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Presbyopia Treatment in Singapore

What is Presbyopia?

Everyone starts to lose some near vision when we reach the 40s. This results from the gradual stiffening of the natural human lens in the eye, with a loss of the ability to focus up close as we age. It is a natural part of the ageing process, which progresses until about 60 years of age.

At first, we may start to notice that lighting needs to be bright enough to read fine print. Later, holding things further away may be necessary to read comfortably. In later years, reading aids or surgical options may be necessary.

This age-related vision loss is medically known as Presbyopia. Fortunately,  correction and treatment options are available at our eye clinic in Singapore for those experiencing symptoms of presbyopia.

Types of Presbyopia

There are five types of presbyopia:

  • Incipient presbyopia is the earliest phase of the condition, often manifesting as subtle difficulties in reading small text or seeing fine details. It’s a warning sign that your eyes are losing their ability to focus on close-up objects.
  • Nocturnal presbyopia affects your ability to focus on close-up objects in low-light or nighttime conditions. If you find it challenging to read or perform close-up tasks in dim light, consider presbyopia correction from an eye specialist.
  • Premature presbyopia occurs before the typical age of 40. Factors like nutritional deficiencies, extensive use of near-vision, and certain health conditions like diabetes can contribute to its early onset. If you experience near-vision issues earlier than expected, consult an eye specialist for diagnosis and correction options.
  • Functional presbyopia is when the need for presbyopia correction becomes more apparent. At this stage, you may find daily tasks like reading or using your smartphone increasingly difficult. This may be a clear sign that presbyopia treatment or presbyopia surgery may be necessary to help you manage your day-to-day activities.
  • Absolute presbyopia is the most advanced stage, requiring immediate presbyopia correction. At this point, the eye completely loses its ability to focus on near objects. Presbyopia correction surgery or other presbyopia treatment options are recommended to help maintain near vision.

For presbyopia correction, the doctor will first test your eyes for the severity and then suggest an appropriate treatment plan to manage the condition.

Symptoms and Causes of Presbyopia

Recognising the early signs of presbyopia can help you seek timely treatment and maintain your quality of life. Common symptoms include:

  • Difficulty reading fine print: Struggling to read small text, especially in dim light.
  • Eye strain: Experiencing eye fatigue when reading or doing close-up work.
  • Holding objects farther away: Needing to extend your arms to make reading material clearer.
  • Frequent headaches: Experiencing headaches after reading or close-up work.
  • Double vision: Seeing double when focusing on close objects.

Presbyopia typically begins around the age of 40 as a natural part of the aging process. This occurs because the lenses in your eyes become less flexible, making it difficult to focus on close objects. However, certain factors can contribute to an earlier onset of presbyopia, including diabetes, high blood pressure, cataracts, or glaucoma.

If you have any of these conditions, you may be more prone to developing presbyopia earlier. Seeking timely treatment can help prevent the condition from worsening. If you are experiencing any symptoms of presbyopia, schedule an eye examination at our EyeWise Vision Clinic in Singapore today

Checks and Diagnosis of Presbyopia

Diagnosing presbyopia involves a series of tests conducted by an eye specialist. Here’s what to expect:

  • Initial Consultation: The eye specialist will begin by asking about any vision issues you’ve noticed, such as difficulty reading small text or eye strain.
  • Medical History Review: A review of your medical history, including any medications you’re taking or other eye conditions you have, will be conducted to rule out other potential causes of vision problems.
  • Visual Acuity Test: This standard eye chart test requires you to read letters from a distance to evaluate your ability to see clearly at various distances. It helps gauge the extent of your near-vision difficulties.
  • Refraction Assessment: In this test, you’ll look through a device known as a phoropter, which contains various lens options. The eye specialist will switch between lenses to find the prescription that offers you clear vision, helping to determine the degree of presbyopia correction needed.
  • Slit-Lamp Examination: Using a slit lamp, the eye specialist will examine the structures at the front of your eyes. This device provides a magnified view, allowing the specialist to assess the health of your eye’s lens and other front structures.
  • Discussion of Findings: Once all tests are complete, the eye specialist will discuss the results with you. If presbyopia is confirmed, they will explain the severity of your condition and its implications for your daily life.
  • Treatment Recommendations: Based on the diagnostic findings, the eye specialist will outline suitable presbyopia correction options. These could range from bifocal spectacles to presbyopia treatment surgery.

