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Lens and refraction · Q

What presbyopia is, and how it can be managed

Glasses · contacts · miotic drops · corneal laser · lens surgery

Last reviewed: 2026-10-03 · 潘家健醫生

Key points

  • Presbyopia is age-related loss of accommodation — strictly not classic refractive error, often grouped with it for optics.
  • Options discussed can include readers, progressives, contacts, miotic drops (overseas approval ≠ HK registration), corneal laser or lens options.
  • No single method fits everyone, and there is no “cure” for presbyopia.
  • Curtain or sudden vision drop: A&E; new flashes / clearly more floaters: same-day dilation when possible.

What it is

Presbyopia is the lens stiffening so near focus fails, usually from the forties. It is declining accommodation, not a classic refractive error. Nothing restores a twenty-year-old lens. Any option will need review as presbyopia progresses.

Five classes a doctor or optometrist may discuss — not a ranking and not a shop. Suitability needs examination (surface, fundus, corneal topography).

1. Spectacles

Readers, progressives, bifocals or indoor intermediate glasses. Reversible; no intraocular risk. You only see clearly with them on; progressives have peripheral swim; they do not “cure” presbyopia.

2. Contact lenses

Monovision, multifocal contacts, or distance contacts plus readers. Trialable and reversible. Microbial keratitis is higher with overnight wear and water; giant papillary conjunctivitis and dry eye occur. See the contact-lens page.

3. Miotic drops

A pinhole effect can ease near work for hours. They do not restore accommodation. Headache, dim night vision and vitreoretinal traction are discussed. Overseas prescription miotic drops for presbyopia are not the same as Hong Kong registration or retail sale. Whether any class can be used is only for a doctor, after Drug Office status and a fundus exam. This page does not list ingredients as a menu. Do not buy online.

4. Corneal laser (including presbyopia designs)

Excimer or femtosecond laser changes corneal shape (LASIK, SMILE, surface ablation). For presbyopia this may be monovision or a multifocal corneal pattern. It does not restore lens focusing. Dry eye, halos, under/over-correction; thin corneas and keratoconus are usually unsuitable. See the laser page.

5. Intraocular lens surgery

The natural lens is removed and an implant placed — with visually significant cataract, or as refractive lens exchange in a clear lens (stricter). Optical classes: monofocal (including monovision), enhanced monofocal, toric, EDOF, multifocal. Intraocular risks (capsule rupture, macular oedema, endophthalmitis, detachment) apply. Multifocal / EDOF designs try far–intermediate–near but bring halos and lower contrast; macular or field disease makes multifocal unsuitable. Lens opacity does not “grow back” (posterior capsule opacification: see YAG); a poorly chosen intraocular lens is hard to exchange lightly; not everyone ends up glasses-free. See phaco and the IOL demo. Surgery done because cataract is already present: the order of the day is on The day of cataract surgery and lens implantation. Refractive lens exchange while the lens is still clear has stricter indications and is not set out on that page.

No option fits everyone and none “cures” presbyopia. This page does not compare clinics or quote prices. A curtain or sudden vision drop: go to A&E now. New flashes or a clear increase in floaters without a curtain or sudden blindness: dilated fundus exam the same day if possible. See the urgent page.

This is general medical information, not a diagnosis, and cannot replace an in-person consultation with a registered ophthalmologist, refraction, or a dilated fundus exam. It is not advice to use any medicine or undergo any procedure. Medicines (including off-label use), laser or surgery must be decided by a registered doctor after examination, according to indications and Hong Kong registration. Figures from the literature are published averages, not any clinic’s results. This site does not book, prescribe or refer. Do not change treatment on your own.