Presbyopia: Causes, Symptoms, Age and Laser Operation


What is Presbyopia and its Symptoms

Presbyopia is the eye's difficulty in focusing on nearby objects. It is a defect that occurs with advancing age, usually after the age of 40. . It is a vision defect due to the loss of the accommodation power of the lens. In fact, the crystalline lens has the ability to vary its shape to better focus on objects placed at different distances. With age, the power of the lens decreases, making it difficult to focus on nearby objects. A corrective solution is glasses with progressive or multifocal geometry which allow good vision at all distances. The different correction segments blend into each other, to allow a comfortable transition from far to near. Unlike bifocal glasses, progressive lenses do not have the edge of the "bezel" intended for near vision. However, they can cause adaptation problems in the first period and may not even be tolerated by some subjects.

Symptoms of presbyopia

Presbyopia has a single and unmistakable symptom: the inability to read up close. If when reading a newspaper or looking at your smartphone you are unable to focus on what is written and you feel the need to distance yourself from what you are reading, it is likely that you are farsighted, especially if you are over the age of 40. Another characteristic symptom is the need for lots of light to be able to read up close. Usually the degree of presbyopia depends on age and is summarized in this table below. Presbyopia is an ever-changing process. Around the age of 65 the final stage is reached.

The Causes of Presbyopia

Presbyopia is part of a physiological aging process. It is caused by the hardening of the nucleus of the lens which becomes less flexible. It thus loses its ability to accommodate, i.e. the ability to vary its shape to focus on objects placed at different distances. All this translates into a progressive deterioration of the ability to clearly focus on nearby objects.

Presbyopia Test

Routine screening can be performed by your optician. It is advisable to carry out regular eye examinations for prevention. In any case, if you have to avoid small written texts and you are over the age of 40, it is likely that you have presbyopia and an eye examination is advisable.

Remedies: Glasses, Contact Lenses and Laser Surgery

Presbyopia can be corrected in various ways. From the simple use of glasses or contact lenses to laser surgery . Presbyopia surgery aims to allow rehabilitation of near vision without strict dependence on glasses. There are various surgical techniques and strategies adopted to solve the problem. The correction can be carried out by modifying the curvature of the cornea or by replacing the natural lens . Corneal correction is obtained with the excimer laser, taking advantage of the various existing surgical techniques. A more recent method, called Intracor, exploits the use of the femtosecond laser which acts deep into the structure of the cornea. The multi-focality of the cornea is thus induced so that the eyes receive focused images at all distances at the same time; the brain will be able to select them depending on the distance to which visual attention is directed. The minimum conditions for laser eye surgery is 45 years . When you are over 50, you can consider other interventions to correct presbyopia, especially if it is associated with myopia . It is the so-called Phacorefractive surgery which consists in replacing the crystalline lens with an intraocular lens that allows you to see well from far away and up close without glasses. After the age of 60 it is usually no longer recommended to perform laser surgery for presbyopia because often there are already opacities in the lens – or they could appear within a short time – and this could cause presbyopia to return. In this case, it is best to perform Phacorefractive surgery, which consists in replacing the crystalline lens itself with an intraocular lens that has the right power to correct myopia and presbyopia. Depending on the type of intraocular lens used, you may or may not need to use glasses for near reading. With the latest generation intraocular lenses you can see well from far away and up close without glasses (multifocal, bifocal, trifocal, high tech etc). Laser surgery can be performed on both eyes. In the case of presbyopia correction through the implantation of phakic intraocular lenses or phacorefractive, it is usually possible to operate on both eyes a couple of days apart. In severe cases, intraocular contact lenses – also called phakic lenses – can be implanted inside the eye with the advantage of having very fast vision recovery.

How Much Does Laser Surgery for Presbyopia Cost

The cost of the operation to correct presbyopia varies from 2,000 to 5,000 euros per eye. The cost depends on the type of technique that is used. Laser surgery costs around 2,000 euros per eye and works for initial degrees of presbyopia. In severe cases, it is necessary to resort to the implantation of intraocular lenses in place of the crystalline lens which is replaced with a phacorefractive operation. In these cases, sophisticated intraocular lenses such as trifocals or those with increased depth of field are used. The cost here varies from 3,500 to 5,000 euros.

Risks of Laser Surgery

There are no particular risks for laser surgery for presbyopia. Complications after this type of surgery are very rare when performed with the latest generation lasers. For an optimal result, presbyopia must be stable, otherwise there could be an incomplete correction of hyperopia which makes it necessary to perform the laser operation again. Alternatively, you go back to using glasses or contact lenses. Finally, if adequate hygiene and health standards are not adopted, there is a risk of infection. For this reason, antibiotic eye drops are usually used immediately after surgery.

Is the Intervention Reimbursable?

Laser surgery for presbyopia in agreement can be performed with the main insurance companies, supplementary funds and health funds . Some insurances provide direct payment of the medical service without any cost to the patient, others provide indirect assistance. In this case the patient will receive a refund after presentation of the invoices for the services received. Each insurance has its own price and reimbursement schedule. Read the list of affiliated insurance companies here. Laser surgery for presbyopia can no longer be performed through the National Health Service (SSN) or ASL (Local Health Authority) . Hyperopia laser surgery was carried out through ASL in past years but today with spending reduction policies this is no longer possible.