HyperopiaHyperopia

Walter Huang, ODWalter Huang, OD

Yuanpei UniversityYuanpei University

Department of OptometryDepartment of Optometry

DefinitionDefinition

The common name for this refractive error The common name for this refractive error is is far-sightednessfar-sightedness

Patients with hyperopia are known as Patients with hyperopia are known as hyperopeshyperopes

DefinitionDefinition

When parallel rays of light enter the eye When parallel rays of light enter the eye ((with accommodation relaxedwith accommodation relaxed) and come ) and come to a single point focus to a single point focus behindbehind the retina the retina

EtiologyEtiology

Axial lengthAxial length The axial length of the eye is The axial length of the eye is shortershorter than than

normal due to imperfect emmetropizationnormal due to imperfect emmetropization

EtiologyEtiology

Refractive powerRefractive power The refractive power of the eye is The refractive power of the eye is too weaktoo weak

Curvature hyperopiaCurvature hyperopia Cornea or lens has a flat curvatureCornea or lens has a flat curvature

Decreased index of refractionDecreased index of refraction Due to decreased density in some parts of the optical Due to decreased density in some parts of the optical

system of the eyesystem of the eye

Loss of accommodationLoss of accommodation Due to age, drug medicationsDue to age, drug medications

Aphakia (no lens)Aphakia (no lens) Due to cataract removalDue to cataract removal

PrevalencePrevalence

Hyperopia is more common than myopiaHyperopia is more common than myopia

PrevalencePrevalence

AgeAge The mean refractive error is +2.00D in The mean refractive error is +2.00D in

newbornsnewborns The mean refractive error is +1.00 to +0.50D The mean refractive error is +1.00 to +0.50D

in children at age 6in children at age 6 The mean refractive error is plano in children The mean refractive error is plano in children

at age 10at age 10 The mean refractive error is skewed toward The mean refractive error is skewed toward

myopia in children after age 10myopia in children after age 10

PrevalencePrevalence

GenderGender Hyperopia is more common in females than in Hyperopia is more common in females than in

malesmales

PrevalencePrevalence

EthnicityEthnicity Higher prevalence in American Indians, Higher prevalence in American Indians,

Blacks, Caribbean, South Sea Islanders, and Blacks, Caribbean, South Sea Islanders, and EskimosEskimos

Compensating AccommodationCompensating Accommodation

FactorsFactors Fatigue Fatigue –– general and ocular general and ocular

Due to continuous focusing of images in and out on Due to continuous focusing of images in and out on the retinathe retina

Illness (e.g., cold, fever)Illness (e.g., cold, fever) Mental state (e.g., stress)Mental state (e.g., stress) AlcoholAlcohol Drugs and medications (e.g., antihistamines)Drugs and medications (e.g., antihistamines)

Antihistamines may relax accommodation and dilate Antihistamines may relax accommodation and dilate the pupilsthe pupils

Facultative HyperopiaFacultative Hyperopia

DefinitionDefinition The amount of hyperopia that can be The amount of hyperopia that can be

overcome by accommodationovercome by accommodation

Absolute HyperopiaAbsolute Hyperopia

DefinitionDefinition The amount of hyperopia that cannot be The amount of hyperopia that cannot be

overcome by accommodationovercome by accommodation

Manifest HyperopiaManifest Hyperopia

DefinitionDefinition The amount of hyperopia revealed with a non-The amount of hyperopia revealed with a non-

cycloplegic refraction (i.e., when no cycloplegic refraction (i.e., when no pharmacological drugs are used to dilate the pharmacological drugs are used to dilate the eyes)eyes)

Latent HyperopiaLatent Hyperopia

DefinitionDefinition The amount of hyperopia revealed with The amount of hyperopia revealed with

cycloplegic refraction (i.e., when cycloplegic refraction (i.e., when pharmacologic drugs are used to dilate the pharmacologic drugs are used to dilate the eyes)eyes)

Latent HyperopiaLatent Hyperopia

CausesCauses Drugs and progressive near work, resulting in Drugs and progressive near work, resulting in

accommodative spasms so that accommodative spasms so that accommodation may not be relaxedaccommodation may not be relaxed

Total HyperopiaTotal Hyperopia

DefinitionDefinition The sum of manifest hyperopia and latent The sum of manifest hyperopia and latent

hyperopiahyperopia

Absolute Hyperopia and Visual Absolute Hyperopia and Visual AcuityAcuity

Uncorrected VAUncorrected VA Refractive Error (D)Refractive Error (D)

20/3020/30 0.500.50

20/4020/40 0.750.75

20/6020/60 1.001.00

20/8020/80 1.501.50

20/12020/120 2.002.00

20/20020/200 2.502.50

SymptomsSymptoms

Asthenopia or ocular fatigueAsthenopia or ocular fatigueFrontal headachesFrontal headachesAvoidance of visual tasks, especially at Avoidance of visual tasks, especially at nearnearBlurry vision at distance and nearBlurry vision at distance and nearIntermittent blurring of visionIntermittent blurring of vision

SignsSigns

Miotic pupilMiotic pupil Enables accommodation and increased depth Enables accommodation and increased depth

of focusof focus

EsophoriaEsophoria Inward deviation of the eyesInward deviation of the eyes With accommodation, eyes tend to convergeWith accommodation, eyes tend to converge

Decreased visual acuities at distance and Decreased visual acuities at distance and near, especially the latternear, especially the latterOccasional diplopia or double visionOccasional diplopia or double vision

Clinical TestsClinical Tests

Visual acuity tests – distance and nearVisual acuity tests – distance and near

Binocular vision tests (e.g., cover test)Binocular vision tests (e.g., cover test)

Accommodation testsAccommodation tests

RetinoscopyRetinoscopy

Subjective refractionSubjective refraction

ManagementManagementAccommodation training (especially in Accommodation training (especially in young patients)young patients)

Convergent or plus lenses in spectacles or Convergent or plus lenses in spectacles or contact lensescontact lenses

Refractive surgeryRefractive surgery

ManagementManagement

SpectaclesSpectacles Single vision glassesSingle vision glasses

ManagementManagement

Contact lensesContact lenses Soft contact lensesSoft contact lenses Rigid gas permeable contact lensesRigid gas permeable contact lenses

ManagementManagement

Refractive surgeryRefractive surgery Photorefractive keratectomy (PRK)Photorefractive keratectomy (PRK) Laser in-situ keratomileusis (LASIK)Laser in-situ keratomileusis (LASIK)