My distance vision is good but I need glasses for reading — what should I do?

It is one of the most common questions I hear in clinic: 'I can see perfectly in the distance, but I need reading glasses for my phone, book or menus. What are my options?' The answer is almost always presbyopia — the natural ageing of the lens inside the eye — and it is very treatable.

Why distance vision stays clear while reading becomes hard

Presbyopia happens because the crystalline lens inside your eye becomes less flexible with age. In a young eye, the lens changes shape to focus from distance to near. By the mid-40s it starts to stiffen, so near focus becomes more difficult. Distance vision is often unaffected because it relies on the relaxed eye, so many people keep excellent long-distance sight while needing reading glasses for the first time.

This is not the same as being long-sighted. Long-sightedness (hyperopia) is a prescription issue that can affect both distance and near vision from childhood. Presbyopia is age-related and occurs even in people who have never worn glasses before.

Your options, from simplest to most permanent

Reading glasses are the simplest solution. They provide magnifying power only for close work and are available from opticians without a prescription for lower strengths. They work well if you only need help for reading and do not mind carrying glasses around.

Varifocal or bifocal glasses give clear vision at distance and near in one pair, but they require an adaptation period and have a 'corridor' of intermediate vision that some people find restrictive at a computer.

Contact lenses can be fitted as monovision or multifocal designs. Monovision corrects one eye for distance and the other for near, which works well for many people but can reduce depth perception. Multifocal contact lenses offer both distances but require excellent tear film and healthy corneas.

Lens replacement surgery (refractive lens exchange) is the permanent option. It removes the stiffening natural lens and replaces it with a trifocal or extended-depth-of-focus intraocular lens. This restores distance, intermediate and near vision in one procedure, and also prevents cataracts from ever forming.

Which option is right for you?

The best choice depends on your age, prescription, eye health, work and lifestyle. Reading glasses are ideal for early presbyopia. Lens replacement surgery is usually most suited to patients in their late 40s to mid-60s who want a long-term solution, particularly those who already need separate glasses for distance and reading.

Patients who have a cataract, even an early one, are often excellent candidates for lens replacement because the same operation treats both problems at once.

What the assessment involves

Before I recommend anything, a full diagnostic assessment is essential. This includes corneal topography, macular OCT, biometry, tear-film analysis and a careful refraction. I also discuss how you use your vision at work and at home — for example, how much screen time you have, whether you drive at night, and whether you enjoy crafts or sports.

This information determines whether reading glasses, contact lenses or a specific type of intraocular lens will give you the best outcome.

Next steps

If you are in your 40s or 50s and finding yourself reaching for reading glasses more and more, book a consultation. Most patients leave the appointment with a clear understanding of what is causing the problem and a plan that fits their lifestyle — whether that is a simple pair of readers or a long-lasting surgical solution.