Presbyopia: why it's still impossible to escape 'tired eyes'

If you're over 40, you've probably noticed that reading a menu at a restaurant or checking messages on your phone requires a little effort: moving your arm away, seeking more light, or even resorting to reading glasses. This difficulty is caused by presbyopia, popularly known as "tired eyes." It's a natural aging process in which the crystalline lens—the eye's natural lens—loses elasticity, making it difficult to focus up close.

Recently, a new eye drop approved by the FDA (Food and Drug Administration), the US regulatory agency, has drawn attention to the debate surrounding this issue. The medication, which works for up to 10 hours, is for daily use and offers relief from blurred vision. To work, it temporarily changes the pupil diameter and increases depth of focus. This creates a pinhole-like effect, making it easier to focus on nearby objects and temporarily improving near vision without the need for glasses.

"Distance and near vision depend on a mechanism called accommodation, which is the ability of the lens to change shape," explained ophthalmologist Mauro Plut of Einstein Hospital Israelita. "In children, accommodation is very strong, but as we age, the lens becomes more rigid and loses this flexibility. This is where presbyopia arises," the doctor said.

According to Plut, presbyopia is a natural process of ocular aging and is not a disease, but an inevitable physiological transformation. "Most people will need glasses for near vision sooner or later," the doctor emphasizes.

Is there prevention?

This inevitability of presbyopia helps explain why there are still no effective prevention strategies for the problem, unlike conditions like cataracts or glaucoma. In the case of cataracts, for example, it is possible to operate and replace the lens with an artificial lens. For glaucoma, there are treatments that slow its progression.

But, in the case of presbyopia, the rigidity of the lens is directly linked to the aging of the fibers and proteins of the ocular lens, a process that, until now, medicine has not been able to reverse.

The FDA-approved eye drops demonstrate how science is seeking alternatives beyond conventional glasses. However, Plut emphasizes that their effect is limited. "It doesn't prevent presbyopia; it only improves vision clarity. The limitations depend on the person's degree of refraction. For some, it may work well, but for others, it may not replace glasses."

In doctors' offices, what we see is that, even with technological advances, glasses remain the simplest, most affordable, and most effective way to treat presbyopia. There are specific lenses for near vision and multifocal lenses, which allow for clear vision at different distances. Multifocal contact lenses are also an option, although they require fitting.

Essential care

Taking care of your eyes throughout your life is essential for preserving your overall vision. Avoiding excessive screen time, keeping your eyes lubricated, wearing sunglasses to protect against ultraviolet radiation, and maintaining healthy habits like a balanced diet and regular exercise can help reduce the risk of eye problems like dry eye, macular degeneration, and early cataracts.

One of the common myths is that excessive screen time can accelerate presbyopia. "Intense computer and cell phone use doesn't worsen presbyopia. What happens is that it can worsen eye lubrication, causing irritation and dryness, which makes it feel like you have trouble seeing. But this is different from altering the lens of your eye," the ophthalmologist emphasizes.

Regular appointments with ophthalmologists are essential for adjusting vision correction and early diagnosis of other problems that can more seriously compromise vision. Although presbyopia is inevitable, scientists continue to investigate substances, eye drops, and techniques that can slow or even reverse lens stiffness.

Source: Einstein Agency

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