The Pandemic May Have Prompted Earlier Onset of Presbyopia

Businesswoman with face mask working at her desk
Businesswoman with face mask working at her desk looking at computer monitor, in office. Female professional back to work after covid-19 pandemic lockdown.
Researchers suspect psychiatric distress caused by the pandemic is a factor in deteriorating accommodation in emerging presbyopia.

Presbyopia developed earlier during the time of the COVID-19 pandemic compared with the last few years, according to a study published in PLOS ONE

“It is possible that the drastic and individual changes in lifestyle, work, screen time, and subsequent psychiatric distress deteriorated accommodation even in individuals who had not previously suffered presbyopia,” according to the researchers. “Early onset of presbyopia may be induced by decreased depth of focus evoked by an enlarged pupillary diameter that is associated with pandemic-related stress.”

Investigators compared binocular near add power at 30 cm, dry eye related signs, and 6 dry eye symptoms in an analysis of 339 participants aged 40 to 55, from 2017 to 2021. This retrospective, cross-sectional study found the mean progression rate of near add power (D/y), rose significantly with the onset of the pandemic. Measured at 0.13 in 2017, D/y was 0.08 in 2020–2021 (P <.001). This finding indicates presbyopia onset began earlier and grew worse during this period. Multiple regression analysis revealed a significant correlation between changes in near add power with age (P <.001) and the pandemic (P =.041).

Previous studies have demonstrated associations between anxiety and depression with pupil responses, and it is known that pupillary diameter is one factor affecting accommodation. Tear break-up time (TBUT) and positive corneal staining were not significantly different from 2017 to 2021, (P =.559) and (P =.095) respectively. However, patients reported higher instances of intensified dryness (P =.002), irritation (P =.036), and pain (P <.001) in 2020-2021 compared with 2017. Symptoms of eye fatigue (P =.216), blurring (P =.195), and photophobia (P =.175) increased slightly. 

Study limitations include its retrospective nature, a single center design, and a lack of pupillary diameter and screen time measurements. 


Negishi K, Ayaki M. Presbyopia developed earlier during the COVID-19 pandemic. PLOS ONE. Published online November 11, 2021. doi:10.1371/journal.pone.0259142