From advanced spectacle and contact lenses to cutting-edge surgical techniques and implants, presbyopes have an abundance of options to now correct their near-vision deficit.
For people living with presbyopia, everyday life is filled with small but relentless challenges. Reading a text message, scanning a restaurant menu, checking a price tag in the supermarket – these all become moments of inconvenience that can snowball into a significant impairment for this large patient cohort.
Many find themselves constantly reaching for glasses, pulling them off, or tilting their heads to find the “sweet spot” through progressive lenses. Others can battle eye fatigue and headaches after long hours in front of screens, unaware that the culprit may be their changing vision.
Presbyopia, the gradual loss of the eye’s ability to focus on nearby objects, is an inevitable part of ageing. According to the Australian Institute of Health and Welfare’s self-reported data, it affects around 690,000 Australians aged 55 and over – though with 25% of the world’s population thought to be presbyopic the true figure is likely higher here.
As Australia’s population ages, so too does the urgency for more effective, tailored solutions.
From next-generation spectacles and contact lenses to advanced surgical techniques and even eye drops on the horizon, today’s presbyopes have access to an enviable suite of treatments – and it’s often up to the optometrist or ophthalmologist to help them figure out what works best.
Informed decision
For patients seeking a less invasive intervention with a lower upfront cost, this usually begins in the optometry setting.
While progressive and occupational lenses have been a mainstay, multifocal contact lenses also play a role. Plus, in 2025 the industry has even seen the establishment of the “early presbyope” category with a lens targeted at people in the late-30s to mid-40s experiencing the first symptoms of this condition.
In Mr Paul Fotkou’s Adelaide City Optometrists, presbyopes are one of the most important patient cohorts, creating a predictable and ongoing income stream for both the consult room and eyewear sales due to regular eye tests.
“Presbyopic patients are often more motivated; they are willing to invest in comfort, convenience and multiple pairs. They often require task-specific eyewear,” he says.
“I have positioned the practice of offering premium lens options – and we are not just selling a lens, we are delivering a tailored visual solution that commands higher prices. Lens sales represent approximately 50% of the practice sales.”
For Fotkou, one of the biggest considerations in today’s presbyopia landscape is the shift in work culture and ergonomics. More practices are embracing ‘second pair’ conversations with presbyopes regarding the need for occupational lenses, helping them avoid the common ‘head tilt’ to look through the near portion of a progressive lens.
“Now, I’m more conscious of ergonomics. My learning curve involves asking questions about people socially interacting with colleagues, in meetings, versus being desk-bound, and the ergonomics of looking at one, two, or three monitors or a laptop, and different working positions,” Fotkou says.
“What’s compounded this is the end-of-day fatigue that comes with close work. There might not be a refractive problem, but just fatigue that requires relief, often through eye-relaxing lenses to counter computer or office fatigue.”
Fotkou emphasises the importance of ensuring patients are well informed – he has captured a large, recurring presbyopic patient base using a targeted and consistent communication strategy.
Often presbyopia can be dismissed as a sign of aging that people put up with, or resolve with a pair of readers from the pharmacy, but the optometrist can provide a higher quality solution.
“We’re very active in communicating with our database, sending monthly newsletters discussing fatigue, presbyopia, headaches, and early signs of presbyopia like headaches, blur, and end-of-day fatigue. This proactive communication helps to educate our patients,” he says.
“When I first started, I’d see people every two or three years. Now, I tend to see most people at least once every 12 months.”
He adds that, as a result, his patients are a lot better informed of their choices, whether it’s about their lens supplier options or a specific contact lens.
With spectacle lens options, Fotkou says the level of personalisation that can be achieved with modern progressives is unprecedented.
Through a combination of precision manufacturing techniques and advanced design informed by highly personal measurements, the very best spectacle lens options – often referred to as premium progressive lenses – aim to provide a tailored eyewear solution to match a patient’s physiology and daily activities.
The big breakthrough came in the early 1980s with the use of Computer Numerical Control (CNC) technology in the manufacturing process, known
as digital or freeform surfaced progressive lenses.
Traditionally, lenses were designed with the power of progression on the front of the lens, however the advent of digital and freeform surfacing has allowed this to also be done on the back.
It meant lenses could be designed factoring in the wearer’s prescription, frame measurements, and specific visual habits.
Today, most, if not all, major manufacturers utilise freeform technology to craft progressive and single vision lenses that precisely meet the wearer’s specifications.
“The lens supplier we use tailors lenses to whether the patient is retired or working in an office, considering their occupation,” Fotkou says. “We use digital mapping for frame and lens choices, customising the corridors. We discuss with clients about their lifestyle to choose the right lens design.
