What is the difference between long-sightedness and presbyopia?

Long-sightedness is a matter of how the eye is built: the eyeball is too short in relation to its refractive power, so the sharp image would form behind the retina — and that is usually present from childhood. Presbyopia is something else: over the course of life the lens of the eye loses its flexibility, so that focusing for near vision falls off; from about the mid-forties this affects everyone, including people with normal sight and short-sighted people. Both lead to the same complaint, 'blurred close up', but they have different causes. As a rule of thumb: anyone who needed plus glasses as a child or young adult, or tired quickly while reading, is long-sighted; anyone who saw everything effortlessly until the mid-forties and now has to stretch their arm out is becoming presbyopic. The two can only be told apart cleanly with a measurement — and both together is common.

My child squints — has that anything to do with long-sightedness?

That is quite possible. To see sharply close up, a long-sighted child has to focus hard, and focusing is coupled in the brain with turning the eyes inwards — with pronounced long-sightedness a convergent squint can arise from this, the so-called accommodative squint. In this form a correctly prescribed pair of glasses often returns the eye position to normal, wholly or in part, because it takes the effort off the child. The timing matters: if an eye squints permanently, the brain increasingly passes it over, and out of that a weakness of sight can develop that can only be made up to a limited extent later. Please do not put this off and have your child examined — including when the squint is only noticeable at times.

Can long-sightedness disappear?

In small children yes, within limits: almost all children come into the world slightly long-sighted, and as the eye grows this often evens out on its own. In adults it does not disappear — the length of the eye and the refractive power of the cornea and lens no longer change appreciably. Only when your own lens clouds over can the value shift again — some people then read better for a time; that is not a cure but a finding that ought to be looked at. What does change is the ability to paper over it: as focusing power declines, a long-sightedness that had gone unnoticed until then becomes visible, which many experience as a 'sudden deterioration'. Vision exercises, eye training or food supplements do not reduce a long-sightedness. If, on the other hand, your sight fluctuates markedly over days, something else is sometimes behind it — a blood sugar level that has got out of hand, say, or a very dry ocular surface — and that ought to be looked at.

Why do I see well at a distance despite being long-sighted?

Because the eye corrects itself. The lens of the eye can curve and so make up the missing refractive power — accommodation is the name of this process, and in younger years so much of it is available that a mild to moderate long-sightedness does not stand out in everyday life at all. Near vision demands more of it than distance, which is why near vision makes itself felt first, and often not as blur but as effort. As the flexibility of the lens declines over the years, the reserve first no longer suffices for near vision and later not for distance either. The eye has not then suddenly become worse — the long-sightedness was there the whole time and is simply no longer covered up.

Can long-sightedness be lasered?

In principle long-sightedness can be corrected both with procedures on the cornea and with lens procedures. The range that can sensibly be corrected is narrower here than in short-sightedness, and whether you are suitable at all depends on your value, on the thickness and shape of the cornea, on pupil width, on age and on the state of your own lens — that is decided by the preliminary examination, not by the wish. No procedure stops presbyopia: glasses for near vision can still become necessary after a correction, or remain necessary. There are no guarantees of freedom from glasses, and we do not hold any out. We set out, open-endedly, which routes are realistic for you — and we say so too when a well-fitted pair of glasses is the most sensible thing.

Do glasses make your eyes lazy?

No. Glasses change neither the length of the eye nor the refractive power of the cornea and lens; they merely take away the continuous work the eye would otherwise do. In adults, everyday life decides how long they are worn: anyone who is free of symptoms without glasses need not wear them, and anyone who gets headaches in the evening feels the difference at once. In children it is different — there a prescribed pair of glasses is treatment and not comfort: with a convergent squint or a threatened weakness of sight, wearing them consistently is the decisive part of the treatment. Deliberately choosing under-strength glasses 'for training' does nobody any good and can harm children.

When should my child first have their eyes examined?

At anything noticeable, straight away: an eye that turns inwards or outwards, a tilted head posture, frequent screwing up of the eyes or rubbing of them, going very close to books and screens, headaches towards evening, or a school eye test that showed something noticeable. Without anything noticeable, an ophthalmic check before school starts makes sense; if there is marked refractive error or squint in the family, correspondingly earlier. The reason for the hurry is not the glasses but the development: vision matures in the first years of life, and an eye that does not get a sharp image in this phase does not learn to see fully. Children never report this of their own accord, because they know nothing else. Examinations with us are possible from kindergarten age; if it is a baby or a toddler, we discuss on the phone whether a paediatric ophthalmology consultation is the more suitable place — so do get in touch in any case, so that the assessment is not left undone.

