Presbyopia: Current Perspectives and Prospects for Patients

Presbyopia, the ubiquitous loss of near vision function with age, has undergone significant reframing over the past decade. Indeed, in the last 10 years since Ophthalmic & Physiological Optics’ last feature issue on presbyopia, research has progressed from viewing the refractive condition primarily as a decline in accommodative amplitude to recognising it as a multifactorial physiological process involving progressive lenticular stiffening, alterations in the capsule and zonule nexus and changes in optics. Advances in imaging and biomechanical assessment have deepened our understanding of the ageing crystalline lens and ciliary apparatus, while providing candidates for future clinical translation. Concurrent developments in correction and treatment have broadened the potential therapeutic landscape. Non-surgical approaches, particularly the emergence of pharmacological options including topical miotics and early-stage lens-softening agents, have marked the first major shift in presbyopia management in decades. Ongoing innovations in spectacle and contact lens designs have refined extended depth of focus and multifocal optics, while surgical strategies have continued to evolve. Despite these advances, consistent challenges remain in balancing near visual performance with quality of vision and in translating innovative laboratory and engineering innovations into stable, real-world patient benefits. In parallel, there has been a growing emphasis on patient-centred outcomes, reflecting an increased appreciation of the variability in visual demands, expectations and tolerance for compromises among presbyopic patients. Consequently, this narrative review synthesises some of the key developments related to presbyopia over the last 10 years, outlining future opportunities for restorative and personalised presbyopia care.