At what age does presbyopia begin?

Most people notice it between the ages of forty and fifty, often around the mid-forties. The process is laid down much earlier, though: the flexibility of the lens of the eye decreases steadily from childhood onwards. It only becomes noticeable at the moment when the remaining reserve is no longer enough for your accustomed reading distance — so there is no date, only a threshold. When you cross it also depends on your day: anyone who reads a great deal and small notices it earlier than someone who mostly looks into the distance. Long-sighted people usually notice it earlier than others, because part of their reserve is tied up anyway. Short-sighted people notice it later — some not at all, as long as they simply take their glasses off to read.

Can presbyopia be stopped or trained away?

No. What falls off is the flexibility of the lens of the eye, and that cannot be brought back either by eye exercises or by food supplements. Vision training of the kind offered on the internet changes at most how used you are to a blurred perception; it changes nothing about the values measured. Deliberately leaving the reading glasses off slows nothing either — it only makes reading more of a strain and gives many people headaches in the afternoon. What actually helps is unspectacular: good light, a reading distance that matches your correction, and glasses determined for your real working distance and not for a standard assumption. That is not an opinion but the reason we take no money from you for a training programme.

What is the difference between presbyopia and long-sightedness?

The place. In long-sightedness the relationship between the length of the eye and its refractive power does not hold — that is a matter of how the eye is built, it is usually present from childhood and can exist at any age. In presbyopia the build of the eye is entirely uninvolved: here the lens loses its flexibility, and with it the ability to switch from distance to near. From about the mid-forties this affects everyone, including short-sighted people and those who never needed glasses. From that follows the practically most important consequence: anyone who has trouble close up well before the age of 40 is not presbyopic — there, an uncorrected long-sightedness is one of the commonest explanations, and there are others that belong assessed. The two can only be told apart cleanly with a measurement, all the more so as they often occur together.

Are ready-made reading glasses from the chemist enough?

As a second pair for the handbag or the holiday house it is usable for many people, and we do not pretend otherwise. You should nevertheless know its limits: both lenses have the same strength, the pupillary distance is fixed, an astigmatism is not compensated for and a prism certainly is not. Anyone whose two eyes have different values tires with them faster than they can explain to themselves. The more important point, though, is a different one: ready-made glasses are no substitute for an examination. The decade of life in which presbyopia begins is also the one in which a glaucoma or a lens beginning to cloud is first noticed — both of them without symptoms. Have it measured once, then decide: that is the sensible order.

Varifocals or two separate pairs of glasses?

Both are defensible choices, and the answer comes from your day, not from the brochure. Varifocals cover distance, the intermediate range and near vision in one frame; in return they need getting used to, have blurred zones at the sides and require you to turn your head rather than only your eyes. Stairs and kerbs feel unfamiliar in the first weeks. Two separate pairs give the calmer optics in their respective ranges, but you are for ever switching. Anyone who works many hours at a screen often gets on more comfortably with an additional pair of occupational glasses, because in varifocals the screen falls in the narrowest part of the lens. We go through this at your appointment against your actual working distances.

Can presbyopia be lasered?

Methods for it do exist — a deliberate inequality between the two eyes, for instance, or a corneal profile that serves several distances. Two things belong said alongside. First: refractive laser surgery we do not carry out ourselves at Sehklinik. What takes place with us is the complete preliminary examination and an assessment with no commercial interest behind it. Second, and this rarely appears in the brochure: a procedure on the cornea changes nothing about the lens. Presbyopia goes on progressing underneath, and what fits today may no longer fit in a few years. Compromises in contrast, in vision at dusk and in the spatial impression are possible. A life free of glasses cannot be assured to anyone, and we do not hold it out either.

Does the health insurer pay for reading glasses?

