Non-surgical treatment options for presbyopia

Introduction: The natural loss in accommodation that occurs with age means that all those who are emmetropic, or have their distance refractive error corrected in some way, start to have problems with near vision at the age of about 40 and have little active accommodation after the age of 55. Presbyopic spectacle and contact lens corrections have been available for many years but efforts continue to improve these and to introduce other non-surgical forms of treatment. Areas covered: After a brief review of presbyopia and its development, some non-optical strategies for delaying the onset of presbyopia or improving near vision in the absence of accommodation are discussed. Current designs of spectacle are then considered, including several which use single-vision lenses of continuously-variable power (liquid-filled, Alvarez, liquid-crystal lenses). The basis and performance of different types of presbyopic contact lens correction (monovision, alternating-image, simultaneous-image) are reviewed. Expert opinion: While some progress in novel forms of non-surgical treatment has been made, as yet none of these is sufficiently developed to become suitable as a routine method. For the present, nonsurgical treatment seems likely to continue to be dominated by spectacle wear, with a smaller proportion of mainly younger presbyopes preferring contact lenses.