Can I treat myopia first and then tackle presbyopia?

I got differentials (+2 diopter compared to my full prescription) that allow me to see clearly up to about 50 cm. My optometrist originally wanted to add just 1.25 (she does this with everyone; so I think she just uses a formula) for near vision, but did not insist. She warned me though that I may develop worse presbyopia because my eyes will get lazy with such strong reading glasses.
Then I saw Jake mentioning that indeed you should not add more than 1 for your differentials.
Now will I get worse presbyopia while trying to control myopia? Can I treat myopia first and then tackle presbyopia?

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General recommendation is 1 to 1.5 diopters under for differentials I believe. I haven’t seen anyone go as far as 2.5. At what distance do you start getting blur with those?

I started EM with presbyopia myself. I’ve gotten much of my accommodation back as my myopia has improved by about 1.0 diopter. Jake says as people reverse myopia, presbyopia seems to go away as well. I can attest that mine has definitely improved.


Ditto here. My accommodation range is still only about 3 diopters, since I rarely use my ciliary muscles. I could probably get 4-5 diopters of accommodation if I trained my eyes. Not sure I want to, not while I’m trying to get back to 20/20.

But the main thing I did notice is my accommodation speed. Prior to endmyopia, going from infinite to 50cm or so took around half a second to a second. After I started getting real gains, that sped up to nearly instant. Before it almost hurt to look close. Now it’s fine (though I only do it for short durations). Huge difference, I regained my childhood ability to go from distance to close quickly.

On the other hand, since I need active focus to see sharply at distance, going back has slowed down :slight_smile: It takes a half second or so to “reengage” active focus for me :slight_smile: Worthy tradeoff :wink:

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At one time I could go from 75cm to 25m in just over 0.1s. Afraid to guess how slow I am now.

@Kevin.L @Hoofjr Thank you for your feedback!
Sorry I checked the prescription; it’s +2. My monitor is a little over 50 cm from my eyes. I need to work on the “make it clear” part, as I prefer to read fast even if it’s blurry without bothering to make the text clear. Since active focus is the magic (and elusive) cure I’ll focus on that.

Yup. That’s going to lead to issues.

With presbyopia you want the gap to be smaller than the usual recommendation, if anything.


This could explain why I could never use more than 1 diopter less with differentials. I think I was using 0.75 less than normalized in the very beginning.

@jakey Thank you so much for confirming!

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The normal treatment for myopia + presbyopia is bifocals. With bifocals you have no reason to practice accommodation. With separate differentials and norms, you will get accommodation practice in norms during normal activities that include occasionally glancing at near


my additional take based on experience with vision therapy for convergence and accommodative insufficiency

or one could do some accommodation training separately.

the one used on me:
eye patch,
normalized glasses, minus lenses (my optometrist used uncut ones -2, -4, -8)
Dr. Hart’s revised 20/20 vision chart (hart chart on page 45)

tape the chart at least 1m but not too far from where one intends to read
patch one eye

read one line with normalized glasses
read the next with a minus lens over the glasses

repeat with a stronger lens over the normalized glasses
repeat for both eyes.

and another one is the same thing but done at reading distance with regular books using flipper lenses. for me they were +2/-2 might need to start lower for presbyopia and work up

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@Bigkittyqueen Thank you so much for sharing! Treating presbyopia sounds like exactly the opposite of treating myopia. So tricky to have both :sob:

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I would say it’s solely focused on training up active focus one eye at a time. It’s more similar to EM when I got a +2 over normalized glasses and have to read a line out of a book, and then refocus as quickly as possible with a -2 and read the next line, and when I flip back to +2 I have to refocus as fast as possible

Accommodation training does involve strong minus lenses for close work, but it is very brief. Switching between the minus and plus lenses should relieve ciliary spasm, just more work than the relaxation method.

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@Bigkittyqueen @Dlskidmore Isn’t switching back and forth trying to focus quickly a type of eye strain? I grew up convinced that one should not read up close in a moving vehicle, because your eyes have to constantly refocus.

reading up close for long periods causes eye strain. gently flexing a muscle is good for it, holding it tight for a long period is not.

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it’s only done for 10 mins per day per eye for me. It’s like simulating a part of the focus switching that goes on when we’re say copying from a blackboard, close, then distance, then instantly switch back to closeup