In adults, as a rule, no. Spectacle lenses, frames and contact lenses are self-pay services; a few supplementary insurance policies contribute an amount, which is a matter of contract and should be settled before the purchase. The ophthalmic examination, by contrast, runs through basic health insurance where there is a medical indication — the deductible and co-payment apply as at any doctor's appointment. Simply determining values for glasses without a suspicion of disease is not a mandatory benefit and is billed privately. If the examination reveals a finding of disease, the judgement changes for that part. Tell us at registration why you are coming; then we will tell you beforehand what to expect.

Does presbyopia keep getting stronger?

It increases from the mid-forties and comes to a stop somewhere between the ages of 60 and 65 — simply because the capacity to focus is used up by then. In practice that means: in the first years the near addition of your glasses is adjusted several times, later hardly at all. If, by contrast, your reading changes markedly within weeks or a few months, that is not a course that fits presbyopia. Then another cause is in the room: a lens beginning to cloud, a blood sugar out of control, a side effect of medicines or a finding at the centre of the retina. A sudden improvement belongs there too — anyone who after years abruptly manages without reading glasses again usually has no good news, but a change in the lens.

Refractive errors

Presbyopia — when the arms get too short, and what helps against it

'The arms have got too short.' That is how most people describe it: the menu moves away, in the restaurant the light is suddenly too dim, and the dose on the package leaflet can only be made out with an outstretched arm. Behind it is almost always presbyopia — not a disease but a process of ageing in the lens of the eye, which reaches everyone from about the mid-forties. There are several ways of compensating for it. Which one suits you is decided less by the technology than by your day.

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What happens in the eye in presbyopia

A healthy eye focuses by changing the shape of its lens. When the gaze is on the distance the lens is flat; as the gaze moves to near, a ring-shaped muscle tenses, the fibres suspending the lens relax, and the lens bulges more strongly. Its refractive power rises, and the image of a near object lands exactly on the retina again. This process is called accommodation, and it runs so much as a matter of course that most people only learn of it when it no longer suffices.

And that is exactly what happens. The lens of the eye goes on growing all through life, layer upon layer, becoming denser and firmer as it does. What falls off is therefore not the strength of the muscle but the flexibility of the lens: the muscle pulls, and the lens yields less and less. The point at which you still see sharply moves away — imperceptibly at first, then to the limit of your arm's length, and finally beyond it.

The medical name for it is presbyopia, from the Greek for 'age' and 'eye'. Colloquially you will also hear age-related long-sightedness. The same thing is meant, but the word misleads: it has nothing to do with long-sightedness — there it is about how the eye is built, here about the elasticity of a single structure inside it. Why that distinction matters day to day is set out further down.

The most important sentence first: Presbyopia is not a disease of the eye and not a sign that something has gone wrong. It affects everyone without exception — including those who managed all their lives without glasses. In that it differs from the other refractive errors: those you either have or do not have, whereas presbyopia reaches everyone. An overview of the others, and of the ways of compensating for them, is given by our overview of refractive errors and the ways of correcting them.

One special case deserves a line of its own, because it causes confusion so often: anyone who is short-sighted and therefore keeps near vision sharp for longer, notices presbyopia later or hardly at all — the short-sightedness makes up for the missing near portion for a while, which is why many short-sighted people simply take their glasses off to read. They are not spared; they merely have a built-in pair of reading glasses, and nobody should take it away from them without having talked about it first.

How you recognise presbyopia

The symptoms are so uniform that many people diagnose themselves — usually rightly. Typical are:

The reading distance grows. The menu, the package leaflet and the phone screen move further out, until the arm no longer reaches.
Small print in poor light first. By the window it still works; in a restaurant in the evening it no longer does.
Tiredness after reading — burning, a pressure above the brows, a dull headache in the late afternoon.
Delayed switching from the book to the clock on the wall and back.
Worse in the evening than in the morning, because the reserve that has grown scarce is scarcer still after a long day.
Both eyes equally, slowly over years, without pain and without redness. Small differences between the sides are normal if your glasses values differ anyway — new one-sidedness is not.

