What Is Presbyopia?

by Lance Kugler, MD

Why Vision Changes After 40

At Kugler Vision in Omaha, Nebraska, we help people of all ages improve their lives by correcting their vision. That means we get questions on all ends of the spectrum of vision issues – from helping a person in their 20s navigate their modern LASIK options to helping explain why a person in their 40s is suddenly reaching for reading glasses. One question we hear a lot from patients over the age of 40 who have been researching changes to their near vision is: “What is presbyopia?” Kugler Vision’s award-winning team of laser vision correction experts are here to help.

 

Presbyopia Is the First Symptom in a Progressive Condition

As you enter  middle age, you may begin to notice some changes, and not just a stiff back or an earlier bedtime. These changes are to your near vision. If you’re over age 40 and you’re finding yourself squinting to read your watch or smartphone, or you’ve been reaching for reading glasses when seeing up close used to be a breeze – it’s likely you’re experiencing presbyopia.

Presbyopia describes the condition of no longer being able to see up close. Presbyopia is different from simply being hyperopic (farsighted). If you are a farsighted person, you have probably always noticed that your vision is clearer farther away than up close. Presbyopia describes a recent change in near vision – gradually worsening with age and time, and starting at about age 43 on average. 

Presbyopia is also known as near vision loss or near vision changes. While presbyopia is a nuisance on its own, the bad news is that presbyopia is actually the first symptom of a progressive three-stage condition known as dysfunctional lens syndrome. 

a woman with presbyopia needs readers to see her watch

What Is Dysfunctional Lens Syndrome?


Dysfunctional lens syndrome (DLS) is a progressive medical condition that describes the gradual deterioration of the eye’s natural crystalline lens. When you’re in your childhood and young adulthood, the lens of the eye flexes and adjusts (called accommodation) to help you focus clearly on objects at all distances. However, during DLS, the lens of the eye begins to harden and lose flexibility, causing vision issues. We all only get one set of eyes, and we understand this may sound a little scary, so let us assure you of two things:

 

  1. With today’s modern laser vision correction technology, dysfunctional lens syndrome is entirely treatable and it is possible to restore vision and live free from glasses and contacts. At Kugler Vision, we specialize in this type of near vision treatment.
  2. DLS describes the natural aging process of the eye. If you’re experiencing DLS, you’re not alone. Everyone will eventually develop DLS and need treatment.

There are three distinct phases to DLS. Understanding your current symptoms is helpful when evaluating which stage of DLS you are experiencing, and working with your surgeon to assess which treatment will be best for your eyes. Let’s look at the three stages of DLS.

 

DLS Stage One

Presbyopia, or the gradual blurring of near vision, is the first sign of DLS. During DLS stage one, the lens is still healthy and clear in color. Throughout DLS stage one, there is no difference in your usual distance vision, though near vision continues to deteriorate. A person in DLS stage one will find themselves relying on reading glasses frequently to see up close, especially when viewing screens or reading in low-light situations (like a menu in a dimly lit restaurant). There are multiple treatment options to address DLS stage one,  including a corneal inlay, monovision LASIK (LASIK in one eye), or possibly a lens replacement.

If you’re curious about your options through the early stages of DLS and want a fast overview of what your recommendations are most likely to be, try our 60-second vision quiz at the button below.


DLS Stage Two

Those in DLS stage two continue to experience worsening near vision, but now also begin to see changes to their distance vision. This is because the lens has continued to harden, and now begins to yellow. This increased rigidness reduces the clarity of vision at all distances, and the gradual yellowing begins to change the way you perceive colors. If it is untreated, most people proceed into DLS stage two in their late 40s to mid-50s. DLS is still treatable in stage two. For people experiencing the symptoms of DLS stage two, our surgeons often recommend Refractive Lens Exchange (RLE). With RLE, the rigid and discolored natural lens is removed and replaced with a biocompatible, technologically advanced lens that allows the patient to see clearly again at all distances without glasses, contacts, or reading glasses.

For those who receive RLE, DLS is over. The progression is stopped in its tracks because the problem has been removed at the source. For those who do not opt for treatment of DLS stage two, DLS stage three will eventually occur and require treatment.

a man researches on his phone what is presbyopia

DLS Stage Three

DLS stage three is more commonly known as a cataract. Cataracts occur when the lens of the eye has become significantly cloudy – so much that it affects vision quality. It is possible to see some cataracts as an observer, as a severe cataract may appear as a cloudiness in the eye. As people enter into DLS stage three, a major clue that cataracts are forming is a change in night vision – like halos around lights when you’re driving after dark. Another clue is that colors appear dull or have a yellowish tint. If left untreated, cataracts will affect your daily life, so it is important to come in for a cataract evaluation.

The Kugler Vision team has cataract experts who specialize in delivering crisp, clear vision results after cataract surgery. We offer advanced lenses that can allow clear distance at near, far, and intermediate distances – it is possible to live free from glasses, contacts, readers, and bifocals after laser cataract surgery at Kugler Vision.

In the meantime, if you’ve been told you have a cataract, or suspect you might, try our easy self-test at the button below for a quick overview of your options.

I Have Dysfunctional Lens Syndrome. What Do I Do Now?


It’s possible you’ve found this article because you’ve begun to notice near vision changes. Don’t worry! While it is likely true that you’re experiencing the first stage of DLS, this condition is entirely treatable. At Kugler Vision, our team has you covered. We use only today’s most advanced technology in our on-site Vision Correction Suite, and offer fully customized treatments expertly matched to your unique needs.

a middle aged couple enjoy books and tablets in the kitchen with no reading glasses

The next step in treating your presbyopia symptoms is to set up your near vision evaluation to discuss your options. This refractive evaluation is called the Kugler Vision VisionTrack Assessment, and is the most advanced diagnostic consultation in the region. The VisionTrack Assessment uses a unique blend of in-person, socially distanced diagnostics and advanced telehealth technology to make the process more convenient than ever for our patients. 

To book your VisionTrack Assessment today, call our friendly team at 402-558-2211 or book online with our easy online scheduler. We look forward to helping you restore your crisp, clear vision.

kugler vision doctor lance kugler

Lance Kugler, MD, is a specialist in LASIK and vision correction surgery and CEO of Kugler Vision. A proud Omaha native, he is passionate about improving lives through clear vision. Dr. Kugler serves on several national boards, and his practice is recognized internationally as a center of excellence. Dr. Kugler is one of the original founders of the Refractive Surgery Alliance, an international organization comprised of over 350 of the world’s leading vision correction surgeons; he also served as its first president. In 2019, Dr. Kugler was selected as a TEDx speaker, and delivered a talk in Omaha about the worldwide epidemic of nearsightedness and refractive solutions. Dr. Kugler is an Associate Professor of Refractive Surgery at the University of Nebraska Medical Center’s Truhlsen Eye Institute, has been published in many medical journals, and participates in numerous clinical studies to advance the field of vision correction surgery. Dr. Kugler and his wife are proud parents to five active kids. When he has a spare moment, he enjoys skiing, tennis, travel, and fine coffee.

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