Refractive errors

Long-sightedness — why reading is tiring even though distance is fine

The text moves away, towards evening the eyes burn, and after two pages the forehead makes itself heard. That can be long-sightedness — but it can also be presbyopia, and those are two different things with the same complaint. This page explains what actually happens in the eye, what tells the two apart, and why an unrecognised long-sightedness means something quite different in children than in adults.

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What long-sightedness is

An eye sees sharply when the incoming light is focused exactly on the retina. With Hyperopia that relationship does not hold: in relation to its refractive power the eyeball is too short, or the cornea and lens refract the light too weakly. The focal point would then, by calculation, lie behind the retina — and the image that arrives there is blurred. With that, long-sightedness counts among the refractive errors of the eye.

The medical name for it is Hyperopia; some reports also write hypermetropia. Long-sightedness and hyperopia mean the same thing: the word from the waiting room and the one from your spectacle prescription. There you recognise it by the plus sign in front of the value — converging lenses bring the focal point forward, whereas minus lenses in Myopia do the opposite.

Up to this point the matter would be simple. What complicates it is a capacity the eye brings with it: accommodation. A ring-shaped muscle in the eye can curve the lens and so increase its refractive power — intended, really, for switching vision from distance to near. A long-sighted eye puts exactly that reserve to work making up for its own structural flaw. It does so automatically, without your noticing.

That is why a young person with mild to moderate long-sightedness sees sharply as a rule — at distance and often close up as well. They see sharply because they are constantly doing muscle work. And because near vision demands more accommodation than distance, it is there that the eye runs out of reserve first. That explains both: why a long-sightedness can go undetected for decades — and why, when it does make itself felt, it usually does so not as blur but as effort.

Technically, a distinction is therefore drawn between the part the eye compensates for itself (latent long-sightedness) and the part that is left over and shows up in the ordinary measurement (manifest long-sightedness). For you this has one practical consequence: in young eyes a measurement without further preparation does not necessarily capture the whole value. How we handle that is further down, in the section on assessment.

Long-sightedness or presbyopia?

This is the commonest confusion in this field, and it is understandable: both announce themselves with the same sentence — 'things go blurry close up'. But the causes have nothing to do with each other.

Long-sightedness: a matter of how the eye is built

It arises from the length of the eyeball and the refractive power of the cornea and lens. This is laid down from birth, changes during growth and is then essentially fixed. A long-sightedness can be present at any age — a twenty-year-old can be long-sighted, and so can a child.

Presbyopia: the lens ageing

Here the build of the eye plays no part — presbyopia comes on top of any starting position. What declines is the flexibility of the lens: over the years it becomes firmer, and the muscle can curve it less and less. With that, the range within which focusing is possible shrinks. This is not a fault and not a disease but a process that affects everyone — short-sighted people too, and people who have never needed glasses in their lives. It usually makes itself felt from the mid-forties. What can make up for the declining focusing power — from reading glasses through varifocals and workplace glasses to procedures on the lens — is set out on the page on presbyopia and the ways of compensating for it in everyday life.

Feature	Hyperopia	Presbyopia
Cause	Eye too short, or refractive power too weak	Lens of the eye loses its ability to change shape
Onset	Laid down from birth, often unnoticed for a long time	Gradual, usually from the mid-forties
Who it affects	A proportion of people	Everyone, regardless of what glasses came before
Distance	Affected as well at higher values	Stays unchanged
Possible in children	Yes, and particularly significant there	No

The rule of thumb — and where it ends

The most honest short version runs: Anyone who tired while reading in their younger years or needed plus glasses is long-sighted; anyone who saw everything effortlessly until the mid-forties and now has to stretch their arm out is becoming presbyopic. That applies in most cases and helps you place it.

