Presbyopia is an age-related condition in which the lens stiffens and muscles weaken, making it harder for eyes to focus on close objects. (Learn more)

Traditionally, presbyopia is treated with glasses. But now, doctors can replace the aging lens with a new version in refractive lens exchange surgery. (Learn more) Surgery can be helpful for some, but people with extreme nearsightedness might not be cleared for surgery. (Learn more)

If you do choose to have surgery, you'll need to understand the cost. This surgery can be expensive, and some types of insurance plans won't cover the complete cost. (Learn more) You must also find a doctor you can trust, as this is a delicate surgery. (Learn more)

Businessman working at office desk, he is staring at the laptop screen close up and holding his glasses, workplace vision problems

What Is Presbyopia?

Presbyopia relates to changes within the eye that come with age. The lens deep within the eye, responsible for helping us to shift focus from near to far, grows stiffer with age. That stiffness makes it hard for the lens to shift from seeing things far away to seeing things close, and it can make it difficult for the eye to focus closely on items held close to the face.

Compounding the problem, the muscles that tug on the lens to shift its position grow weaker with age. They cannot tug as hard as they once did, and that can also make close vision difficult.

Presbyopia is remarkably common. In fact, researchers quoted in an article in Science Daily suggest that the condition is "universal" among people older than 65. As we age, our eyes change, and those changes can lead to blurred close vision.

People with presbyopia may notice that they need to hold items slightly farther from their eyes in order to see them clearly, and they may need to shift their arms from close to far (in a movement similar to the one used in playing trombone) to find the ideal visual distance. Those who use glasses to correct the issue might need to place those glasses on and off multiple times each day, as their need for distance and close vision changes throughout the day.

These shifts may seem minor, but as the World Health Organization (WHO) points out, presbyopia can have a significant impact on a person's ability to tackle everyday tasks. According to WHO, people in developing countries without access to glasses may be unable to weed, sort grains, sew, cook, and care for children.

We may be accustomed to thinking of distance vision as vital, so we can see threats coming or manipulate a car through traffic, but it's clear that close vision is also important for our day-to-day heath. Presbyopia takes that close vision from us, and it is a big problem.

How Lens Exchange Surgery Works

Lens problems can be corrected with surgery. In fact, surgery is the method of choice for people with lenses clouded by cataracts. The surgery used to help those with cataracts is the same surgery used to help with presbyopia.

Only a small incision within the eye is required, according to experts writing in the journal Lychnos. That incision is no bigger than 3.2 mm. Doctors use tools within that incision to break apart and remove the original lens. Then, the new lens is folded and placed within the eye. Very tiny stitches or prongs hold the lens inside of the eye.

For decades, the lenses doctors used in these surgeries offered people clear distance vision. Doctors would determine how powerful the lens must be to offer 20/20 distance vision to their patients, and they would put the appropriate lens within the eye. People who wanted to see both near objects and faraway ones could have a weaker lens put in one eye and a stronger one in another, but this was the only real way to help them deal with the difficulties of seeing close and far away.

Newer lenses are different. Some offer different zones of vision, similar to bifocals, allowing people to shift the head or the eyes in order to shift from close to far distance optimization. Other lenses are made to work with the muscles inside the eye, offering the ability to shift focus without moving the head or the eye.

These new lenses seem tailor-made for those with presbyopia, as they allow people to see in a manner they're accustomed to. But, as authors writing for the American Academy of Ophthalmology point out, these lenses cannot exactly replicate a natural, human lens. People who have these lenses may not have the type of vision they experienced when their eyes were 30. It's a different experience, and those who aren't prepared for that difference may be disappointed with the results.

Lenses made to accommodate close and distant vision can come with side effects that some people find bothersome. According to research published in the journal Clinical Ophthalmology, those side effects can include haloes around lights, glare from bright lights, and a lack of contrast sensitivity. These aren't issues common with reading glasses, and they aren't common in healthy eyes. For some, these minor irritations are well worth the opportunity to avoid the hassle of glasses. But for others, these are unacceptable side effects that can lead to dissatisfaction after surgery.

During a consultation appointment for surgery, doctors should explain these risks and help their patients to understand whether or not surgery is a good choice. Those who rely on crisp vision for work or hobbies, and those who simply don't like to take any kind of risk with their vision, may be encouraged to seek out another solution for the vision issues they're experiencing.

But those who do move through the surgery process are typically happy with the results. According to The Royal College of Ophthalmologists, about 95 percent of patients are happy with the outcome of refractive lens exchange surgery, and about four patients in five don't need to use glasses at all after this kind of surgery.

Results like this demonstrate just how remarkable this surgery can be when performed on the right patient at the right time.

An opthamologist is listening to the patient in an exam room.

When Is Surgery Not Right for You?