The course over time is just as characteristic: it begins around the mid-forties, increases over the following years and comes to a stop somewhere between the ages of 60 and 65, because by then nothing is left that could fall off. In practice that means: the first pairs of reading glasses rarely last long, and the later ones last all the longer.

Just as characteristic is the age, and this point is often missed: Anyone who can no longer manage close up well before the age of 40 is not presbyopic. Then something else is behind it, and that belongs measured rather than covered over with reading glasses — the possibilities are set out below under Warning signs.

What likewise does not belong to presbyopia: a deterioration within days, distorted lines, a grey patch in the middle of the image, pain, a red eye, new double vision or a finding that is new and occurs in one eye only. These signs are listed below — they do not belong to the glasses consultation but to the examination.

Presbyopia or long-sightedness?

Hardly any question is put to us by patients more often, and for good reason: anyone told they are 'age-related long-sighted' hears a word that sounds like long-sightedness and is not. The two have nothing to do with each other, and which of them is present decides what goes on the prescription — and from what age the finding fits together at all.

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

It arises from the interplay of the length of the eye and its refractive power: in relation to its refractive power the eye is too short, and the sharp image would form behind the retina. That is laid down from birth and hardly changes after growth. A twenty-year-old can be long-sighted, and so can a child — and because young eyes still have plenty of accommodation left, they often make up for the error unnoticed for years. What that looks like in detail, why it has to be judged differently in children and what it is corrected with, is set out on its own page: Long-sightedness — causes, signs and correction in detail.

Presbyopia is the lens ageing

Here the build of the eye plays no part. The process is added to every starting position, in short-sighted people as in those with normal sight, and it cannot be avoided by never having needed glasses before. What shrinks is the range within which focusing is possible at all — distance vision remains untouched by it.

The rule of thumb — and where it ends

The usable short version runs: Anyone who tired quickly 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 is usually true and helps in placing it. The reverse, though, holds more strictly than the rule of thumb sounds: near-vision symptoms well before the age of 40 are not presbyopia, even if they feel exactly like it.

It just does not always help, for three reasons. First, the two occur together, and often — then the values add up instead of replacing one another. Second, long-sighted people feel presbyopia earlier than others: part of their reserve was already being used up to make up for their own structural flaw, and 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 — a developing Cataract, an unsettled ocular surface with dry eyes or, more rarely, a change at the point of sharpest vision.

These possibilities cannot be told apart by how it feels, only by the measurement — and that takes less time than most people fear.

Correction with glasses and contact lenses

All corrections for near vision do the same thing: they supply the refractive power the lens no longer produces. They differ in where they do it and how many distances they serve at once — and in what you accept in return.

Reading glasses

The simplest solution and for many the most fitting: one lens for one distance, optically calm, inexpensive, changeable at any time. The price is the reach — with reading glasses alone you see blurred at a distance, which is a nuisance when you look up. Anyone who needs glasses only for reading the newspaper usually gets on with them perfectly well.

We say nothing disparaging about ready-made glasses off the shelf: as a second pair they are usable. They do, though, have the same strength on both sides, a fixed pupillary distance, and they can compensate for neither an astigmatism nor a difference between your eyes. Anyone who wears them for hours and does not understand why reading is a strain usually finds the explanation there.

Varifocals

A lens in which the strength increases from top to bottom: distance at the top, the intermediate range in the middle, near vision at the bottom. That is the most convenient solution for people who wear glasses constantly anyway. It requires getting used to, because the zones at the sides are blurred, and you learn to turn your head rather than only your eyes. Stairs, kerbs and the look down at your own feet feel unfamiliar in the first weeks. Almost everyone manages this adjustment — what matters is not to break it off, and not to use the glasses 'only for reading'.

Occupational and screen glasses

The screen is further away than a book and nearer than the wall — that is, exactly where varifocals have the narrowest part of their lens. Anyone who works many hours at a computer therefore often sits with their chin raised and feels it in the neck in the evening. Occupational glasses instead serve the range between keyboard and screen generously and do without distance vision. They do not replace the everyday pair; they take the strain off the working day.

