Optometrists are well-versed in the clinical manifestations of presbyopia and optical methods to alleviate its impact on near vision. However, despite over a century of research exploring factors that lead to the decline in ocular accommodation, the exact aetiology of presbyopia remains elusive. It is perhaps for this reason why a successful method of either preventing or reversing the decline in accommodation with age is still out of reach.  This article reviews the evidence underpinning our contemporary understanding of the mechanics of presbyopia by outlining the multifactorial nature of its progression with age.