Cataract or Age-Related Farsightedness: How to Tell?

After the age of 40–45, vision can deteriorate for different reasons. A cataract is a clouding of the lens, while age-related farsightedness, or presbyopia, is a loss of the ability to focus up close. For some people reading glasses are enough, while others need treatment. You cannot determine the cause by how your eyes feel, but the typical differences will help you get examined in time.

What is age-related farsightedness?

To understand what age-related farsightedness is, you need to know how the lens works. In youth it is flexible and changes shape when you shift your gaze from far to near. Over the years, the lens becomes denser and focuses light less well. This is how presbyopia develops, usually becoming noticeable after the age of 40–45.

What is presbyopia of the eyes? It is a natural age-related change and not necessarily a sign of disease. However, persistent blurriness should not be put down to age without an examination.

How presbyopia differs from hyperopia

Hyperopia is a refractive error that can occur at any age. Light is not focused correctly, so near objects — and, in more severe cases, distant ones too — look blurry.

Presbyopia appears with age, when the lens becomes less able to change focus. That is why presbyopia and farsightedness are not exact synonyms. Degrees of farsightedness refer mainly to how severe hyperopia is, which is determined during a refraction test.

What is a cataract?

A cataract is a clouding of the eye's natural lens. Less light reaches the retina and it is scattered, so the image becomes blurry, dim or hazy. It is not a film on the surface of the eye that can be washed away with drops.

When talking about cataracts, it is important to remember that they do not occur only in very old age. The disease develops gradually in one or both eyes, and the rate of change can vary.

How age-related farsightedness begins

The main symptoms of age-related farsightedness show up at close range. A person holds their phone or book further away, enlarges the font and turns on bright light. The eyes tire more quickly, and strain and headaches may appear after reading.

These signs of farsightedness are more noticeable in the evening, while distance vision often remains sharp at first. This is what age-related farsightedness looks like in practice.

How a cataract begins

It is not easy to tell how a cataract begins: early changes are almost unnoticeable. Later, blurring, low contrast and faded colours appear. Bright light becomes bothersome, halos are visible around headlights and street lamps, and vision in dim light gets worse.

With a cataract, sharpness decreases both up close and at a distance. The glasses prescription often changes, and new lenses help only for a short time or fail to restore the previous sharpness. This should not be put down to tiredness alone.

Key differences between cataract and presbyopia

In presbyopia, the lens stays clear but gradually loses its flexibility. As a result, it becomes harder to read, use a phone and see small details up close. Distance vision is usually preserved, colours do not change, and glare and poor night vision are not typical signs. Properly fitted glasses help restore sharpness at close range.

With a cataract, the lens gradually becomes cloudy, so vision may deteriorate both up close and at a distance. The image becomes blurry, colours seem faded, and halos appear around light sources. People may also find it harder to see in the dark. Ordinary glasses help only partially or give only a temporary effect. The exact cause of deteriorating vision can only be determined after an examination by an ophthalmologist.

Can cataract and presbyopia occur at the same time?

Yes. Both conditions are related to age-related changes in the lens, so cataract and farsightedness can occur together. Glasses improve reading, but blurring, glare or dull colours remain.

Correcting farsightedness does not remove the clouding. If new glasses help only partially, sharpness keeps decreasing or the prescription has to be changed often, you need an examination.

How an ophthalmologist determines the cause of poor vision

The doctor checks distance and near vision and measures refraction to detect presbyopia, hyperopia and other refractive errors. A slit-lamp examination shows whether there is a cataract.

Eye pressure is also measured and the back of the eye is examined, sometimes after the pupil is dilated. Farsightedness is not the only cause of blurry vision: similar symptoms can occur with diseases of the cornea, retina and optic nerve.

How age-related farsightedness is corrected

Regular glasses are used for reading. Progressive lenses suit different distances, and office lenses suit computer and desk work. Contact lenses and surgical correction of farsightedness are also possible, but they have limitations.

The choice depends on your distance vision, profession, visual workload and eye health. Symptoms of age-related farsightedness do not require wearing glasses all the time: sometimes they are needed only for close work. If hyperopia is present, the degree of farsightedness is taken into account when choosing glasses.

Can a cataract be cured?

When answering whether a cataract can be cured, it is important to be clear: drops and exercises do not restore the lens's clarity. If the changes hardly bother you, the doctor may simply monitor them. A diagnosis does not mean that surgery is needed straight away.

If your vision makes it difficult to read, work or drive, surgical cataract removal is used: the lens is replaced with an intraocular lens. Cataract surgery is planned based on the examination results and your complaints.

When to see an ophthalmologist

A routine examination is needed if you have persistent blurring, glare, worsening night vision, reduced distance sharpness or frequently changing glasses. Even if you know how a cataract begins and what the signs of farsightedness look like, you cannot tell them apart at home.

Urgent help is needed for sudden vision loss, flashes, a dark curtain or severe pain. These are not typical of gradually developing presbyopia or cataract: the cause may be a dangerous condition.

Summary

In presbyopia, near focusing is affected first, whereas a cataract most often causes general blurring, glare, faded colours and problems with night vision. This helps explain what age-related farsightedness is and how it differs from clouding of the lens. However, only an ophthalmologist can determine the exact cause, so if your vision keeps getting worse, do not settle for buying glasses on your own.

If surgery has already been recommended to you, find out how cataract removal surgery is performed at the British Ophthalmological Center: the stages, recovery and what the price includes.