It just does not always help. For one thing, the two occur together, and often. Secondly, it is long-sighted people in particular who notice presbyopia earlier than others: part of their reserve was already being used up to make up for their own structural flaw — as it runs low, it is missing twice over. And thirdly, there are causes of blurred near vision that have nothing to do with either, such as a developing cataract or an unsettled ocular surface in dry eyes.

The two can only be told apart cleanly by a measurement — in most adults in a short appointment, in young eyes with the additional step of the drops. And depending on how the answer comes out, a quite different correction is needed. An overview of the various forms of refractive error can be found on the page Refractive errors.

Symptoms in adults

In adults, long-sightedness rarely announces itself with 'I see badly'. It announces itself as exhaustion. Typically:

Close work is an effort — reading, sewing, craft work, the screen. The text is sharp at first and blurs after a while, not the other way round.
Headaches, usually above the eyes, in the forehead or in the temples, typically towards the end of a day of reading
Tired, burning, reddened eyes in the evening, often together with the urge to rub your eyes
Your eyes have to 'click into place' again, when you switch from near to distance — blurred for a few seconds
Reading distance grows: the book, the phone, the menu move further away
Concentration falls off while reading — in children and teenagers sometimes the only sign
Later distance too: signs, faces and subtitles become blurrier once the reserve no longer stretches to both

What stands out is the course over the day: in the morning it is fine, in the evening it is not. That is because there is muscle work behind the sharp image, and muscles tire. Many describe it as 'it takes me longer to get into a text' or 'after half an hour I have to stop'.

The point at which it becomes uncomfortable is often not the beginning of the long-sightedness but the decline of focusing power — usually between forty and fifty. What then feels like a rapid deterioration is in reality the surfacing of something that had been there for a long time.

These symptoms are unpleasant, but they are not an emergency and, taken on their own, they usually do not point to a disease of the eye. What is behind them is shown by the examination. An appointment in the next few weeks is enough. It is different if your sight suddenly changes, if flashes of light, a swarm of black dots, a shadow from the edge of your vision, double vision or a painful red eye join it — then please call us the same day.

Long-sightedness in children

In adults an uncorrected long-sightedness is mainly a nuisance. In children it is something else: it can disturb the development of vision — and children say nothing. They cannot say it, because they have nothing to compare it with. A child who sees with effort takes that to be the normal state.

Why children are born long-sighted anyway

Almost all newborns are slightly long-sighted: the eye is still short. As it grows, the relationship between length and refractive power as a rule evens out on its own. A mild long-sightedness in the toddler years is therefore normal and not a finding. It becomes significant when it is markedly pronounced, when it turns out markedly different between the two eyes — or when the child begins to squint.

Convergent squint: why it arises here in particular

Focusing and turning the eyes inwards are coupled together in the brain: when you look at something close, you focus and turn both eyes towards each other. But a long-sighted child has to focus hard for ordinary seeing already — and takes the inward turn along with it, unintentionally. Out of that can come an accommodative convergent squint that often becomes noticeable in the toddler years, at first only at times, when the child is tired or looking at things close up.

The remarkable thing about this form: a correctly prescribed pair of glasses takes the effort off the child, and with that the eye position often returns to normal, wholly or in part. Here the glasses are not a visual aid in the everyday sense but the treatment — which also explains why wearing them consistently matters so much.

Weak sight — the real risk

If an eye goes without a sharp image for a longer period, the brain does not learn to use it. It suppresses the poorer image, and the eye's sight stays weak — technically, an amblyopia. One-sided long-sightedness is particularly treacherous: the healthy eye delivers a faultless image, the child sees perfectly normally with both eyes open, and nobody notices anything. That is precisely why each eye is tested separately.

Timing is what decides here: vision matures in the first years of life. What is not laid down in this phase can only be made up to a limited extent later — which is why an assessment at kindergarten age is not a formality.

Why children's eyes need drops

In children and young adults the focusing power is so great that the ordinary measurement leaves a long-sightedness underestimated or completely hidden: the eye corrects itself during the examination. That is why, where the question calls for it, we give eye drops that switch this focusing off for a time. Only then does the measurement show the actual value — this is what is called cycloplegic refraction.

In practice that means: the pupils stay wide and near vision blurred — in children often until the next day, with certain drops for longer — and your child is sensitive to glare during that time. Allow time for the appointment, bring sunglasses or a cap, and reckon with reading and homework not going well on that day and often the next as well. That is the price of a number that is right — glasses based on a hidden long-sightedness would be too weak.

