Presbyopia: One Condition with Many Solutions

The quest to find an effective presbyopia solution continues, with ongoing research driving the development of new treatments and highlighting the need for personalised solutions to meet the needs of every patient, according to Laura Maubon BMBS.

Presbyopia is a problem affecting around 1.8 billion people worldwide, which is expected to become 2.1 billion by 2030. “It is really a burden, because the people that are affected are economically the working age group,” Dr Maubon said. In this situation, the challenge lies in identifying the right target and range in a heterogeneous population with diverse needs and an expanding array of options.

The onset of presbyopia starts around the age of 40 and is a gradual decline, with most patients experiencing more difficulties focusing on near objects. However, it is a very personal variable, with some people maintaining a good level of near vision through their 60s, and others experiencing blurred vision, headaches, eye strain, fatigue, poor recognition, loss of independence, and embarrassment—all affecting their daily activities and hobbies.

As Dr Maubon explained, there are two main theories on the mechanism of presbyopia: the Young–Helmholtz theory suggests there is a zonular relaxation and lens contraction, with ageing leading to a loss of elasticity and flexibility due to protein accumulation. In contrast, the Schachar theory focuses on peripheral changes and lens widening, with an increasing tension in the equatorial zonules. Both theories sparked many debates, but lens stiffness and protein accumulation are established and well-accepted factors in presbyopia, she said.

So, what are the solutions now available? IOLs remain the most common surgical treatment for presbyopia. New treatments that have emerged, such as pilocarpine and aceclidine eye drops, have shown good adaptation in some studies but are associated with side effects. Contact lenses are another option focusing on the concept of asphericity to manipulate aberrations in the eye. Other options include corneal inlays and scleral treatments.

“Our future challenge is an ongoing ageing population, with an increasing number of presbyopes to come. Just look at how big the screens on our phones are getting. However, the most important thing to bear in mind when treating presbyopia is that patients have different needs in their lives according to their professions and lifestyles,” Dr Maubon concluded. “The real quest for presbyopia is to find an individualised option for each patient, respecting their uniqueness and finding a compromise. There is no perfect range and no perfect lens. It is all about getting the best focal range but without losing the retinal contrast image.”

Dr Maubon spoke at the 2026 ESCRS Winter Meeting in Helsinki.

Laura Maubon FRCOphth, BMBS, BMedSci, PGCert (Surg Ed) is a consultant ophthalmologist specialising in anterior segment surgery, ocular surface disease, and surgical education in the UK. lauramaubon@nhs.net