Contact lenses and monovision

Near vision can be served with contact lenses too. Multifocal lenses spread the light across several distances; with monovision one eye is set for distance and the other for near, and the brain selects. Both work very well for some people and not for others — that cannot be predicted, only tried out, which is why a trial wear is part of the fitting at this point.

The price belongs before the trial wear, not after it: a permanent inequality between the eyes costs spatial vision, and multifocal optics cost contrast. Both are noticed first on night drives — glare, halos around headlights, a distance that is harder to judge. Anyone who drives for work or a great deal in the dark should say so expressly, so that the trial wear covers exactly that situation and not only the desk.

The limit is almost always set by the ocular surface. From midlife onwards, symptoms from an unstable tear film and dry eyes increase, and that makes every lens uncomfortable in the evening and every multifocal optic unsettled on top of that. Here it is worth treating the surface first and only then talking about lenses. And regardless of that, the rule holds for everyone who wears lenses: a red or painful eye means lens out and a call the same day.

When the lens itself becomes the subject

Because presbyopia comes from the lens, the lens is the only place where anything about the cause can be changed. Whether that makes sense depends decisively on one question that has nothing to do with reading: Is your own lens still clear?

When the lens is clouded anyway

If the lens clouds — cataract —, the operation is due for a medical reason, and the clouded lens is replaced with a clear artificial one. Its strength can be chosen so that it compensates for an existing refractive error at the same time; an astigmatism can be taken into account with a toric lens. So anyone who is thinking about near vision in the second half of life and at the same time has a clouding that is beginning should not plan two procedures but one. How lens surgery for cataract works with us, is set out in detail on the treatment page — including preparation, follow-up checks and the question of posterior capsule opacification, which can show itself months to years later.

When the lens is clear: refractive lens exchange

Technically it is the same procedure, medically a different situation: here a clear lens is removed solely in order to change the refractive power. Two things then have to be weighed differently. First, the loss of accommodation is no longer an argument once it is used up anyway — in younger people, by contrast, it very much is. Second, it remains an operation inside the eye, with the risks of an operation inside the eye, and in short-sighted eyes the risk of a retinal detachment rises afterwards as well. An implanted lens can only be reversed with a further procedure.

A lens exchange on a clear lens — that is, a procedure whose only purpose is to replace glasses — we do not carry out ourselves at Sehklinik. What we take on is the same as with the laser methods: the complete assessment and an honest appraisal — whether your lens is already changed, whether cornea, tear film and retina meet the requirements, and whether a procedure would be the right thing at all in your situation. If it comes into question and you want it, we name you a suitable place and go on supporting you ophthalmically. If it does not come into question, we tell you that just as clearly and give the findings as the reason.

Which artificial lens for which distance

This question arises as a rule in the first of the two cases — with cataract surgery, which we carry out ourselves. Various lens types are available, and they differ above all in how many distances they serve at once:

Standard monofocal lens — one distance becomes sharp, usually the distance; for near vision a pair of reading glasses remains. Optically the calmest solution, and the standard case charged to basic health insurance (OKP).
Extended depth-of-focus lenses — they stretch the sharp range out instead of creating two separate focal points. The intermediate range gains; the small print often still needs glasses.
Multifocal lenses — they spread the incoming light across several distances. For many people that works well; halos around lights at night and a softer contrast are possible, though.
Toric lenses — they also correct an astigmatism and are combined with the other designs.

The honest frame for that: no artificial lens accommodates. What can be planned is a distribution — which distance is to manage without glasses and which is not. Not every eye suits every design; findings at the centre of the retina, an irregular cornea or an unstable tear film argue against the more demanding optics. That is a conversation before the procedure, not an extra on the cost estimate.

Laser methods: what they can do, and what they cannot

Refractive laser surgery we do not carry out ourselves at Sehklinik. What takes place with us is the complete preliminary examination, the assessment of your suitability — with no commercial interest behind it — and ophthalmic support through the decision, whichever way it falls. If it falls for a procedure, we name you a suitable place and take on the follow-up checks afterwards if you wish. So you do not have to piece the next steps together yourself.