Please come in with your child, if one eye turns inwards or outwards, if the head is held at an angle when looking, if the child often screws up their eyes or rubs them, moves very close to books and screens, complains of headaches towards evening — or if a school eye test showed something noticeable. We examine children from kindergarten age; for babies and toddlers we work out on the phone whether a consultation specialising in paediatric ophthalmology is the better place — in that case please call all the same, so that the assessment does not wait.

Long-sightedness and the narrow anterior chamber angle

There is a connection that hardly anyone knows about and that belongs here for exactly that reason: long-sighted eyes have a somewhat higher risk of a particular form of glaucoma — angle-closure glaucoma.

The explanation is purely anatomical. A long-sighted eye is a short eye, and in a short eye the front section is smaller too: the anterior chamber between the cornea and the iris is shallower, and the anterior chamber angle — the corner where the aqueous humour drains — is narrower. On top of that, the lens of the eye grows thicker over the course of life and gradually pushes the iris further forward. Together, the two can narrow that narrow angle further.

If the outflow is partly obstructed, the intraocular pressure rises slowly, usually without symptoms. If it is blocked suddenly, an acute attack of glaucoma results: severe pain in the eye and in the head, a red eye, rapidly worsening vision, coloured rings around light sources, an eyeball that appears rock-hard, often nausea and vomiting. This combination is an emergency — it ought to be treated within hours, because the high pressure can damage the optic nerve permanently.

Please do not read this as a threat. The great majority of long-sighted people never have an attack of glaucoma, and a narrow angle is a risk, not a finding. All that follows from it is that a look is worthwhile — and that look is unspectacular: we assess the depth of the anterior chamber at the slit lamp and the anterior chamber angle with a contact lens after an anaesthetic drop (gonioscopy) or without contact at the device, and we measure the intraocular pressure. It takes minutes and does not hurt.

Such an assessment is worthwhile, if there is a more pronounced long-sightedness and you are past midlife, if glaucoma runs in your family, if you see coloured rings around lamps in the evening or know recurrent dull pain in the eye — and before you are given medicines that dilate the pupil. If a very narrow angle shows up, there are preventive options, which we then discuss with you unhurriedly. What glaucoma is, how it arises and how it is treated, you can read under Glaucoma.

How long-sightedness can be corrected

What is corrected is always the same: refractive power is missing, and it is added. The routes there differ in effort, cost and requirements — not in principle.

Glasses

Converging lenses with plus values are the simplest and by far the cheapest route, and for children they are the first choice. How much you wear them depends in adults on the symptoms: some need the glasses only for reading and at the screen, others all day. When presbyopia is added, near vision is strengthened further — as reading glasses, as workplace glasses for the monitor distance, or as varifocals covering several distances.

Contact lenses

Long-sightedness can also be corrected with contact lenses, spherical as well as multifocal. Whether they are an option for you depends on the ocular surface: an unsettled tear film and dry eyes go badly with lenses, and people who work at a screen often have exactly that. Hygiene matters — lenses and a red eye are always a reason to take the lens out and call us.

Refractive procedures

There are procedures that change refractive power permanently: treatments on the cornea, and procedures in which an additional lens is placed in the eye. For long-sightedness the range that can sensibly be corrected is narrower than for short-sightedness, and suitability is decided by the preliminary examination: the value, the thickness and shape of the cornea, pupil width, age and the state of your own lens. What none of these procedures achieves is stopping presbyopia — glasses for near vision can still become necessary afterwards, or remain necessary. There are no guarantees of a life free of glasses, and we do not hold any out: we set out what is realistic in your situation, and we say so too when a well-fitted pair of glasses remains the most sensible thing.

Lens procedures from midlife on

Over the years your own lens clouds over — that is cataract. When it is replaced, the power of the new artificial lens determines how the eye refracts afterwards: at this step the long-sightedness can be corrected at the same time. That is why, in people past midlife, the question of the state of the lens comes before any thought of a treatment on the cornea. How such an operation works, what types of lens there are and what they achieve, you can read under Treating cataract. Here too: the goal is agreed together beforehand, and depending on the lens chosen, glasses for particular distances remain part of the result.