“Generally, we opt for the latest free-form designs, only reverting to conventional multifocals if price is an issue.”
Don’t forget about contact lenses
Although less popular in the presbyope demographic, contact lenses are another option – and a potentially under-utilised one, according to Melbourne optometrist Ms Jessica Chi.
The Cornea and Contact Lens Society of Australia Victorian president says contact lenses for presbyopes can overcome some of the shortfalls and limitations of spectacles, such as impeding daily activities, the inconvenience of having to take spectacles on and off, or the challenge of locating the ‘sweet spot’ for progressive spectacles.
Although prescribing them often requires a greater chair time, Chi says the payoff for both practitioner and patient is worthwhile.
“Fitting contact lenses can take longer compared to spectacles, but it’s an investment in a lifelong patient relationship. Contact lens wearers are more loyal, and more likely to return for additional purchases, including glasses,” she says.
“Unlike some glasses-only patients who might not replace their glasses for up to 10 years, contact lens patients often need both lenses and glasses, leading to more frequent visits and increased revenue.”
Recent advancements in multifocal contact lens design and materials have also significantly improved comfort and vision for presbyopic patients, making them a more viable and appealing alternative to traditional spectacles, she notes.
Chi adds that when it comes to fitting multifocal lenses, the process should not be rushed. Allowing lenses to settle and ensuring the patient has adequate time to adjust is crucial.
“Imagine if we treated multifocal glasses the same way – quickly discarding them if the initial impression wasn’t perfect,” she says.
“Instead, we educate patients that they need time to neuro-adapt. Charging appropriately for contact lens fittings reflects confidence in the product and encourages patient buy-in. It shows confidence in the product and encourages the patient to persevere. However, it’s also vital to set realistic expectations: while multifocal glasses offer better vision for many tasks, they have limitations.
“By clearly communicating both the benefits and drawbacks, we can better manage patient expectations and ensure satisfaction.”
Eye drop evolution
But could patients circumvent the need for spectacles, contact lenses or surgery altogether?
Since 2021, Vuity eye drops (pilocarpine HCI ophthalmic solution 1.25%) have been available via prescription in the US to provide relief for presbyopic patients. According to its manufacturer Abbvie, it is a a daily, prescription eye drop that works in as early as 15 minutes and lasts up to six hours to improve near and intermediate vision without impacting distance vision.
It features a formulation of pilocarpine delivered with proprietary technology that allows Vuity to rapidly adjust to the physiologic pH of the tear film. It then uses the eye’s own ability to reduce pupil size, improving near vision.
The FDA approval of Vuity was based on data from two pivotal Phase 3 studies involving 750 people aged 40-55 with presbyopia. Participants were instructed to administer one drop of Vuity or placebo once daily in each eye. Both studies met their primary endpoints with a statistically significant proportion treated with Vuity gaining three lines or more in mesopic (in low light), high contrast, binocular distance corrected near visual acuity (DCNVA), without losing more than one line of corrected distance visual acuity (CDVA) at day 30, hour three, versus placebo.
Additionally, the drops were well-tolerated, with less than 5% of participants reporting side effects such as eye-irritation, altered vision and headaches.
The eye drop isn’t approved for Australia, but if it was, Fotkou believes it won’t replace the need for glasses.
“I see more it more as an evolution in therapy and an addition to things like contact lens wear and surgical solutions – it will not be a replacement,” he says.
Chi notes Vuity is simply a miotic resulting in a smaller pupil to try and increase depth of field. Common side effects can be headache, eyebrow ache or pain, ocular discomfort and difficulty in dim lighting and when changing focus between objects.
“Less commonly there could be risk for traction on the retina in susceptible individuals – i.e. high myopes and those with retinal issues. I am also uncertain whether Vuity will even gain approval in Australia,” she says.
Where the ophthalmologist comes in
For presbyopes seeking a more permanent, spectacle-free solution, then it’s off to the ophthalmologist with a referral in hand.
Huge advancements in IOL designs such as extended depth of focus (EDOF) or multifocal lenses – with diminishing but not-fully-resolved dysphotopsia profiles – are opening up new possibilities, while also heaping greater demands on the skills of ophthalmologists.
One of those is Dr Joanne Goh, a Victorian-based cataract and refractive surgeon who sees many patients seeking spectacle independence.
She says that a big shift in those seeking surgical presbyopic solutions has been an emerging younger cohort.
“Many want refractive lens exchanges to get rid of glasses for distance and near vision because they want freedom from glasses or are not adjusting well to multifocals,” says Dr Goh, director of City Eye Surgeons in Melbourne.
As culture and technology shift – especially with the increased use of screens – people are becoming more conscious of their symptoms at an earlier stage.