For presbyopia the decisive insight is anatomical: a laser changes the Cornea, that is, the refractive power right at the front. The declining flexibility, though, sits in the lens, a little further back. From that follows the sentence that appears in hardly any brochure: A procedure on the cornea does not stop presbyopia — it goes on progressing underneath. Anyone who has their distance vision corrected at forty will still need reading glasses a few years later.

What laser methods attempt instead is a redistribution: a deliberate inequality between the two eyes — the same idea as monovision with contact lenses — or a corneal profile that serves several distances at once. Both are compromises with a price that belongs on the table before the decision: contrast, vision at dusk and the spatial impression can suffer under them, and some people tolerate a permanent inequality between the eyes badly. That is why it is sensibly tried out with contact lenses first, before anything lasting happens.

And there are situations in which we advise against a procedure on the cornea: a cornea that is too thin or irregular, a suspicion of a Keratoconus, fluctuating values, an unstable ocular surface or a lens that is already clouding anyway. In the last case the procedure would not be done wrongly but in the wrong place — the question is then not the cornea but the lens.

How we determine your near values

Establishing presbyopia itself is easy. The work lies in finding the right addition for your actual day — and in ruling out everything that can hide behind it. That includes:

Distance first. The near value builds on the distance value; anyone who skips the distance part measures the addition on a false basis. How such a determination works is set out under Eye test.
The near addition at your real working distance. So we ask you to bring what you actually read — a book, sheet music, your phone, a workpiece. 'Near' is a different distance for a cellist than for a goldsmith.
The lens at the slit lamp. A clouding that is beginning changes the advice fundamentally, even if it does not yet need treatment of its own.
Tear film and ocular surface. An unsettled tear film produces exactly the symptoms that get blamed on the reading glasses — and it decides whether contact lenses are an option at all.
Intraocular pressure, optic nerve head and retina depending on the findings. The decade of life that brings the first reading glasses is also the one in which a Glaucoma is first noticed — without causing any symptoms.

That is exactly why the appointment for reading glasses is often the occasion on which something else is found. Which examinations come together at this stage of life, and at what intervals they make sense, is described by our overview of ophthalmic examinations.

What you should bring: all the glasses you currently use, together with their glasses prescriptions; a list of your medicines; and if you wear contact lenses, please leave them out for a few hours before the measurement if you can — they change the cornea temporarily, and with it the values measured.

And plan the way back without a car, if the pupil is dilated to assess the back of the eye. You will then see blurred at close range for several hours and be markedly sensitive to glare; public transport, someone to collect you and a pair of sunglasses in your bag are the simple answer. Very rarely, in an eye with a very narrow anterior chamber angle, dilation triggers an acute glaucoma attack: if in the hours after the appointment the eye hurts badly, turns red, appears hard, you see coloured rings around lights or you feel sick, call at once — outside consulting hours the ophthalmic emergency service or the emergency department of an eye clinic, and do not wait until the next day.

When it is not presbyopia

Presbyopia is bilateral, gradual, painless, affects only near vision and begins from the mid-forties. Everything that departs from that pattern is something else and belongs assessed — the only question is how fast. Hence three tiers rather than one list.

Immediately, at night and at weekends too

These three situations do not wait for the next free appointment and not until the morning. They stand expressly on this page because they become more common in exactly the stage of life in which presbyopia also begins — and because with them it is not days but hours that decide the outcome.

