Age-related Long Sight (Presbyopia)

What is a refractive error?

A refractive error is an eyesight problem. Refractive errors are a common reason for reduced level of eyesight (visual acuity).

Refraction refers to the bending of light. In terms of the eye. A refractive error means that the eye cannot focus light on to the retina properly. This usually occurs either due to abnormalities in the shape of the eyeball, or because age has affected the workings of the focusing parts of the eye.
There are four types of refractive error:

• Myopia (short sight).
• Hypermetropia (long sight).
• Astigmatism (a refractive error due to an unevenly curved cornea).
• Presbyopia (age-related long sight).

In order to understand refractive errors fully, it is useful to know how we see.
When we look at an object, light rays from the object pass through the eye to reach the retina. This causes nerve messages to be sent from the cells of the retina down the optic nerve to the vision centres in the brain. The brain processes the information it receives, so that in turn, we can see.

The light rays have to be focused on a small area of the retina; otherwise, what we look at is blurred. The cornea and lens have the job of focusing light. The cornea partly bends (refracts) the light rays which then go through the lens, which finely adjusts the focusing. The lens does this by changing its thickness. This is called accommodation. The lens is elastic and can become flatter or more rounded. The more rounded (convex) the lens, the more the light rays can be bent inwards.
The shape of the lens is varied by the small muscles in the ciliary body. Tiny string-like structures called the suspensory ligaments are attached at one end to the lens, and at the other to the ciliary body. This is a bit like a trampoline with the middle bouncy bit being the lens, the suspensory ligaments being the springs, and the ciliary muscles being the rim around the edge.
When the ciliary muscles in the ciliary body tighten, the suspensory ligaments slacken, causing the lens to fatten. This happens for near objects. For looking at far objects, the ciliary muscle relaxes, making the suspensory ligaments tighten, and the lens thins out.
More bending (refraction) of the light rays is needed to focus on nearby objects, such as when reading. Less bending of light is needed to focus on objects far away.