Understanding Vision Changes and Solutions

Insights from Dr. Erin Lally, MD, Ophthalmologist

Hello, I’m Dr. Erin Lally, a board-certified ophthalmologist who specializes in cataract surgery and retinal disease. Today, I want to talk about a common question I often hear from my patients: “Why can’t I see up close anymore, and how can I fix this?” Let’s delve into the causes of this issue and explore various solutions including glasses, LASIK, cataract surgery, and eye drops, with a special focus on multifocal and extended-depth of focus lenses, specifically PanOptix and Vivity.

The Problem: Difficulty Seeing Up Close

Presbyopia is a natural, age-related condition where the eye’s lens loses its flexibility, making it difficult to focus on close objects. This process typically begins in our early to mid-40s and progresses over time. The lens hardens and becomes less elastic, reducing its ability to change shape and focus on near objects—a process essential for clear near vision. This change can lead to symptoms like difficulty reading fine print, needing to hold reading materials at arm’s length, and eye strain or headaches during close work. Understanding presbyopia is key in exploring corrective options, as each solution addresses different aspects of this visual decline.

Solutions to Presbyopia


The simplest solution is reading glasses. Bifocals, trifocals, and progressive lenses can also help if you need correction for distance vision.

Contact Lenses

Some people opt for bifocal or multifocal contact lenses, which offer both near and far focus in one lens. A contact lens may also be used in one eye only to give one eye distance vision and one eye near vision to compensate for presbyopia

LASIK Surgery

For a more permanent solution, LASIK surgery can reshape the cornea. However, it might not be suitable for everyone, especially those with certain eye conditions, very thin corneas, or very high refractive errors. LASIK eye surgery is also not recommended in older individuals when cataracts are present. While LASIK can result in clear vision at a single, fixed-distance, it does not reinstitute the range of vision (the ability to see clearly at different focal points) that the patient had prior to the development of presbyopia. For all focal points outside of a single fixed-distance, glasses are needed. 


Vuity is an FDA-approved prescription eye drop that can temporarily improve symptoms of presbyopia in adults. The eyedrop begins to improve near vision as quickly as 15 minutes after application and lasts up to 6 hours.  Because the effects are temporary, daily use of the eyedrop is needed for ongoing benefits.

Cataract Surgery

During cataract surgery,  certain lenses, both multifocal and extended-depth of focus lenses,  can be implanted into the eye to restore one’s ability to see multiple different distances, thus permanently correcting presbyopia! Let’s delve deeper into these lenses and the technology that makes them successful. 

Advanced Solutions: Multifocal and Extended-Depth of Focus Lenses

In recent years, there have been significant advancements in intraocular lenses (IOLs) used in cataract surgery. During cataract surgery, a lens is implanted into the eye. Traditionally, patients had to choose between a distance-aim and a near-aim of-focus visual target. If far distance was the goal, the patient would need to wear glasses for near, and on the contrary, if near vision was the goal target, patients would have to wear glasses for distance.  With the advent of these newer multifocal and extended depth of focus lenses, patients no longer need to choose a single, fixed point for clear vision. 

Unlike LASIK surgery, which results in clear vision at a single distance, both, multifocal and extended-depth of focus lenses offer clear vision at a broad range of focal points. This range of clear vision most closely replicates one’s natural ability to focus, prior to the onset of presbyopia. Let’s explore two revolutionary types: PanOptix and Vivity.

In-Depth Look at PanOptix Lenses

The PanOptix lens, a trifocal intraocular lens (IOL), is a cutting-edge solution designed to address the challenges of presbyopia, especially post-cataract surgery. It provides a full range of vision – near, intermediate, and far distances, reducing the dependency on glasses. Here’s how it works:

  1. Trifocal Design: Unlike traditional lenses, PanOptix has three focal points. It splits light to focus on near, intermediate, and far objects, offering a more seamless visual experience.
  2. Light Utilization: It optimizes light transmission, ensuring clear images under various lighting conditions.
  3. ENLIGHTEN Optical Technology: This unique feature enhances image quality and reduces visual disturbances, like glare and halos, which are common in earlier multifocal designs.

