Presbyopia therapy reference (2026)

Presbyopia management in 2026 organises around several modalities.

Optical correction: reading glasses, bifocals or progressive-addition lenses, monovision contact lenses, multifocal contact lenses, and over-the-counter readers. The mainstay for most people.

Surgical: refractive lens exchange with multifocal or extended-depth-of-focus intraocular lenses, corneal inlays in selected populations, monovision LASIK or PRK in appropriate candidates, and combined cataract-and-presbyopia surgery (a major use case as cataracts develop in the same age group).

Pharmacological: pilocarpine ophthalmic solution provides reading-vision improvement through pupil constriction and ciliary muscle effect, with limitations including dim-vision difficulty and headache in some patients. Follow-on miotic-class programs with improved tolerability profiles are in late-stage trials. Emerging non-miotic mechanism programs target lens elasticity (a different intervention point) and may avoid the miotic-class side effects.

The selection question. Patients with intact distance vision who only want a reading-vision lift are candidates for pharmacological therapy. Patients with cataract have an opportunity to address presbyopia and cataract together with appropriate intraocular lens choice. Patients with active lifestyles or specific occupational needs may prefer surgical correction.