“I think awareness plays a big role. Patients are more aware of the options available, often through friends or family who have had the procedure done and are happy with the results. People come in knowing what they want,” Dr Goh says.
But patients sometimes find the solution isn’t always straightforward. The state of their tearfilm, corneal topography and even their retina can have a big bearing on the course of action.
Similarly, Dr Goh says a key concern for those seeking a premium IOL is whether their surgery will meet their expectations regarding the level of spectacle independence and quality of vision.
“We’re fortunate to have many options, ranging from lenses to laser options,” Dr Goh says.
“Not all options are suitable for every patient, and while we are very good at correcting presbyopia, we’re still not perfect. Patients need to understand the limitations of what we can and cannot do.”
Dr Goh clearly defines the benefits and disadvantage of each option.
“Presbyopia correction is a significant part of my practice. It’s important to counsel patients about their suitability for these lenses, as some may not be good candidates due to their personality or expectations. Sometimes, other options like glasses, which are low risk, might be better for them,” she says.
“Managing expectations means discussing all the potential side effects and making sure patients understand that achieving greater spectacle independence comes with trade-offs.”
Even for the optometrist this is an important issue. It’s something Fotkou sees when patients return to his care post-operatively.
“Expectations can be high, especially post-surgery when people have lens replacements,” Fotkou says. “Patients often expect perfect results because of the high accuracy of surgeons today.
“For example, they might now have 6/6 vision but complain about dryness or slight discomfort, and their expectations need to be managed realistically – they need to know that near perfect outcomes are not realistic.”
Another way out
Melbourne ophthalmologist Dr Anton van Heerden believes another form of refractive surgery is the future of presbyopia treatment. One that doesn’t inflict quite as much trauma on the eye and is better suited to younger presbyopes.
One of the directors at Eye Laser Specialists in Melbourne, he is a proponent of laser blended vision surgical technology, which is an extended depth of focus surgical option for presbyopic patients who don’t have cataract.
He says the concept is very similar to some EDOF IOL optics: there is a greater depth of focus per eye, which allows good binocular distance, intermediate and near vision.
One such example is ZEISS’s Presbyond Laser Blended Vision. In this system, the company product information states the dominant eye is corrected for distance vision to plano, while the non-dominant eye is corrected to be slightly myopic for near vision to -1.50 D. The algorithm controls the amount of spherical aberration induced in each eye which gives an extended depth of focus and a full range of binocular vision.
In 2020, approximately a third of Dr van Heerden’s refractive laser patient cohort were in the presbyopic age range and had Presbyond laser vision correction.
Now, he says this cohort has expanded and make up about 40% of his laser vision practice.
“Patients come wanting a presbyopic solution, and Presbyond, being non-invasive, is far safer, more accurate and predictable than IOLs. So, if someone is suitable for both IOL and laser vision correction, I’ll recommend laser vision correction,” he says.
Additionally, he says the procedure is favourable for the younger presbyobic cohort with no other ocular pathology.
“It’s a fantastic solution for younger presbyopic patients without lenticular problems who want a safe, quick, and accurate procedure. It’s much better than lens exchange in this cohort.”
Dr van Heerden expects that presbyopic laser vision correction will be more popular due to the safe and accurate nature of these procedures. However, the uptake is limited by the capital outlay and experience required to deliver this surgical option.
“I believe the role of corneal refractive surgery in the presbyopic space will continue to grow due to its benefits. Presbyond and other presbyopic laser solutions are gaining popularity. We were early adopters, and I expect interest to increase,” Dr van Heerden says.
For the patients that do not qualify for refractive laser surgery, Dr van Heerden says EDOF IOLs are the future.
However, the success of EDOF lenses hinges on better diagnostics and patient selection – choosing the right patients who will benefit most from these lenses is crucial.
“Currently, EDOF lenses can give unpredictable and variable outcomes. This is partly because as a society, we have been ignoring pre-existing corneal spherical aberration, pupil size and angle kappa. If we improve diagnostics, EDOF lenses will have more predictable and better outcomes,” Dr van Heerden says.
Dr Goh adds: “There are now refractive lenses aiming to reduce dysphotopsia, such as glares, halos, and starbursts, which are promising. If they can provide good functional near vision without these side effects, it would be a significant advancement.
“We’re getting closer to this ideal, and hopefully, a lens will eventually meet these expectations.”
Today, surgeons and patients must make trade-off decisions when selecting an IOL. For example, a lens can offer clear sight at all distances without spectacles, but at the price of possible night-time visual disturbances.
Dr Goh says a dysphotopsia profile that is comparable to a monofocal IOL with little to no halo, glare, and starbursts is what she hopes to see in her armamentarium in the future.
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