However, it’s important to note that while PanOptix significantly improves vision at all distances, some patients might still experience mild visual phenomena, such as rings around lights at night.

Exploring Vivity Lenses

Vivity lenses are another advanced option, falling under the category of extended-depth of focus (EDOF) IOLs. Unlike PanOptix, Vivity uses a non-diffractive design, which extends the depth of focus. Key features include:

  1. X-WAVE Technology: This patented design stretches and shifts light without splitting it, offering a continuous range of vision from near to far.
  2. Non-Diffractive Design: By not splitting light into distinct focal points, Vivity reduces the incidence of glare and halos, making it suitable for patients sensitive to these phenomena.
  3. Versatility: Vivity is versatile, performing well under different lighting conditions and suitable for patients with various lifestyle needs.

Both PanOptix and Vivity represent significant advancements in IOL technology, offering tailored solutions to patients with presbyopia, especially in the context of cataract surgery. However, the choice between these lenses depends on individual visual needs, lifestyle, and how the patient’s eyes respond to different types of light distribution.

The Future of Presbyopia Treatment: Technological Innovations on the Horizon

As we look toward the future, ongoing technological advancements promise even more effective and personalized solutions for presbyopia. The field of ophthalmology is rapidly evolving, leveraging cutting-edge research and technology to revolutionize how we address age-related vision changes. Here are some key areas of future development:

  1. Customizable Intraocular Lenses (IOLs): Research is ongoing into IOLs that can be adjusted post-surgery using light or other stimuli. These lenses aim to provide a more personalized vision correction based on the patient’s changing needs.
  2. Advanced Refractive Surgery Techniques: Developments in laser eye surgery may offer more tailored and precise corrections for presbyopia. Techniques that allow for a dynamic adjustment of the eye’s focusing ability are under exploration.
  3. Smart Contact Lenses: These lenses, still in the research phase, could provide adjustable focus, potentially controlled by a mobile device. They aim to automatically adapt to different visual needs throughout the day.
  4. Regenerative Medicine: Breakthroughs in regenerative medicine might one day allow for the restoration of the eye’s natural lens elasticity. This could lead to treatments that reverse presbyopia at its biological root.
  5. Digital and Augmented Reality Aids: Augmented reality (AR) technologies and digital applications could offer personalized visual aids, enhancing day-to-day activities for those with presbyopia.
  6. Topical Medications and Eye Drops: Following the introduction of Vuity, further research is being conducted into more advanced formulations and new pharmacological approaches to treat presbyopia non-invasively.

Personalized Care for Your Eyes

Each patient’s eyes are unique, and the best solution varies depending on individual needs, lifestyle, and eye health. As your ophthalmologist, I’m here to guide you through this journey, offering personalized care and advanced treatment options.

In summary, while aging and changes in vision are inevitable, modern medicine offers a range of solutions to help you see clearly at all distances. Whether it’s glasses, contact lenses, LASIK, or advanced lens implants like PanOptix and Vivity, there are more options than ever to address presbyopia and related conditions.

The future of presbyopia treatment is bright and full of potential. With ongoing advancements in technology, we are moving towards more effective, less invasive, and highly personalized treatment options. These innovations not only aim to improve vision but also enhance the overall quality of life for individuals with presbyopia. As an ophthalmologist, staying abreast of these developments is essential to provide the best possible care to our patients, ensuring that as we age, our vision continues to support our lifestyles and daily activities.

Remember, regular eye exams are crucial for maintaining eye health and catching any issues early. If you’re experiencing changes in your vision or have concerns about your eye health, don’t hesitate to reach out to your ophthalmologist. Together, we can find the best path to clear and comfortable vision.

Dr. Erin Lally, MD
Board Certified Ophthalmologist
Specialist in Anterior Segment and Retina

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