What does not help

Eye training and vision exercises change neither the length of the eye nor the refractive power of the cornea and lens — a long-sightedness cannot be trained away. Nor can food supplements do it. And the most persistent piece of advice of all is the most wrong: wearing deliberately under-strength glasses, 'so the eyes don't get used to them'. Glasses do not make an eye lazy; they take work off it that it otherwise does continuously. In children a deliberately under-strength correction can even do harm, because it keeps up exactly the effort that leads to squinting.

How we assess

What happens is unspectacular and done in one appointment. First the conversation: what is bothering you, at what distance, since when, how you work and read. Then we measure your current glasses, determine the values at the device and afterwards settle them together with you — 'better like this, or like this?'. Near vision we test separately, and for screen work at the distance of your monitor as well. What is measured in detail is described on the page Eye test.

For young eyes and for children, the step described above is added: without switching the focusing off, the value measured in a long-sightedness is not necessarily the right one. We tell you beforehand whether drops are needed, so that you can plan the appointment accordingly — after dilating drops you should not drive yourself. Very rarely the intraocular pressure rises after dilating drops — particularly with a very narrow anterior chamber angle. If in the hours after the appointment you notice severe pain in the eye, a red eye, headache with nausea or coloured rings around light sources, call at once; outside consulting hours, the ophthalmic emergency service.

With us, refraction always includes a look at the eye itself: cornea, lens, anterior chamber and anterior chamber angle, intraocular pressure and — depending on the question — optic nerve and retina. A spectacle prescription says nothing about whether the eye is healthy. What a complete ophthalmic examination covers is set out under Eye examinations; the whole field you will find under Ophthalmology.

We examine at all three locations — in Zürich, in Wetzikon and in Meilen; addresses, opening hours and directions can be found under Locations. You can reach us on +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30, or in writing through the contact form. Outside consulting hours the ophthalmic emergency service applies. Referring colleagues will find the necessary details under Referring physicians.

Costs & health insurance

What does the insurer pay for — and what not?

For the cost question what counts is the reason, not the device: assessing symptoms is medical treatment; the aid that follows it, as a rule, is not. We tell you before the examination what applies in your case.

Service	Coverage	What this means for you
Ophthalmic assessment for symptoms	Basic insurance (OKP)	Headaches with close work, rapid tiring while reading, changed or blurred vision are a medical question. The deductible and co-payment apply as for any visit to a doctor.
Examination of children with suspected squint or refractive error	Basic insurance (OKP)	Assessment, cycloplegic refraction and follow-up checks are medical treatment for this question. For children, separate and lower rates apply to the deductible and the co-payment.
Glasses: lenses and frame	Self-pay service	In adults, basic health insurance (OKP) does not as a rule cover the visual aid; some supplementary insurance policies contribute. For children there is a statutory arrangement with a limited annual contribution, and beyond that with certain eye conditions — settle this with your health insurer.
Contact lenses and fitting	Self-pay service	Lenses, care products and the fitting are, as a rule, yours to pay for. For children and adolescents, and with certain eye conditions, the same statutory arrangement applies as for spectacle lenses — ask your health insurer. Checks of the ocular surface for symptoms, by contrast, are a medical service.
Refractive procedure for freedom from glasses	Self-pay service	A procedure whose only purpose is to replace glasses is not medical treatment. Cataract surgery with a medical indication is different: it runs through basic health insurance, while surcharges for special lenses are yours to bear.

Not sure which category your concern falls into? Call us — +41 44 500 69 00. We tell you on the phone what to expect, and with that same information you can check with your health insurer if in doubt. A bill that comes as a surprise is an avoidable annoyance.

Related conditions

Presbyopia Glaucoma Refractive errors

Medically reviewed by PD Dr. med. Andrea von Rückmann · Last reviewed 13 August 2026

