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Hyperopia


Presentation

The clinical suspicion for hyperopia or farsightedness is usually clinched when patients present with following signs and symptoms:

Broad Thumb
  • A family is reported with conductive hearing loss, hyperopia, broad thumbs and broad first toes.[ncbi.nlm.nih.gov]
Brachydactyly
  • The patient and his family had many congenital anomalies including hereditary brachydactyly, syndactyly, and hyperopia. The association of these anomalies seems not to have been previously reported in the literature.[ncbi.nlm.nih.gov]
Blurred Vision
  • People with this condition often visit their eye care professional with complaints of visual discomfort or blurred vision. Treatment How is hyperopia corrected? Hyperopia can be corrected with eyeglasses, contact lenses, or surgery.[web.archive.org]
  • These findings were responsible for the blurred vision that was reversed by chalazion resolution or removal.[ncbi.nlm.nih.gov]
  • Hyperopia develops in eyes that focus images behind the retina instead of on the retina, which can result in blurred vision. This occurs when the eyeball is too short, which prevents incoming light from focusing directly on the retina.[aea-ny.com]
Eye Pain
  • If you have been diagnosed with farsightedness or suspect you may have farsightedness and you suddenly develop severe eye pain, eye redness, or decreased vision you should see your eye doctor immediately. Katz M, Kruger PB.[web.archive.org]
  • See a provider right away if you think you have farsightedness and you suddenly develop the following symptoms: Severe eye pain Eye redness Decreased vision Diniz D, Irochima F, Schor P. Optics of the human eye. In: Yanoff M, Duker JS, eds.[nlm.nih.gov]
  • Reading in particular can cause asthenopic symptoms such as eye pain or headache, burning sensation in the eyes, blepharoconjunctivitis, blurred vision, and rapid fatigue. Esotropia can also occur, as was mentioned above.[alpfmedical.info]
  • See your doctor if you develop changes in vision or if you have eye pain, red eyes, or a discharge from your eyes.[healthline.com]
Vision Disorder
  • Definition A hyperopia is a vision disorder, not a disease. A hyperopic eye is too short eye, the image of a distant object is formed so behind the retina. Symptoms Symptoms of farsightedness can include: Blurred vision, especially at night.[provisu.ch]
Corneal Opacity
  • Four weeks after treatment with excimer laser, a perforating keratoplasty was performed for persistent corneal opacities. The corneal button was examined using light and electron microscopy.[ncbi.nlm.nih.gov]
Dyslexia
  • […] subjects with eye diseases (amblyopia, strabismus, glaucoma, corneal abnormalities, chromatic aberrations, accommodative and binocular dysfunction and asthenopia); other specific clinical diseases or conditions (intellectual disability, cerebral palsy, dyslexia[doi.org]
Myelopathy
  • Abstract Cervical myelopathy due to developmental cervical canal stenosis occurred in a 13-year-old boy. The patient's father and aunt also had an abnormally small cervical canal, although both were asymptomatic.[ncbi.nlm.nih.gov]

Workup

Hyperopia is easily diagnosed with a simple eye examination. Other instrumentation like funduscopy (direct examination of the retina) or slit lamp examination may be used to demonstrate any defect in the eye’s anatomy.

Staphylococcus Aureus
  • Corneal smear culture showed a positive growth of Staphylococcus aureus. The patient was immediately treated with subconjunctival gentamicin and intensive topical ofloxacin 0.3% with systemic cephalosporin.[ncbi.nlm.nih.gov]

Treatment

The conservative treatment of hyperopia includes the prescription of graded lenses (glasses) and the use of contact lenses. The early use of corrective glasses and contact lenses in the treatment of hyperopia in children reduces the temporal risk for advanced age myopia [6]. 

For corneal imperfections, refractive surgery may be applied to correct vision. These are the most common refractive surgical procedures done in hyperopia correction: Laser assisted in situ Keratomileusis or LASIK [6], Laser assisted subepithelial keratectomy or LASEK, Photorefractive Keratectomy or PRK [7], Conductive Keratoplasty or CK.

Prognosis

Congenital or acquired hyperopia may easily be addressed with proper prescription lenses or corrective ophthalmologic surgery. In some cases, mild hyperopia may resolve spontaneously. Mortality with hyperopia rarely occurs but are usually related to driving accidents or industrial accidents in heavy equipment due to an impaired visual acuity.

