What Can You Do When Your Near Vision Gets Worse?
Do you hold your phone farther away to read in your 40s? Then your near vision is changing. Besides reading glasses, you can choose contact lenses, laser monovision or smart lenses.
The gradual loss of near vision with age is called presbyopia, and it starts in everyone in their 40s. Besides reading glasses, there are three main options. These are multifocal contact lenses, laser monovision and smart lenses. With laser monovision, one eye is set for distance and the other for near, which suits myopic people. Smart lenses replace the natural lens of the eye. They are the first choice, especially for farsighted people over 45.
What is presbyopia?
The natural lens of the eye is flexible in youth. It changes shape to focus when you look at something close. However, the lens stiffens with age, and this focusing power declines. As a result, from your 40s on, you hold your phone farther away to read small print. You also need more light, and your eyes tire quickly in the evening.
This is not a disease. It is the natural ageing of the eye. Worldwide, an estimated 1.8 billion people have presbyopia. Farsighted people notice it earlier, while myopic people notice it later. Myopic people have an advantage for a while, because they can see near objects when they take off their glasses.
“When near vision gets worse, our options are multifocal contact lenses, laser monovision or mini monovision, and smart lenses. Smart lenses are the first choice, especially for farsighted people.”
— Prof. Dr. Fırat Helvacıoğlu, from his video
What can we do when our near vision gets worse?
In 1 minute, Prof. Dr. Fırat Helvacıoğlu explains the options other than glasses for near vision problems.
Three main solutions when near vision declines
Besides reading glasses, you can solve a near vision problem with contact lenses, laser or an intraocular lens. Your age, your prescription and the condition of your natural lens decide which one is suitable.
- MonovisionIn myopic people, the laser sets the dominant eye for distance and the other eye for near. We recommend trying it with contact lenses first.
- Multifocal contact lensZones on the lens give different focus for distance and near. It is an option for people who do not want surgery.
- Smart lensA multifocal intraocular lens replaces the natural lens. It is the first choice, especially for farsighted people over 45.
Multifocal contact lenses for near vision
Multifocal contact lenses give focus for distance and near at the same time through different zones on the lens. They are a good option for people who do not want surgery and are used to wearing contact lenses. However, comfort can be limited in people with dry eyes. It can also be limited in people who work with very small print for long hours. We determine which lens suits your eye during the examination.
Laser monovision for near vision
In monovision, the dominant eye is set for distance and the other eye for near. Your brain then combines the two images. In mini monovision, the difference between the two eyes is smaller. Therefore you lose less distance vision, and you gain a moderate amount of near vision.
- It may suit myopic people in particular: while the laser corrects the distance prescription, a small amount of myopia is left in one eye.
- In a study of patients who had monovision with LASIK, the success rate was 97.6%. None of the patients who tried monovision with contact lenses before surgery asked to go back.
- For this reason, I recommend trying monovision with contact lenses for a few days before you decide.
There are also laser profiles that shape the cornea specifically for near and distance. We shared the long-term results of this method at the ESCRS congress. Laser does not change the lens of the eye, so near vision may decline again as you get older.
Smart lenses for near vision
In smart lens surgery, the surgeon removes the natural lens of the eye. Then the surgeon places an intraocular lens designed for distance, intermediate and near vision. In trifocal lenses, diffractive rings on the surface spread light to different distances. Because this treatment replaces the lens, near vision no longer declines again with age. A cataract will also not develop in that eye later.
This is the first choice, especially for farsighted people over 45. I explained the details in the articles “Can you have a smart lens without cataract?” and “Trifocal or EDOF?”.
Which near vision option suits whom?
| Situation | What we usually recommend |
|---|---|
| Does not want surgery, used to contact lenses | Multifocal contact lens |
| Myopic in the 40s, healthy lens | Laser monovision or mini monovision |
| Farsighted, over 45 | Smart lens |
| Cataract has started in the lens | Smart lens together with cataract surgery |
| Not bothered by glasses | Reading or progressive glasses |
We make the final decision after we evaluate your eye measurements, dry eye, profession and expectations together. You can find all the options on the presbyopia treatment page.
Frequently asked questions
People usually notice it between the ages of 40 and 45. Farsighted people notice it earlier, while myopic people notice it later.
Partly. Laser monovision or mini monovision can improve near vision. However, the lens of the eye keeps ageing, so near vision may decline again over the years.
No. Some people cannot adapt to the difference between the two eyes. For this reason, we recommend a trial with contact lenses before you decide.
No. Reading glasses do not speed up the progression of presbyopia. They only help you focus on near objects.
Mainly farsighted people over 45 who wear glasses for both distance and near, and people whose lens has started to develop a cataract.
Related pages
References
- Fricke TR, Tahhan N, Resnikoff S, et al. Global prevalence of presbyopia and vision impairment from uncorrected presbyopia: systematic review, meta-analysis, and modelling. Ophthalmology. 2018;125(10):1492-1499. doi:10.1016/j.ophtha.2018.04.013
- Reilly CD, Lee WB, Alvarenga L, Caspar J, Garcia-Ferrer F, Mannis MJ. Surgical monovision and monovision reversal in LASIK. Cornea. 2006;25(2):136-138. doi:10.1097/01.ico.0000178722.19317.7b
- Sunay E, Helvacıoğlu F, Kavalcıoğlu Ö, Akyurt A, Akın T. Long term outcomes of cornea modulation with excimer laser for simultaneous correction of presbyopia and ametropia. 34th ESCRS Congress, Copenhagen, 2016 (paper).
- Schallhorn SC, Schallhorn JM, Pelouskova M, et al. Refractive lens exchange in younger and older presbyopes: comparison of complication rates, 3 months clinical and patient-reported outcomes. Clin Ophthalmol. 2017;11:1569-1581. doi:10.2147/OPTH.S143201
This article is for patient information only. It does not replace an examination and medical evaluation. The treatment that suits you is decided after an eye examination and measurements. Publication date: September 25, 2026.
Contact Prof. Dr. Fırat Helvacıoğlu with your questions
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Cad. No: 257, Caddebostan – Kadıköy / Istanbul