Study links alcohol consumption to earlier advanced presbyopia in men

A clinic-based study of more than 6,000 Japanese adults has found that men who drink alcohol regularly develop advanced presbyopia earlier than non-drinking men, adding to a growing body of evidence connecting lifestyle factors to the age-related loss of near vision.

The study, published in Clinical Optometry in May 2026 by researchers at Keio University School of Medicine, measured near add power—the corrective lens strength needed to restore close-up vision—in 6258 patients aged 40 to 79. Participants were drawn from a single eye clinic in Kanagawa, Japan, between December 2018 and April 2024.

“Drinking was a risk factor for near add power solely in men, and it was further confirmed that the mean near add power of male drinkers was higher than male non-drinkers. The results with Kaplan-Meyer survival analysis were consistent with these findings. Collectively, drinking may be one of the potential risk factors for the sex difference in presbyopia,” the study authors, led by Masahiko Ayaki, PhD, from the Department of Ophthalmology, Keio University School of Medicine in Tokyo, Japan; and the Otake Eye Clinic in Kanagawa, Japan, stated.

Logistic regression analyses identified male sex, drinking habit, myopic spherical equivalent, astigmatic errors, and a thin ganglion cell complex as common significant risk factors associated with near add power levels of 1.50 D and 2.50 D—thresholds the researchers defined as representing symptomatic and advanced presbyopia, respectively. Smoking status, HbA1c levels, and the presence of diabetic retinopathy were not significant factors.

Among the study population, 50.3% of men and 23.4% of women reported drinking at least twice a week. Kaplan-Meier survival analysis showed that men reached the 1.50 D threshold significantly earlier than women, and that male drinkers reached the 2.50 D threshold significantly earlier than male non-drinkers, particularly in the 50 to 59 age range.

The effect of drinking on presbyopia was observed in men but not women. The authors note that acetaldehyde, a byproduct of alcohol metabolism, induces cellular damage through reactive oxygen species and mitochondrial dysfunction. Chronic alcohol consumption has also been associated with higher intraocular pressure and open-angle glaucoma risk. The researchers suggest these mechanisms may impair the ciliary muscle's ability to accommodate and contribute to earlier lens stiffening.

The study's authors acknowledge several limitations. Drinking and smoking habits were self-reported, introducing the possibility of recall bias. The observational, cross-sectional design prevents causal conclusions. The study did not capture variables such as education, occupation, or working distance, and did not distinguish between the frequency, quantity, or type of alcohol consumed.

The authors concluded that their findings "should complement previous investigations and be helpful for healthcare education to emphasize the harmful effects of alcohol consumption on ocular health."