44-year-old woman with worsening blurred vision and headaches while reading
Refractive Mgmt/Intervention
What is your diagnosis?
The diagnosis is...
The image is consistent with a diagnosis of presbyopia.
- Presbyopia is an unpreventable, natural, age-related condition that typically occurs after age 40.
- For accommodation to occur, (1) the pupils must constrict, (2) the eyes must converge, and (3) the lens must increase its curvature.
- In presbyopia, the lens of the eye becomes progressively rigid and unable to change shape, resulting in the loss of accommodation.
What is the role of the primary care or emergency medicine physician?
- Considering this patient’s age and progressively worsening visual acuity, a referral to an eye doctor is warranted to properly assess ocular health and rule out any vision-threatening conditions.
- Early diagnosis and correction of presbyopia is essential to prevent visual disability.
What is the role of the ophthalmologist?
- Perform a detailed 8-point eye examination, including a slit-lamp examination, eye health evaluation, fundoscopic examination, visual acuity test, and refractive error assessment via a phoropter.
- Rule out vision-threatening causes of reduced visual acuity.
- Restore visual acuity back to baseline, allowing patients to resume the activities they enjoy, such as reading.
What is the treatment?
- Reading glasses remain the first-line treatment option for cases of simple presbyopia.
- Patients who already use eyeglasses for distance vision can benefit from bifocal, trifocal, or progression lenses. Contact lens users may consider monovision or multifocal contact lenses.
- Patients can now also use eye drops to correct presbyopia. There are 2 types of these drops: one that has pupil-constricting properties and one that has lens-softening properties.
- Surgical options such as intraocular lens implantation during cataract surgery, laser refractive surgery, or surgery to insert corneal inlays serve as restorative and well-tolerated long-term solutions for treating presbyopia.
Learn more: Ophthalmology resources for medical students