quotes before committing to the cataract procedure. However if you need cataract surgery which is covered by Medicare and health insurance policies, you will only need to pay the difference to upgrade the standard monofocal lens to a multifocal or accommodating lens. The difference is usually around $800 and up, depending on the lens required. Once again reading glasses may still be required after surgery.
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