Back to School for the Pupils: Education 101 for the Pre-presbyopic Patient

MILLENNIALS HAVE STARTED to celebrate their 40th birthdays, and Gen Z is not far behind. Representing more than 70 million Americans who belong to the first official generation on digital devices, the oldest Millennials (born in 1982) are part of another wave of aging adults who are quickly becoming presbyopic and are starting to present in their eye doctor’s chair with a decrease in near vision.1,2

The loss of focusing at near is usually a patient’s first sign (to themselves) that they are no longer “young.” I find it helpful to pre-educate pre-presbyopic patients on the expectations of the natural, normal, age-related vision change at near that they will likely notice by their 45th birthday. By regularly having that conversation at annual exams in the decade beforehand, the patient understands that presbyopia is natural, that there are alternate solutions to the problem when it occurs, and that I am here for them.

Clinically, I think there is even value in educating the young, emmetropic patients who don’t need glasses (for now) on the future of their aging eyes. For example, if I have an emmetropic 15-year-old teenager in my chair who doesn’t need to wear glasses and has perfect ocular health, I will still take the time to educate them that, one day, they may eventually need help with their vision. I also routinely start the discussion of presbyopia between the ages of 35 and 39 so that patients are not caught off guard by the unpreventable. Personally, I find it best to be upfront and honest with the impending inevitability of presbyopia but empathetic and to the point.

I find that explaining in a way that the patient can understand—while reassuring the pre-presbyopic patient that, when the time comes, there will be options available to improve their loss of near vision—is also an important component of the emerging presbyope’s annual exam. I try offering comedic comfort sometimes, saying, “If we are blessed to have ‘enough’ birthdays, nearly all of us, even the best eye doctors, will eventually experience this same change.”

In the U.S., we are fortunate to have access to resources available for presbyopia: glasses, contact lenses, pharmaceutical options, surgical interventions, etc. Unfortunately, in developing countries, the prevalence of unmanaged presbyopia (often due to lack of accessibility and education) for those 50 years old and older is estimated to be upwards of 50%.3 Although the measured prevalence of presbyopia is greater in regions with longer life expectancies,3 it is estimated that, in developing countries, 94% of those with significant near vision disability due to presbyopia are uncorrected, and as many as 34% in developed countries.4

Educating our pre-presbyopia patients before they have a problem with near vision helps solidify a caring patient-doctor relationship and ensures that the patient understands optometrists are here to help when their presbyopia concerns become more imminent. ■


  1. Arensberg LC, Kalender-Rich J, Lee J, Gibson CA. Millennials Seeking Healthcare: Examining the Degree to Which Patients Utilize Online Resources. Kans J Med. 2022;15:347-351. Published 2022 Sep 21.
  2. Sherber N. The Millennial Mindset. J Drugs Dermatol. 2018;17(12):1340-1342.
  3. 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.
  4. Goertz AD, Stewart WC, Burns WR, Stewart JA, Nelson LA. Review of the impact of presbyopia on quality of life in the developing and developed world. Acta Ophthalmol. 2014;92(6):497-500.