How is it Diagnosed?
Presbyopia is an age-related refractive condition characterized by the gradual loss of
the eye's ability to focus on near objects due to decreased lens elasticity. It commonly
becomes noticeable after age 40.
Diagnosis is primarily clinical, based on patient-reported symptoms and routine eye
examination. Symptoms include difficulty reading small print, needing to hold reading
material farther away, eye strain, and headaches during near work.
The examination begins with assessment of visual acuity using a Snellen or near vision
chart. The near point of accommodation (the closest point at which one can maintain
clear focus) is tested, often using reading cards or devices.
Refraction testing with and without cycloplegia helps determine the patient's distance
and near correction needs. The amplitude of accommodation is measured to quantify
the focusing ability of the lens, which typically declines with age.
Slit-lamp examination and fundoscopy are performed to exclude other ocular conditions
such as cataracts, glaucoma, or retinal disorders that may affect vision.
In patients with uncorrected refractive errors (myopia, hyperopia, astigmatism), proper
correction of distance vision is necessary before evaluating for presbyopia.
Presbyopia is confirmed when near vision improves significantly with the addition of
plus-powered lenses. The diagnosis guides prescription of reading glasses, bifocals,
progressive lenses, or multifocal contact lenses to correct near vision.
No imaging or invasive tests are required. Regular eye examinations are recommended
as presbyopia progresses gradually and may need periodic updates in corrective
prescriptions.