The perimenopause/menopause intersection with presbyopia

In an exclusive interview with Optometry Times, Jessica Crooker, OD, discussed how perimenopause and menopause intersect with presbyopia and overall eye health, and how clinicians can better support patients during this life stage.

Crooker began by establishing that menopause typically occurs in the 40s–50s, which overlaps with the age when presbyopia and other visual changes usually emerge. Hormonal fluctuations—especially in estrogen—during perimenopause and menopause can significantly affect the eyes. These changes can alter tear production, leading to dry eye, and impact overall visual comfort, particularly with prolonged computer use. Patients may notice new light sensitivity, “weird” visual fluctuations, and discomfort they have never experienced before, which often raises anxiety about whether something is seriously wrong.

Crooker emphasized that many women in their early 40s who bring possible perimenopausal symptoms to primary care providers are often dismissed as “too young”, which makes them hesitant to raise similar concerns in eye care settings. She stressed the importance of creating a safe, open environment where patients are encouraged to ask questions and share symptoms, rather than blaming themselves or assuming it is simply due to long hours on screens.

Clinically, the most common ocular manifestations discussed are:

• Dry eye: increased need for artificial tears, desire to rub the eyes, morning dryness.
• Fluctuating vision: noticeable changes from morning to afternoon, or day to day, which can be frightening to patients who have had stable prescriptions for years.
• Light sensitivity and visual strain, sometimes overlapping with presbyopic symptoms like needing to hold reading material farther away or experiencing headaches with near work.

Crooker’s approach to patient care involves asking targeted questions about dryness, watering, fluctuating vision, and comfort in both distance and near tasks, even starting as early as the mid-30s. She positions herself as a trusted resource, aiming to provide accurate information before patients turn to Instagram or peer “mom groups”, where advice may be inconsistent. She recommends normalizing these conversations by checking in on how patients feel now, then letting them know what symptoms might arise in the future and inviting them to return if issues appear.

Finally, Crooker highlighted a key misconception about presbyopia management: many patients believe their only option is OTC readers or “grandma glasses on a string.” She stressed that there are multiple, more modern solutions, including multifocal contact lenses that correct both distance and near vision. Many patients are surprised to learn these exist. Building trust, educating proactively, and reassuring patients that there are tailored options—if not needed today, then available in the future—are central themes throughout her message.