Your ophthalmologistPD Dr. med. Andrea von RückmannView profile

Frequently asked questions about long-sightedness

: Long-sightedness is a matter of how the eye is built: the eyeball is too short in relation to its refractive power, so the sharp image would form behind the retina — and that is usually present from childhood. Presbyopia is something else: over the course of life the lens of the eye loses its flexibility, so that focusing for near vision falls off; from about the mid-forties this affects everyone, including people with normal sight and short-sighted people. Both lead to the same complaint, 'blurred close up', but they have different causes. As a rule of thumb: anyone who needed plus glasses as a child or young adult, or tired quickly while reading, is long-sighted; anyone who saw everything effortlessly until the mid-forties and now has to stretch their arm out is becoming presbyopic. The two can only be told apart cleanly with a measurement — and both together is common.
: That is quite possible. To see sharply close up, a long-sighted child has to focus hard, and focusing is coupled in the brain with turning the eyes inwards — with pronounced long-sightedness a convergent squint can arise from this, the so-called accommodative squint. In this form a correctly prescribed pair of glasses often returns the eye position to normal, wholly or in part, because it takes the effort off the child. The timing matters: if an eye squints permanently, the brain increasingly passes it over, and out of that a weakness of sight can develop that can only be made up to a limited extent later. Please do not put this off and have your child examined — including when the squint is only noticeable at times.
: In small children yes, within limits: almost all children come into the world slightly long-sighted, and as the eye grows this often evens out on its own. In adults it does not disappear — the length of the eye and the refractive power of the cornea and lens no longer change appreciably. Only when your own lens clouds over can the value shift again — some people then read better for a time; that is not a cure but a finding that ought to be looked at. What does change is the ability to paper over it: as focusing power declines, a long-sightedness that had gone unnoticed until then becomes visible, which many experience as a 'sudden deterioration'. Vision exercises, eye training or food supplements do not reduce a long-sightedness. If, on the other hand, your sight fluctuates markedly over days, something else is sometimes behind it — a blood sugar level that has got out of hand, say, or a very dry ocular surface — and that ought to be looked at.
: Because the eye corrects itself. The lens of the eye can curve and so make up the missing refractive power — accommodation is the name of this process, and in younger years so much of it is available that a mild to moderate long-sightedness does not stand out in everyday life at all. Near vision demands more of it than distance, which is why near vision makes itself felt first, and often not as blur but as effort. As the flexibility of the lens declines over the years, the reserve first no longer suffices for near vision and later not for distance either. The eye has not then suddenly become worse — the long-sightedness was there the whole time and is simply no longer covered up.
: In principle long-sightedness can be corrected both with procedures on the cornea and with lens procedures. The range that can sensibly be corrected is narrower here than in short-sightedness, and whether you are suitable at all depends on your value, on the thickness and shape of the cornea, on pupil width, on age and on the state of your own lens — that is decided by the preliminary examination, not by the wish. No procedure stops presbyopia: glasses for near vision can still become necessary after a correction, or remain necessary. There are no guarantees of freedom from glasses, and we do not hold any out. We set out, open-endedly, which routes are realistic for you — and we say so too when a well-fitted pair of glasses is the most sensible thing.
: No. Glasses change neither the length of the eye nor the refractive power of the cornea and lens; they merely take away the continuous work the eye would otherwise do. In adults, everyday life decides how long they are worn: anyone who is free of symptoms without glasses need not wear them, and anyone who gets headaches in the evening feels the difference at once. In children it is different — there a prescribed pair of glasses is treatment and not comfort: with a convergent squint or a threatened weakness of sight, wearing them consistently is the decisive part of the treatment. Deliberately choosing under-strength glasses 'for training' does nobody any good and can harm children.
: At anything noticeable, straight away: an eye that turns inwards or outwards, a tilted head posture, frequent screwing up of the eyes or rubbing of them, going very close to books and screens, headaches towards evening, or a school eye test that showed something noticeable. Without anything noticeable, an ophthalmic check before school starts makes sense; if there is marked refractive error or squint in the family, correspondingly earlier. The reason for the hurry is not the glasses but the development: vision matures in the first years of life, and an eye that does not get a sharp image in this phase does not learn to see fully. Children never report this of their own accord, because they know nothing else. Examinations with us are possible from kindergarten age; if it is a baby or a toddler, we discuss on the phone whether a paediatric ophthalmology consultation is the more suitable place — so do get in touch in any case, so that the assessment is not left undone.

Blurred near vision has several causes. Which one it is, the measurement shows.

Whether long-sightedness, presbyopia or both together — telling them apart takes a measurement, and it decides which correction actually helps you. For children with a noticeable eye position we keep appointments free at short notice.

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+41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30. Or book an appointment online.