Why We Lose Our Near Vision and How We Can Retrieve It

Our stiffening eye lenses can be preserved with nutrition or improved through a variety of new treatments

(Prostock studio/Shutterstock)

You may not need glasses when you’re young, but as you age, you may find yourself reaching for a pair. The urge typically develops one day while looking at a menu, a newspaper, or an exit sign on the freeway.

For many, this deterioration takes the form of near-vision loss, known to eye doctors as presbyopia. It’s a condition where your eyes fail to focus on details up close. Most people begin to notice presbyopia sometime in their 40s, but experts say that with time, it eventually impacts nearly everyone.

So why does it happen, and can we do anything to change it?

Presbyopia is part of the aging process. Just as your body may begin to lose flexibility as you get older, your eyes also lose the flexibility they once had.

When our eyes are in their prime, we typically take our vision for granted. But seeing is a complex affair, and it’s a very sophisticated organ that delivers the images.

One part of the eye that contributes to our sight is called the lens. Unlike a camera lens (which focuses on details by adjusting the distance between two glass discs), the lens of your eye actually changes shape, becoming flatter or more curved depending on whether the objects you’re looking at are near or far.

However, as our eyes grow older, their once-dynamic lenses start to stiffen. As a result, they lose the ability to view things up close.

Over time, this sight deterioration results in a significant loss of performance. A study published in a 2015 edition of the journal Ophthalmology estimated that, based on census records, the potential productivity loss due to uncorrected or undercorrected presbyopia would be more than $25 billion, or 0.037 percent of global gross domestic product.

Solving the Problem Via Spectacles

Difficulty reading small print is a telltale sign of presbyopia, but the condition doesn’t just impact jobs that require reading. A study published in a 2018 edition of The Lancet looked at tea pickers in India who were older than 40 years of age. This randomized study is known as the PROSPER trial, which stands for productivity study of presbyopia elimination in rural-dwellers. Researchers found that providing workers with reading glasses increased the daily weight of tea picked by nearly 22 percent compared to the control group.

When it comes to treating presbyopia, wearing glasses remains the most common approach. Basic reading glasses are found in most drug stores and can be purchased for only a few dollars. It’s affordable to own several pairs, which can be placed in the car, office, living room, or any location where you might have to read fine print, pick tea, or do some other detail-oriented task.

Glasses serve as a magnifying glass to assist your eye in doing what it no longer can on its own. The basic design of spectacles has been around for a few hundred years, but simpler prototypes existed much earlier. Monks in the Middle Ages, for example, used glass spheres to read manuscripts.

If your distance vision is also compromised, the glasses needed for the onset of presbyopia become a little more complicated. You need one type of assisting lens to help you see far and another to see near. Benjamin Franklin is credited with creating the first set of glasses that tackle both jobs. Known as bifocals, the invention incorporates two needed lenses set in a spectacle frame. Modern bifocals, including bifocal contacts, still follow Franklin’s basic design.

Eye Drops

Glasses are tried-and-true and for years had been the only option for dealing with presbyopia. But a number of alternatives are now available.

In 2021, the U.S. Food and Drug Administration (FDA) approved the first eye-drop drug to treat presbyopia, called Vuity. Similar drops are expected to gain approval later this year.

Vuity is a very dilute solution of the chemical pilocarpine hydrochloride. The drops work by reducing the pupil size, making it easier for the eyes to see up close. Recommended use is once per day for adults with mild to moderate presbyopia, but even with this small dosage, there are some cautions. The drug's maker, Allergan, warns that Vuity may cause temporary dim or dark vision and urges those who use it to take care while driving at night or performing hazardous activities in poor lighting.

Temporary problems when changing focus between near and distant objects may also occur. However, some of the more worrisome side effects include sudden onset of flashing lights, floaters, or vision loss.

Dr. Bobby Saenz, an optometrist and clinical director of LASIK San Antonio in Texas, says Vuity can give your near vision a “boost,” but he believes that the help it offers is more appropriate for special occasions rather than as a long-term fix.

