Priyanka Singh, Bachelor of Optometry
Fellow Optometrist, Dr Shroff’s Charity Eye Hospital
Have you entered in your 30’s? Have you noticed you’re holding your phone far away from your face and squeezing while reading? You might be experiencing premature presbyopia.
Presbyopia is a physiological natural ageing process which occurs mostly after the age of 40-45 years.(1) It is an eye condition in which, our eyes slowly lose their ability to focus on a nearby object. With increasing age, our crystalline lens loses their flexibility and accommodative power to focus light properly on sensitive layer of retina while seeing nearby object
When these symptoms occur earlier, i.e., before 40s, it is called pre presbyopia. In old age, the crystalline lens’s nucleus is stiffer than the cortex, whereas in adults the cortex is stiffer than the nucleus and this stiffness, of both the cortex and nucleus, equalizes in between 30-40 years of age and thus leads to pre presbyopia symptoms in 40’s.(2,3)
In premature presbyopia, a person’s accommodative power is insufficient for carrying out daily near vision tasks earlier than as expected. According to a recent study (4) the mean age of a person with presbyopia before the age of 40 was 36.2 year. Pre-presbyopic patients mainly complain about headache, asthenopic symptoms, fatigue while doing near work, while working distance increases, and the need of brighter light for reading as compared to earlier stages of life.(1,2,5,6)
Factors responsible for premature presbyopia include:
- Excessive work on computer and increased time on smart phone (4)
- Low degree of uncorrected hyperopia can be manifested as an early need of near correction with onset of presbyopia (7)
- Gender: Women are more prone to have pre presbyopia than men because of their preferred arm length distance for doing near task (8)
- Environmental factors -Exposure too much in UV radiation (9)
- Occupations that require near vision, such as tailors, jewellery or watch industry, mobile technicians, and electricians.
- Nutritional deficiency more likely anaemic (9-10) whereas in male those who are tobacco chewer ,alcoholic, smokers are more prone to have pre presbyopia
Pre presbyopia can be misdiagnosed as accommodation inefficiency in which the accommodative power is less than the physiological limit of that age-group, in which asthenopic symptoms are more common. In presbyopia, near vision is affected and should be differentiated from macular disorder, posterior sub capsular cataract. Near vision can be improved bin bright light unlike presbyopia
Prevention measures include proper diet, working on ambient light, avoid spending more time in digital devices, and avoid smoking and alcohol consumption. Finally, regular eye examinations help in to detecting hyperopia.
Treatment measures include: Providing suitable near glasses as sometimes people hesitate to wear bifocal glasses. Monovision contact lens correction, where one eye is used for distance and the fellow eye for near vision. (11,12) Surgeries like conductive keratoplasty, monovision with intraocular implantation of intraocular lenses. Pre-presbyopia should be treated as early as possible as it will increase asthenopic symptoms and hamper the quality of life of many individuals.
- Ilesh Patel, Sheila K West, El-Maghraby, Presbyopia: prevalence, impact, and interventions, Community Eye Health.2007 Sep; 20(63): 40–41
- Miranda M N. The geographical factor in the onset of presbyopia. Trans Am Ophthalmol Soc. 1979; 77: 603
- Karl Robert Heys , Sandra Leigh Cram, Roger John Willis Truscott, Massive increase in the stiffness of the human lens nucleus with age: the basis for presbyopia, Mol Vis. 2004 Dec 16;10:956-63
- Mukuria M, Kariuki MM, Kollman M, Trivedi J. Magnitude & pattern of presbyopia among patients seen on outreach with Lions Sight First Eye Hospital, Loresho-Nairobi. East African Journal of Ophthalmology 2012: 42-47.
- Xianmin L, Kymes SM, Gordon MO, et al. Lens fluorescence and accommodative amplitude in pre presbyopic and presbyopic subjects. Exp Eye Res. 2007;84(5):1013–1017.
- Brien A Holden, Timothy R Fricke, S May Ho, Reg Wong, et al. Global vision impairment due to uncorrected presbyopia, Arch Ophthalmol,2008 Dec;126(12):1731-9
- Adam Hickenbotham, Austin Roorda, Craig Steinmaus, and Adrian Glasser, Meta-Analysis of Sex Differences in Presbyopia, Invest Ophthalmol Vis Sci.2012 May; 53(6): 3215–3220
- Stevens M A, Bergmanson J P. Does sunlight cause premature aging of crystalline lens? J Am Optom Assoc. 1989 Sep;60 (9):660-3
- Emerole C G, Nnelir O, Osim EE. Presbyopia: Prevalence, distribution and determinants in Owerri, Nigeria. J Exp Clin Anat. 2014;13(1).
- Gupta N,Wolffsohn JS,Naroo SA, Comparison of near visual acuity and reading metrics in presbyopia correction. Journal of Cataract & Refractive Surgery 2009 Aug, Pages 1401-1409
- Charman WN, Developments in the correction of presbyopia II: surgical approaches. Ophthalmic Physiol Opt. 2014 Jul;34(4):397-426