Presbyopia can be corrected in several ways. Glasses and contact lenses are simple and reversible. To reduce dependence on reading glasses, surgery may be considered: laser on the cornea or replacement of the crystalline lens with an implant. Each solution involves trade-offs, and the choice depends on age, starting vision, the state of the lens and lifestyle.
Key points
- Reading, progressive or office glasses: the basic solution.
- Multifocal lenses or monovision: no glasses, with an adaptation period.
- Laser (Presby-LASIK, Presby-PRK): reshapes the cornea, often based on monovision.
- Multifocal or trifocal implant: replaces the lens, rather after 55-60 or in case of cataract.
Glasses
Reading glasses correct near vision only. Progressive lenses correct distance, intermediate and near in a single lens; they require a few days of adaptation. Office lenses (degressive) are designed for screens and reading.
Contact lenses
Multifocal lenses spread distance and near vision over the same lens. Monovision with contact lenses corrects one eye for distance and the other for near. These solutions also make it possible to test monovision before surgery. They require good tolerance and strict hygiene.
Good to know
Like any surgery, presbyopia surgery carries risks, explained during the consultation. Its aim is to reduce dependence on reading glasses; the result varies from person to person.
Laser: Presby-LASIK and Presby-PRK
The laser reshapes the cornea to extend the range of clear vision. The most widely used strategy is monovision or micro-monovision: the dominant eye is set for distance, the other slightly for near, and the brain combines the two images. Some treatment profiles also create a multifocal cornea. Presby-LASIK works under a thin corneal flap; Presby-PRK works on the surface. The laser can correct myopia, hyperopia or astigmatism at the same time.
Multifocal and trifocal implants
The crystalline lens is replaced by an implant that distributes light between several distances: two for a multifocal implant, three (distance, intermediate, near) for a trifocal implant, or a continuous range for extended depth of focus implants. This surgery, similar to cataract surgery, is generally offered after 55-60 or when the lens starts to become cloudy. It removes the risk of future cataract, but may come with halos around lights at night.
Trade-offs to know
- Monovision requires adaptation and does not suit everyone: a trial with contact lenses is often offered first.
- Multifocal solutions can slightly reduce contrast and cause halos at night. See Night driving after Presby-LASIK.
- As presbyopia keeps progressing until 60-65, a pair of glasses may become useful again for some tasks over time.
Who can have surgery?
Presbyopia surgery is for people bothered by their near vision, with healthy eyes, without corneal or retinal disease, after a full assessment. Age, starting vision and the state of the lens point towards laser or implant. Learn more: Am I a candidate? and Presbyopia surgery after 60.
Further reading
Frequently asked questions
There is no solution that suits everyone. Glasses remain the basic solution; laser or implant are discussed according to age, starting vision, the state of the lens and your habits.
A strategy in which one eye is set to see far and the other to see near. The brain combines the two images. It can be tested with contact lenses before surgery.
The laser works on the cornea and leaves the crystalline lens in place; it is generally offered before 55-60. The implant replaces the lens; it is generally offered later or in case of early cataract.
In France it is not covered by the public health insurance, except when a cataract justifies the operation. Check with your own insurer.
This general information does not replace a consultation: only an eye examination can establish a diagnosis and discuss a suitable treatment.