“This is a solution that could be used in early presbyopia during certain situations where you don't want to wear glasses,” Dr. Saenz said. “Date night, for example.”

Exercise and Lifestyle

Aging is a fact of life, but can we keep it from taking such a strong toll?

People can regain some of the strength and flexibility of their aging bodies by eating healthy food and exercising regularly. But can such habits preserve or perhaps even improve our vision as well?

Dr. Saenz says there are obstacles to aging eyes that make it difficult.

“The problem in presbyopia is not the muscle, it's the replication of the skin-like cells in the lens,” he said. “Currently, there is no way to stop these cells from replicating or these bonds from forming.”

Dr. Saenz pointed to studies testing drops that aim to break these age-hardened eye bonds to make the lens more flexible. Yet progress is slow. One drop was already in clinical trials, but it never met its statistical endpoint.

But we may still hold some power to preserve our near sight. Aging is the biggest risk factor for presbyopia, but UV light exposure may also play a role. Some research suggests that presbyopia may be delayed by providing aging eyes with UV protection (sunglasses).

“This may be the reason why in the south we see presbyopia a few years sooner than for patients in the north,” Dr. Saenz said.

Since presbyopia isn't an issue of muscle weakness, strength training exercises aren't likely to bring back lens flexibility. But Dr. Marc R. Grossman, an optometrist and acupuncturist licensed in New York state, believes that there are some holistic ways to preserve or maintain vision that includes lifestyle and dietary changes, as well as certain supplements. He mentioned one product that contains beta carotene, tomato extract (for its lycopene content), rosemary, and Aristotelia chilensis (Chilean wineberry).

Other supplements often recommended for eye health include lutein, zeaxanthin, and bilberry.

Periods of rest and relaxation are always important for good health, so consider giving your eyes a well-deserved break once in a while as well. Dr. Grossman mentioned one easy habit that you can try to put into practice.

“I advise adhering to the  20/20/20 rule of every 20 minutes, looking 20 feet away for 20 seconds to relax the eyes,” Dr. Grossman said.

Another way to give your up-close vision a break is to manage your screen time and spend some hours away from your favorite devices.

“They can damage the eye silently over a period of time,” Dr. Grossman said.

Other lifestyle considerations to preserve eye health include the same commonsense guidelines known to help the whole body, such as getting enough sleep and avoiding smoking.

Surgical Solutions

Surgery is a newer option for addressing presbyopia, and the most common technique is LASIK—a procedure used to reshape the cornea (a part of the eye beneath the lens) using lasers. However, success depends on several factors.

LASIK can’t help bring the lens of your eye the flexibility it once had, but it can provide an option to improve near vision. Dr. Saenz explained one common strategy using LASIK for presbyopia that involves shaping one eye for better near vision and leaving the other eye dedicated to distance-vision duties.

The results can take some getting used to, and not everyone can comfortably make the adjustment. And even those who can adjust may eventually need glasses anyway.

“As you age, and the lens gets harder, you will need to wear glasses for up close again,” Dr. Saenz said. “Now, many patients are okay with this, because for 80 percent of activities, they aren't wearing glasses, it's just for the tiny objects up close.”

Dr. Saenz’s preferred surgical technique for presbyopia is a newer procedure. It’s called laser lens treatment, or refractive lens exchange.

The procedure involves a laser that's used to break up the lens cells that have hardened over time. Next, the patient receives an intraocular lens placed just beneath the surface of the eye.

“The lens used most commonly is a trifocal lens, and this allows patients to see at distance, intermediate (computer range), and up close,” Dr. Saenz said. “This is a diffractive lens, meaning the No. 1 side effect will be circles on the lights at night, but your brain adapts over a three- to six-month period.”

Recent research shows a high rate of patient satisfaction with the procedure. One significant benefit of laser lens treatment is that it can save you from more eye surgery in the future. Because you're removing those hardened lens cells, it also removes the risk of cataracts later in life.

Cataracts are another common occurrence with the aging eye. And one study suggests that the same protein linked to cataract formation may also be a root cause of presbyopia.