Sudden loss of vision in one eye — particularly together with headache, pain on chewing, or difficulty with language or speech, or signs of paralysis. That does not belong in our consultation but in an emergency department: call the ambulance (144). Behind it can be a vascular occlusion or a vascular inflammation, where minutes and hours count. That applies expressly even when it has passed off again: a curtain that draws down from above over minutes and then disappears is no reason to stand down, but a warning sign that belongs in the emergency department within the same hour.
Severe pain in the eye or head with nausea, a red eye, an eyeball that appears hard and coloured rings around lights — that can be an acute glaucoma attack. The intraocular pressure rises suddenly and very sharply and damages the optic nerve within hours. It ought to be treated within hours, not the next day — outside our consulting hours through the ophthalmic emergency service or straight to the emergency department of an eye clinic.
New double vision that disappears as soon as you cover one eye — particularly with a squint, a drooping lid, unequal pupil sizes, headache or dizziness. Here the two eyes no longer stand together, and the causes for that lie with the nerves, the eye muscles and the vessels — not with the eye itself. This is a case for now, not for tomorrow.

Call the same day

Deterioration in vision within hours or days, close up or at a distance
Distorted lines — straight edges appear crooked — or a grey patch in the middle of the image
Flashes of light, a sudden swarm of black dots or a shadow that moves into your field of vision from the side
A new finding that affects only one eye — check that by covering each eye in turn. What is meant is a one-sidedness that was not there before; anyone who has always had different values legitimately reads better with one eye than with the other.

Soon, but without a call the same day

Double vision or ghost images that persist, when you cover the other eye. That is the reverse sign to the one above and usually far more harmless: it points to the affected eye itself — to a lens beginning to cloud, to an astigmatism, to an unsettled tear film or to an irregular cornea as in keratoconus. An appointment in the next few weeks is as a rule enough for that.
Trouble close up well before the age of 40. That is not presbyopia, however much it feels like it, and it should not be covered over with reading glasses. The commonest explanation is a long-sightedness so far uncorrected. Alongside that, a weakness of near focusing, a blood sugar out of control, side effects of medicines — for allergies, bladder weakness, depression or migraine, for instance —, and more rarely a pupil disorder or a neurological cause come into question. And if your values keep shifting in your younger years, the cornea belongs in the assessment too.
A rapid change in your ability to read over weeks — a pace that does not fit presbyopia.
An unexpected improvement. Anyone who after years suddenly manages without reading glasses again usually has no good news, but a change in the lens.

Our phone number: +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30. Describe the symptoms to us, and we will place them together with you. For the first tier, please do not call us first but the ambulance (144) or the ophthalmic emergency service — you will be helped faster there, and nobody will hold it against you that you came.

Immediately — not 'later today', not until tomorrow. A sudden loss of vision in one eye, particularly together with headache, pain on chewing or difficulty with language and signs of paralysis: not into the consultation but to the emergency department — call the ambulance (144). Immediately as well: severe pain in the eye or head with nausea, a red eye and coloured rings around lights. That can be an acute glaucoma attack and ought to be treated within hours — at night and at weekends through the ophthalmic emergency service or the emergency department of an eye clinic.

Call the same day with a deterioration in vision over hours to days, distorted lines or a grey patch in the middle of the image, flashes of light, a swarm of black dots or a shadow from the side: +41 44 500 69 00. Outside consultation hours, the ophthalmic emergency service applies.

Where to find us

We offer the determination of near values, the examination of the lens and advice on presbyopia at all three locations. An overview with directions and opening hours is under Locations.

Sehklinik Zürich

Hallenstrasse 8, 8008 Zürich
Phone: +41 44 422 25 55
Mon–Fri 08:00–12:00 / 13:00–17:30
Tram 11/15 to 'Zürich, Kreuzplatz', three minutes on foot — Getting here and details

Sehklinik Wetzikon

Bahnhofstrasse 126, 8620 Wetzikon
Phone: +41 44 930 61 00
Mon–Fri 08:00–12:00 / 13:00–17:30
Bus 850/851/852 to 'Wetzikon ZH, Schloss', one minute on foot — Getting here and details

Sehklinik Meilen

Dorfstrasse 94, 8706 Meilen
Phone: +41 44 923 03 81
Mon, Tue, Thu, Fri 08:00–12:00 / 13:00–17:30; Wednesday varies, please ask by phone
S6/S7 to Meilen station, two minutes on foot — Getting here and details

Outside consulting hours the ophthalmic emergency service applies. If you would rather write than phone, you can reach us through the contact form; referring colleagues will find the details they need under Referring physicians.