As mentioned, this surgery does come with some risks, and there are some side effects that people might find inconvenient. Those who rely on close vision for jobs or hobbies, along with those who dislike risks in general, might be advised to avoid this surgery. They are not likely to be happy with the results when the surgery is complete.

There are also some health conditions that could prevent doctors from performing the surgery. For example, experts cited in an article in the journal Touch Ophthalmology report that retinal detachment is a risk with lens replacement surgery in people with high myopia. People with high levels of myopia tend to have eyeballs that are slightly longer than optimal. This length tends to up the risk of retinal detachment, and performing lens replacement surgery compounds that risk. For some surgeons, this risk is just not acceptable and would disqualify someone from surgery.

Your overall eye health should also be assessed before surgery, and some conditions may also make you less likely to heal properly. If you have glaucoma or an autoimmune disorder, for example, your doctor may advise that you avoid surgery in order to ensure that your eyes stay as healthy as possible.

Understand the Cost

There are times when a lens replacement surgery is vital to preserve vision. For example, if you're living with a cataract, lens replacement offers you the only path toward clear vision. Nothing else will get to the root of the problem.

Lens replacement for presbyopia is different. In the minds of insurance companies, you could use glasses or another inexpensive method to help you see things close up. They may not consider your surgery vital for your success, and as a result, they may refuse to pay for some or all of the cost of care.

As experts writing in Optometry Times point out, the lenses used in surgery are not inexpensive, and the surgery itself can also be expensive. If your insurance company will not help with the cost, you might be asked to cover thousands of dollars in fees on your own.

The amount you might be expected to pay for lens replacement for presbyopia can vary depending on the type of insurance you have and your diagnosis. For example, the insurance provider Health Partners reports that lens replacements for cataracts are covered, but only if you use standard lenses. Accommodating lenses are not considered necessary, so if you use them to replace a cataract, you may need to pay for them. Also, if you have no cataract and are using lens replacement for presbyopia alone, you might be asked to cover the entire cost of care, as this surgery is not considered medically necessary.

Medicare covers the issue in much the same way. According to MLN Matters, surgery to replace a lens clouded with cataracts might be covered, but if you choose a lens to help with presbyopia after your cataract surgery, you might need to pay for the lens along with changes in surgical charges for that lens.

Before you schedule surgery, you should understand just how much you might be expected to pay for that care out of your own budget, and you should be prepared to discuss payment plans if you cannot afford to cover the cost upfront. Many providers offer financing and payment plans, so you can get the care you need at a price that fits your budget.

Find a Doctor You Can Trust

As experts writing in the journal Eye and Vision point out, this elective surgery is not without risks, and it's vital for doctors to minimize that risk in order to make their patients as happy as they can possibly be. Doctors with a great deal of experience in performing these surgeries are adept at explaining the risks and benefits to their patients, and they also have the surgical skill required to ensure surgical success. Those who only dabble in the surgery may not be able to do the same. It's important to work with a doctor who performs these procedures often.

It's also important to work with a doctor who can explain lens types to you. As the American Academy of Ophthalmology explains, different lenses may be perfect for different people. Someone who spends a lot of time on close work may benefit from one lens, while someone who is often working on distant projects may prefer another. Your doctor should ask about your lifestyle and tailor the approach as a result.

At NVISION, we specialize in providing patients with doctors they can trust. We perform in-depth examinations, and we always listen closely to what patients want and need. We'd like to tell you more about how we can help. Contact us for an appointment.

	

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References

 

Age-Related Farsightedness May Affect More Than 1 Billion Worldwide. (December 2008). Science Daily.

Towards Better Estimates of Uncorrected Presbyopia. (October 2015). World Health Organization.

Ocular Ageing: Improving the Quality of Sight for Cataract and Presbyopia Sufferers. (September 2010). Lychnos.

 The Refractive Lens Exchange Debate. (June 2005). American Academy of Ophthalmology.

Refractive Lens Exchange in Younger and Older Presbyopes: Comparison of Complication Rates, 3 Months Clinical and Patient-Related Outcomes. (2017). Clinical Ophthalmology.

Patient Information: Refractive Lens Exchange. (February 2012). The Royal College of Ophthalmologists.

Updates and Challenges in Refractive Lens Exchange. (November 2018). U.S. Ophthalmic Review.

 The Pros and Cons of Clear Lens Exchange. (August 2014). Optometry Times.

 Eye Surgery: Refractive. Health Partners.

Implementation of the Centers for Medicare and Medicaid Services (CMS) Ruling 05-01 Regarding Presbyopia-Correcting Intraocular Lenses (IOLs) for Medicare Beneficiaries. (February 2013). MLN Matters.

Refractive Lens Exchange in Modern Practice: When and When Not to Do It? (December 2014). Eye and Vision.

Getting Clear on Refractive Lens Exchange. (April 2011). American Academy of Ophthalmology.