Understanding each step of this diagnostic process can help you feel more prepared and informed when you go for your eye examination. Consulting with an eye specialist is crucial for proper diagnosis and exploring available options for presbyopia correction in Singapore.

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Treatment Options for Presbyopia

Several treatment options are available for presbyopia, and the most suitable option for each individual may vary depending on factors such as age, health, and lifestyle. Some common treatment options include:

1. Bifocal Spectacles

Bifocal spectacles are a widely used option for presbyopia correction. These glasses feature two distinct optical zones: the upper part is for distance vision, and the lower is for near vision. This dual functionality lets you switch focus between distant and close-up objects without changing glasses.

While some individuals with myopia might find relief by simply removing their glasses for close-up tasks, bifocal spectacles offer a more versatile solution. They are useful for those with both presbyopia and other refractive errors like myopia or hyperopia.

2. Bifocal and Multifocal Contact Lenses

Alternative nonsurgical methods involve bifocal or multifocal contact lenses, and contact lenses worn for an optical approach called “monovision”. Essentially, this calls for full optical presbyopia correction with a contact lens in the master eye, with slight under-correction in the other eye, leaving a low amount of myopia or short-sightedness. This low amount of myopia allows clear near vision.

3. Implantation of Multifocal Lenses

Cataract surgery is often recommended for presbyopia correction, particularly when cataracts are already present. During this procedure, the clouded lens is replaced with a multifocal lens, which provides clear vision at various distances—distance, intermediate, and near. This approach helps prevent the progression of presbyopia by addressing it directly through the lens implant.

When to Consider Implantation of Multifocal Lenses:

  • Presence of Cataracts: If cataracts are affecting your vision, cataract surgery with the implantation of multifocal lenses is an effective option. These lenses can restore your vision to what it was in your 30s, reducing or eliminating the need for glasses.
  • Dry Eyes or Contact Lens Issues: If you experience dry eyes or other issues that make contact lenses unsuitable and you wish to avoid glasses, multifocal lens implantation can be a suitable alternative.

This treatment option provides improved vision across all ranges and can offer a more convenient solution if traditional glasses or contact lenses are not ideal for you.

Presbyopia Surgery: Preparation, Recovery & Risks

Pre-Presbyopia Surgery Preparation

Before undergoing eye surgery for presbyopia, it is essential to consult with your ophthalmologist for a comprehensive eye exam to evaluate your suitability for the procedure. Your eye doctor may recommend stopping contact lens use a week prior to the evaluation to ensure your cornea’s shape is in its natural state. Additionally, blood tests and other medical evaluations may be required to confirm that you are fit for surgery.

Post-Presbyopia Surgery Guidelines and Recovery

After presbyopia correction surgery, your eye doctor will prescribe specific eye drops, including antibiotics and anti-inflammatories, to prevent infection and manage swelling. It is crucial to follow your medication schedule and make lifestyle adjustments, such as avoiding strenuous activities and reducing screen time, to support the healing process.

Regular follow-up appointments are vital to monitor recovery and address any complications early. Having someone assist you during the initial recovery phase is also recommended as your vision stabilizes.

Possible Risks and Side Effects of Presbyopia Surgery

  • Dry Eyes: A common but usually temporary side effect, dry eyes can cause discomfort and may require lubricating eye drops for relief.
  • Glare and Halos: Increased sensitivity to light may lead to glare or halos around light sources, especially in low-light conditions.
  • Infection: Although rare, post-operative infections are a serious concern that requires prompt medical attention to prevent further complications.
  • Corneal Haze: Temporary cloudiness in the cornea can affect vision quality but usually resolves on its own. Persistent cases may need treatment.
  • Epithelial Ingrowth: This occurs when corneal epithelial cells grow under the flap created during surgery and may require additional surgical intervention.