Costs & health insurance

What does the insurer pay for — and what not?

The dividing line runs particularly clearly here: the medical assessment of a finding is treatment of illness; the visual aid you then read with, in adults, as a rule is not. What applies in your case we tell you before the examination — not with the bill.

Service	Coverage	What this means for you
Ophthalmic assessment for declining near vision	Basic insurance (OKP)	Where there is a medical indication — when there are symptoms, when vision has changed, or when a finding has to be assessed or followed up. The deductible and co-payment apply as at any doctor's appointment.
Determining values for glasses or near vision without a suspicion of disease	Self-pay service	Simply determining correction values is not a mandatory benefit for adults. If a finding of disease emerges in the process, the judgement changes: the rest of the assessment is then medically indicated.
Reading glasses, varifocals or occupational glasses: lenses and frames	Self-pay service	In adults, basic health insurance as a rule does not pay for glasses — regardless of how strong the near addition is. A few supplementary insurance policies contribute an amount; that is a matter of contract and should be settled before the purchase.
Multifocal contact lenses or monovision: fitting and material	Self-pay service	As with glasses, including the trial wear that belongs to a serious fitting. Narrow exceptions exist with certain medical findings; that needs a medical justification and a request to your insurer before the fitting, not after it.
Lens surgery for cataract with a medical indication	Basic insurance (OKP)	Where there is an indication, the procedure is a mandatory benefit — with the standard lens. Specialist lenses that also serve an astigmatism or near vision go beyond that: the difference and the additional examinations that go with them you pay yourself. What that means in your case we set out for you before the procedure.
Refractive lens exchange without clouding of the lens	Self-pay service	A procedure whose purpose is to make a visual aid unnecessary is not a mandatory benefit of basic health insurance. Some supplementary insurance policies contribute a share and tie it to conditions — obtain the agreement in writing before an appointment is fixed. We do not carry out this procedure ourselves; we advise and we examine.
Suitability assessment for a planned refractive procedure	Self-pay service	The examination that establishes whether you are suitable for a procedure to replace glasses does not serve the treatment of illness and is billed privately. We tell you its extent beforehand. If the assessment shows a finding that needs treatment, that part is billed as what it is.

Deductible and co-payment. Of the costs that run through basic health insurance, you first bear your chosen deductible in full yourself, then the co-payment of ten per cent up to the statutory annual maximum. An appointment 'at the insurer's expense' is therefore rarely free of charge — that is not a peculiarity of our clinic but the way Swiss basic health insurance is built.

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 check with your health insurer. An invoice that comes as a surprise is an avoidable annoyance.

