Aims To investigate the prevalence and incidence of presbyopia in an urban Chinese population.

Methods 1817 subjects aged ≥35 years were identified by random cluster sampling in Yuexiu District, Guangzhou, China, at baseline in 2008, and all were invited for the follow-up examination in 2014. Distance and near visual acuity (VA) tests, as well as non-cycloplegic automated refraction were performed at each examination as per standardised protocol. Participants with presenting near VA ≤20/40 were further tested with add power at a standard distance of 40 cm to obtain their best-corrected near VA. Functional presbyopia was defined as near VA under presenting distance refraction correction of <20/50 and could be improved by at least one line with add power.

Results A total of 1191 (83.5% of the 2014 follow-up) participants were included in the current analysis with a mean (SD) age of 50.4 (9.7) years, and 52.9% were female. Prevalence of functional presbyopia at baseline was 25.2% (95% CI 21.5 to 28.9) and the 6-year incidence was 42.8% (95% CI 39.4 to 50.1). Older and more hyperopic subjects had both higher prevalence and incidence of presbyopia (P<0.001). Average presbyopic correction coverage (PCC) was 87.7% at baseline and was significantly lower in myopic participants (P=0.006).

Conclusions Prevalence of functional presbyopia in urban China is relatively lower along with a higher PCC compared with previous population-based rural cohorts. We identified a high presbyopia incidence, and further studies are needed to understand longitudinal presbyopia progression as well as the urban–rural gap in presbyopia to throw light on future strategic planning.