There are actually several conditions where you can be both nearsighted and farsighted, and each one has its own name. The most common scenario is presbyopia, where someone who has always been nearsighted starts losing the ability to see up close as they age. If your two eyes have different prescriptions, with one being nearsighted and the other farsighted, that’s called antimetropia. And if a single eye focuses light unevenly so that one angle is nearsighted while another is farsighted, that’s mixed astigmatism.
Presbyopia: Age-Related Near Vision Loss
Presbyopia is by far the most common reason people experience both nearsightedness and farsightedness. It affects nearly all adults over 40 and currently impacts roughly 1.8 billion people worldwide. If you’ve been nearsighted your whole life and suddenly notice that reading menus or texts requires holding them at arm’s length, presbyopia is almost certainly the cause.
The lens inside your eye is flexible when you’re young, changing shape to shift focus between near and far objects. Starting in your late 30s, proteins in the lens begin to stiffen through a process of cross-linking and compaction. By your early to mid-40s, the lens has lost enough flexibility that focusing on close objects becomes noticeably harder. Symptoms typically start as blurriness during reading, especially in dim lighting, and progress through your 50s. By age 60, the loss of near focusing ability is essentially universal.
The result is a frustrating combination: your distance vision still requires the same nearsighted correction it always has, but now you also need help seeing things up close, the way a farsighted person does. You haven’t become farsighted in the traditional sense. Your eye’s shape hasn’t changed. Instead, the internal lens has simply lost the ability to flex for close-up work.
Antimetropia: Different Eyes, Different Problems
When one eye is nearsighted and the other is farsighted, the clinical term is antimetropia, also called mixed anisometropia. Anisometropia broadly means that your two eyes have different refractive errors. Antimetropia is the specific version where those errors go in opposite directions.
Your brain typically relies more heavily on one eye for distance and the other for near tasks, which can sometimes mask the problem for years. But when the difference between the two eyes is significant, you may notice eye strain, headaches, difficulty with depth perception, and fatigue after sustained reading. Children with untreated antimetropia are at risk for amblyopia (lazy eye), because the brain may start ignoring input from the weaker eye.
Mixed Astigmatism: Two Focal Points in One Eye
Mixed astigmatism is a less commonly discussed condition where a single eye is both nearsighted and farsighted at the same time. This happens because the cornea or lens is curved unevenly, like a football rather than a basketball. Light entering through one angle focuses in front of the retina (nearsighted), while light entering through a perpendicular angle focuses behind it (farsighted). The result is that no distance, near or far, is truly in sharp focus without correction.
How These Conditions Feel Day to Day
Regardless of the specific cause, living with competing refractive errors tends to produce a similar set of complaints. Blurry vision is the obvious one, but the secondary symptoms often bother people more: headaches after reading, a dull aching sensation in or around the eyes, squinting, and visual fatigue that worsens as the day goes on or in low light. Double vision while reading can also occur. These symptoms happen because your eye muscles are constantly working overtime trying to compensate for a focusing system that can’t satisfy both near and far demands at once.
Glasses That Correct Both Problems
The classic solution is a lens with more than one prescription built in. There are three main types:
- Bifocals contain two lens powers. The upper portion corrects distance vision, and a visible segment in the lower portion handles close-up work. The near segment can be shaped like a half-moon, a small circle, or the full bottom half of the lens.
- Trifocals add a third zone in the middle for intermediate distances, like a computer screen. The lens is split into three visible sections: bottom for near, middle for intermediate, top for far.
- Progressive lenses work on the same principle as trifocals but without any visible lines. The prescription gradually shifts from distance at the top to near at the bottom, creating a seamless transition. They look identical to regular single-vision glasses from the outside.
For antimetropia or mixed astigmatism, single-vision glasses with different prescriptions in each lens (or a special astigmatism-correcting lens) may be sufficient if presbyopia hasn’t set in yet.
Contact Lens Options
Contact lenses handle dual refractive errors through two main strategies. Multifocal contacts build multiple prescription zones into a single lens, similar to progressive glasses. They maintain depth perception and stereoscopic vision well because both eyes are correcting for all distances simultaneously. The tradeoff is reduced contrast sensitivity, halos around lights, and slightly dimmer brightness perception compared to standard lenses or reading glasses.
The monovision approach takes a different path: one contact lens is set for distance and the other for near. This eliminates the halos and brightness issues of multifocals, but it reduces depth perception because only one eye is doing the work at any given distance. A middle-ground option called modified monovision pairs a single-vision lens in one eye with a multifocal in the other, offering better depth perception than pure monovision and fewer halos than full multifocal correction.
Surgical Corrections
For people who want to reduce dependence on glasses or contacts, monovision LASIK is one of the more established surgical options. The procedure reshapes the cornea of one eye for distance and the other for near vision. In studies of this approach, patients achieved clear distance vision in one eye while the other was tuned to about negative two diopters for reading. The brain learns to favor the appropriate eye depending on what you’re looking at.
Another route is refractive lens exchange, where the eye’s natural lens is replaced with an artificial one. The replacement lens can be multifocal, accommodating, or extended depth of focus, each designed to provide a range of clear vision. This option is particularly relevant for people with presbyopia, since it addresses the root problem: a stiffened natural lens that can no longer change shape.