A large Japanese study suggests that regular alcohol consumption may accelerate the progression of presbyopia in men, adding to growing evidence that lifestyle factors can influence age-related changes in visual function.
Researchers from Keio University School of Medicine and Otake Eye Clinic evaluated 6,258 adults aged 40–79 years to investigate whether common lifestyle factors, including alcohol use, smoking, and diabetes-related measures, were associated with presbyopia severity. Using near add power as an objective measure of presbyopia, the investigators found that male sex and drinking habits emerged as significant risk factors for more advanced disease.
The study analyzed ophthalmic and lifestyle data collected during routine examinations at a community eye clinic in Japan between 2018 and 2024. Participants underwent comprehensive ocular assessments, including refraction, intraocular pressure measurement, optical coherence tomography (OCT), and determination of near add power. Patients were also surveyed regarding alcohol consumption, smoking status, and diabetes-related health measures.
Overall, the mean near add power was 2.09 D. More than 80 percent of participants had a near add requirement of at least 1.50 D, while nearly one-third required 3.00 D or more. Men were considerably more likely to report regular alcohol consumption than women, with approximately half of male participants classified as drinkers.
After adjusting for age and sex, logistic regression analysis identified male sex, alcohol consumption, myopic refractive error, astigmatism, and thinner ganglion cell complex measurements on OCT as significant factors associated with higher near add power requirements. In contrast, smoking status, HbA1c levels, and the presence of diabetic retinopathy were not significantly associated with presbyopia severity.
The effect of alcohol appeared particularly pronounced in men. Male drinkers demonstrated significantly higher mean near add power than male non-drinkers, indicating more advanced presbyopia. Kaplan–Meier analysis further showed that male drinkers reached a near add threshold of +2.50 D at a younger age than their non-drinking counterparts. The difference was most evident in individuals aged 50–59 years.
According to the study authors, several biological mechanisms could potentially explain the association. Chronic alcohol exposure has been linked to oxidative stress, mitochondrial dysfunction, inflammation, autonomic dysregulation, and microvascular damage. These processes may impair ciliary muscle function, reduce accommodative efficiency, and contribute to earlier lens sclerosis, ultimately accelerating the onset of symptomatic presbyopia.
The investigators also observed associations between higher near add power and increased intraocular pressure as well as thinning of retinal neural tissues measured by OCT. While the clinical significance of these findings remains unclear, they support emerging evidence that presbyopia may be influenced by broader age-related changes throughout the eye rather than lens stiffening alone.
The study authors acknowledge several limitations, including the study’s observational design, reliance on self-reported drinking habits, and the absence of detailed information regarding alcohol quantity or beverage type.
Nevertheless, they note that the large sample size and detailed ophthalmic examinations strengthen the findings and should “be helpful for healthcare education to emphasize the harmful effects of alcohol consumption on ocular health.”