Related conditions

Hyperopia (long-sightedness)Cataract Refractive errors

Medically reviewed by PD Dr. med. Andrea von Rückmann

Your ophthalmologistPD Dr. med. Andrea von RückmannView profile

Frequently asked questions

: Most people notice it between the ages of forty and fifty, often around the mid-forties. The process is laid down much earlier, though: the flexibility of the lens of the eye decreases steadily from childhood onwards. It only becomes noticeable at the moment when the remaining reserve is no longer enough for your accustomed reading distance — so there is no date, only a threshold. When you cross it also depends on your day: anyone who reads a great deal and small notices it earlier than someone who mostly looks into the distance. Long-sighted people usually notice it earlier than others, because part of their reserve is tied up anyway. Short-sighted people notice it later — some not at all, as long as they simply take their glasses off to read.
: No. What falls off is the flexibility of the lens of the eye, and that cannot be brought back either by eye exercises or by food supplements. Vision training of the kind offered on the internet changes at most how used you are to a blurred perception; it changes nothing about the values measured. Deliberately leaving the reading glasses off slows nothing either — it only makes reading more of a strain and gives many people headaches in the afternoon. What actually helps is unspectacular: good light, a reading distance that matches your correction, and glasses determined for your real working distance and not for a standard assumption. That is not an opinion but the reason we take no money from you for a training programme.
: The place. In long-sightedness the relationship between the length of the eye and its refractive power does not hold — that is a matter of how the eye is built, it is usually present from childhood and can exist at any age. In presbyopia the build of the eye is entirely uninvolved: here the lens loses its flexibility, and with it the ability to switch from distance to near. From about the mid-forties this affects everyone, including short-sighted people and those who never needed glasses. From that follows the practically most important consequence: anyone who has trouble close up well before the age of 40 is not presbyopic — there, an uncorrected long-sightedness is one of the commonest explanations, and there are others that belong assessed. The two can only be told apart cleanly with a measurement, all the more so as they often occur together.
: As a second pair for the handbag or the holiday house it is usable for many people, and we do not pretend otherwise. You should nevertheless know its limits: both lenses have the same strength, the pupillary distance is fixed, an astigmatism is not compensated for and a prism certainly is not. Anyone whose two eyes have different values tires with them faster than they can explain to themselves. The more important point, though, is a different one: ready-made glasses are no substitute for an examination. The decade of life in which presbyopia begins is also the one in which a glaucoma or a lens beginning to cloud is first noticed — both of them without symptoms. Have it measured once, then decide: that is the sensible order.
: Both are defensible choices, and the answer comes from your day, not from the brochure. Varifocals cover distance, the intermediate range and near vision in one frame; in return they need getting used to, have blurred zones at the sides and require you to turn your head rather than only your eyes. Stairs and kerbs feel unfamiliar in the first weeks. Two separate pairs give the calmer optics in their respective ranges, but you are for ever switching. Anyone who works many hours at a screen often gets on more comfortably with an additional pair of occupational glasses, because in varifocals the screen falls in the narrowest part of the lens. We go through this at your appointment against your actual working distances.
: Methods for it do exist — a deliberate inequality between the two eyes, for instance, or a corneal profile that serves several distances. Two things belong said alongside. First: refractive laser surgery we do not carry out ourselves at Sehklinik. What takes place with us is the complete preliminary examination and an assessment with no commercial interest behind it. Second, and this rarely appears in the brochure: a procedure on the cornea changes nothing about the lens. Presbyopia goes on progressing underneath, and what fits today may no longer fit in a few years. Compromises in contrast, in vision at dusk and in the spatial impression are possible. A life free of glasses cannot be assured to anyone, and we do not hold it out either.
: In adults, as a rule, no. Spectacle lenses, frames and contact lenses are self-pay services; a few supplementary insurance policies contribute an amount, which is a matter of contract and should be settled before the purchase. The ophthalmic examination, by contrast, runs through basic health insurance where there is a medical indication — the deductible and co-payment apply as at any doctor's appointment. Simply determining values for glasses without a suspicion of disease is not a mandatory benefit and is billed privately. If the examination reveals a finding of disease, the judgement changes for that part. Tell us at registration why you are coming; then we will tell you beforehand what to expect.
: It increases from the mid-forties and comes to a stop somewhere between the ages of 60 and 65 — simply because the capacity to focus is used up by then. In practice that means: in the first years the near addition of your glasses is adjusted several times, later hardly at all. If, by contrast, your reading changes markedly within weeks or a few months, that is not a course that fits presbyopia. Then another cause is in the room: a lens beginning to cloud, a blood sugar out of control, a side effect of medicines or a finding at the centre of the retina. A sudden improvement belongs there too — anyone who after years abruptly manages without reading glasses again usually has no good news, but a change in the lens.

Measure first, then talk about glasses or a lens.

Bring what you actually read — your book, your sheet music, your phone — and the glasses you have had so far. We determine your near values at your real working distance, look at the lens and the retina, and tell you what suits your day. Including when the most honest answer is 'a well-made pair of reading glasses'.

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