Understanding these aspects of presbyopia surgery can help you prepare effectively, recover well, and be aware of potential risks.

Get professional eye care treatments from our eye specialists at EyeWise Vision Clinic. Beyond presbyopia correction, we offer various other eye care services, including diabetic eye screening, dry eye treatment, glaucoma surgery, and more.

Take the first step towards comprehensive eye health by booking an appointment today.

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About Dr Christopher Khng

Dr. Christopher Khng specialises in Complex Cataract and Anterior Segment Reconstruction Surgery, particularly Iris Reconstruction and Surgery for Aniridia. His other areas of expertise include Complex Lens surgery, New Lens and Phacoemulsification technologies, Refractive surgery, Phakic IOLs (the Implantable Collamer Lens, ICL), and small-incision, topical anaesthesia phacoemulsification cataract surgery.

He completed his first two years of medical undergraduate studies at Aberdeen University, Scotland (UK). Because of cost, he completed his medical degree of MBBS at the National University of Singapore (NUS).

Dr. Khng served as Registrar, then Associate Consultant Ophthalmic Surgeon at the Singapore National Eye Centre (SNEC). Following his stint in SNEC, Dr. Khng was a Consultant at The Eye Institute, Tan Tock Seng Hospital, Singapore.

Dr. Khng’s interest in correcting Presbyopia employs a multi-faceted approach, including progressive lens implant technologies and surgical methods like corneal inlays and monovision strategies. By conducting thorough pre-operative assessments, he provides treatment plans to match each patient’s visual requirements and lifestyle needs. His approach aims to help near vision and reduce the reliance on reading glasses, offering a more functional range of vision for daily activities.

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Dr Christopher Khng

MBBS, M.Med(Ophth), FRCS(Edin), AMS(Ophth 2003) Consultant Ophthalmologist

Frequently Asked Questions

Several factors that can affect how quickly presbyopia progresses, including the health of the eyes and the overall health of the individual. Typically, presbyopia progresses slowly and steadily over time. However, it is recommended to see a doctor as soon as you start noticing symptoms of presbyopia so that a treatment plan can be provided to prevent the condition from deteriorating further.

Cataract surgery is the most common and recommended treatment for presbyopia. Presbyopia occurs with age when you start losing the ability to focus on near objects. This happens due to the natural ageing of the lens inside the eye, which becomes harder and less elastic over time. Today, with technological advances, it has become possible to treat presbyopia with cataract surgery through multifocal lens replacement.

Eye doctors can perform various types of eye surgery for presbyopia correction, including cataract surgery, refractive lens exchange and others. Which type of surgery is suitable for correcting presbyopia for you will depend on your individual needs and preferences. For an evaluation of your eye condition and presbyopia correction, book an appointment at our clinic in Singapore.

Bifocal spectacles feature two distinct zones, each designed for a specific range of vision—distance or near. A visible line separates these zones, and the wearer switches focus by looking through the appropriate zone. Multifocal contact lenses, on the other hand, transitions between multiple focal lengths, providing a more fluid and natural visual experience. The choice between these two presbyopia correction options often depends on individual comfort and lifestyle needs.

Indeed, non-age-related factors like uncontrolled diabetes, cardiovascular diseases, and certain medications such as antihistamines and antidepressants can hasten the onset of presbyopia. Additionally, occupations or activities that require prolonged close-up focus can contribute to the earlier development of the condition.

Monovision is a specific presbyopia correction option where one eye is adjusted for distance vision and the other for near vision. While it offers an alternative to presbyopia surgery, it’s not suitable for everyone. Issues such as compromised depth perception and visual clarity may arise, requiring an adaptation period. For personalised presbyopia treatment in Singapore, consult EyeWise Vision Clinic’s team of eye specialists.

Cataract surgery primarily contributes to clear vision by removing a cloudy lens and replacing it with a monofocal intraocular lens (IOL). Refractive lens exchange, on the other hand, focuses on addressing presbyopia by replacing the eye’s natural lens with a multifocal or accommodating IOL, resulting in clear vision at various distances. This key distinction in outcome makes refractive lens exchange a specialised option for individuals seeking a broader range of vision correction.