Presbyopia: why your arms stop being long enough after 45 (and what the science says)

It happens to almost everyone in the same way: the restaurant menu drifts further away, the smartphone gets held at arm’s length, the bedside lamp no longer seems bright enough. Around the age of 45, focusing up close starts to take real effort. It is called presbyopia, and it is not a disease: it is a natural process that, sooner or later, affects every human being.

In this article, the ophthalmology department of Istituto Chirurgico Palazzo Manzoni in Brescia explains what happens inside the eye, the typical signs of presbyopia and the solutions available today, with a look at the most recent scientific evidence.

What happens inside the eye

Inside the eye there is a natural lens, the crystalline lens, which throughout youth changes shape in a fraction of a second to focus near and far. Over the years the lens progressively loses its elasticity: the focusing mechanism becomes slower and less effective, and the minimum reading distance moves further away. The process actually begins in childhood, but it usually becomes noticeable between 42 and 48 and stabilises around 60.

The typical signs

Beyond the classic “text moving away”, the most common signs are visual fatigue at the end of the day, headaches after reading or computer work, needing more light to read, and near vision that worsens in the evening. People with myopia often notice it later, because they can still read by taking their glasses off; people with hyperopia, on the contrary, notice it earlier.

Today’s solutions

The options are varied and none is right for everyone. Reading glasses or progressive lenses remain the simplest solution. Multifocal contact lenses work well for some people. On the surgical side, there are laser techniques that create a “blended vision” between the two eyes and, when early cataract adds to presbyopia, replacing the crystalline lens with latest-generation intraocular lenses can solve both problems in a single procedure. The choice depends on age, pre-existing refractive errors, the health of the cornea and lens, and lifestyle: that is why the starting point is always a complete eye examination.

The pilots’ test

How reliable can the surgical correction of presbyopia be? A good indication comes from a study published in 2023 in the Journal of Refractive Surgery by the London group of Dan Reinstein, who developed the laser blended vision technique (Presbyond): 23 airline and military pilots with presbyopia, operated on and followed for one year. At the end of the study all of them had 20/20 uncorrected distance vision or better, all could read up close, and all regained Class 1 aeromedical certification, the strictest there is, returning to fly without glasses.

A detail that concerns us directly: Dr. Andrea Russo, head of ophthalmology at Palazzo Manzoni, works and publishes with the same group, and is first author, together with Reinstein, of a 2022 study on the same technique in 139 patients. If you would like to explore the surgical side further, you can do so on the Gruppo Refrattivo Italiano website.

When to book an eye exam

If you are over 45 and reading up close has become a daily annoyance, a complete eye examination serves two purposes: giving a precise name to what is happening (simple presbyopia, presbyopia plus another refractive error, or early cataract) and understanding which solution suits your eyes and your life.

Frequently asked questions

Can presbyopia be prevented?

No. It is a physiological process linked to the ageing of the crystalline lens and it affects everyone, regardless of lifestyle, diet or eye exercises. It can, however, be corrected well, with different solutions depending on the person.

Do reading glasses “weaken” your eyes?

No, this is a myth. Glasses do not accelerate presbyopia: it is presbyopia that progresses naturally with age, with or without glasses. Postponing correction only means straining your eyes more.

Can presbyopia be treated surgically?

Yes, with laser techniques (blended vision) or, in cases with associated cataract, by replacing the crystalline lens with intraocular lenses. Not everyone is a candidate: an assessment of ocular dominance, a simulation with lenses and a check of corneal and lens health are required.

Presbyopia should not be experienced as a surrender to age: understanding what is changing in your eyes is the first step towards choosing the right solution. At Palazzo Manzoni, the eye examination takes about an hour and includes all the necessary diagnostics.

If reading up close has become a daily struggle, book an eye examination by calling 030 294 2437 or online: together we will assess your situation and the path best suited to you.