• In Greek, Presbyopia means "old eye"!

• So Presbyopia basically means a person is just getting old, and so are their eyes 

• This usually starts to become apparent between 35- 45 years old

• In a sense, think of it as someone with pre- cataracts. Near vision will become more difficult for these patients and they will start to rely on reading glasses 

• This is due to the lens of the eye becoming more stiff and not able  to change it's shape to accommodate for near vision. 

Clinical Pearls

• After Presbyopia, cataracts will begin to form

• Proteins within the Crystalline Lens start to break down 

• Cataracts are caused primarily by age, but can also be caused by trauma, steroid use, or are congenital

Clinical Hallmarks of Cataracts

• Clouding of the vision

• Colors will be dulled as well

• Difficulty seeing in low- light and at night

• Inability to see up close as the lens is now hard and can't change shape anymore

• The lens gets locked into seeing distance. This is why older people usually need reading glasses

• Glare and halos from lights (hence doing the Glare/BAT test!). Patients with cataracts hate driving at night due the glare from headlights!

Note:

• Everyone will get cataracts; it is just a question of when

• The only treatment for cataracts is to get cataract surgery!

Types of Cataracts

Nuclear Sclerotic (NS)

• Most common form. This occurs in the center of the lens

Cortical 

• Where the lenses outer layer is affected and moves inwards towards the center

Posterior Subcapsular

• The cataract starts in the back of the lens

• This is a mature cataract

• This person's vision would likely not even be HM!