Complications

Hyperopia is commonly associated with the following complications:

  • Reduction in the quality of life: Daily chores and activities are adversely affected with a hyperopic visual impairment. Children and adults with farsightedness may experience learning problems in school [4].
  • Headache and eye strain: The unconscious desire to focus on the blurry objects may lead to eye strain and headache especially in cases of chronically uncorrected hyperopia.
  • Strabismus or squinting in children with farsightedness may often succumb to this complication which are easily addressed with a corrective prescription glasses [5].
  • Impaired safety: Hyperopia can adversely affect driving skills and reduce one’s capacity to safely operate industrial heavy equipment. This impairment heightens the risk for accidents.

Etiology

In the normal eye, there are two distinct parts that focuses the image – the cornea and the lens. They both have a soft curvature that refracts (bends) the image and focuses it to the retina.

Any imperfections in natural curvature of the cornea and the lens disrupts the focus off the cornea. While the eyeball is too short, images sent through the normal cornea and lens are focused at the back of the retina giving a blurry object in our vision.

Epidemiology

There are no definite data as to the exact number of hyperopic individuals are in the population. Ophthalmologic data in the US suggest that there are millions of people suffering from hyperopia.

Approximately half of those wearing glasses and contact lenses suffer from farsightedness. Studies have shown that hyperopia is the most common refractive error in both Asian and Non-Hispanic white children [1].

Presbyopia or the natural tendency of the eye to be hyperopic with increasing age may occur in the great majority of the population. Presbyopia is oftentimes confused with primary hyperopia in clinical practice because of it close similarities [2].

Sex distribution
Age distribution

Pathophysiology

  • These findings in EDI-OCT measurements may play a role in developing population nomograms, as a correcting parameter and in understanding the pathophysiology of certain diseases in short eyes.[ncbi.nlm.nih.gov]
  • Pathophysiology: In farsighted patients, the virtual far point of the eye lies posterior to the retina (Fig. 16.10b). Only convergent incident light rays can be focused on the retina (Fig. 16.10b).[alpfmedical.info]

Prevention

In general, congenital and acquired hyperopia may not be preventable. The following tips of prevention may however protect your eyes and your vision:

  • Regular eye check-up with an ophthalmologist.
  • Shield your eyes from the sun. The wearing of shades and sunglasses significantly protects your eyes from the ultraviolet light from the sun which can damage your eyes.
  • Control of chronic illnesses. Patients with long standing diabetes mellitus and hypertension may lead to complications that may impair vision if left untreated
  • Eye vigilance is important. Patient should pay particular attention to any acute visual disturbances like blurring of vision, flashing of light, black spots, perception of halos in the vision. These innocent signs may herald an impending serious eye disorder or a neurologic event.
  • Refrain from smoking. Nicotine can damage almost all kind of cells in the body including your eyes. Smoking pregnant mothers has been demonstrated to increase the incidence of hyperopia in the unborn child as depicted in a large cohort study [8].
  • Consume healthy foods: The regular consumption of fruits and vegetables with high vitamin content and antioxidants may prevent the emergence of macular degeneration that affects vision and the retina.
  • The use of proper prescription glasses is very important to ensure that the defect is corrected properly. 
  • Better lighting at home and in work can provide good lighting contrast for the eyes and keep them healthy.

Summary

Hyperopia or more commonly known as “farsightedness” is a clinical condition characterized by the difficulty in focusing in nearby object which gradually improves when the object in focus is brought to a nearer distance.

Clinically, hyperopia occurs when the eyeball’s diameter is shorter than normal, or the corneal curvature is defective enough to impair normal focusing. Farsightedness is believed to be hereditary in nature or may be influenced by environmental factors. A number of hyperopic individuals may actually be born with the condition. Hyperopia may easily be correctable with use of spectacle glasses or eye surgery.

Patient Information

Patients must understand that farsightedness or hyperopia is very common. Any changes in the quality of vision or any detraction on your everyday enjoyment must be brought promptly for medical or ophthalmologic evaluation.

Adults reaching the age of 40 must submit for a baseline eye examination and a regular eye check-up every two to four years before the age of 55. Frequency of visits may be adjusted yearly beyond the age of 60 years. However, those with prescription glasses and contact lenses must visit their doctors annually. Children and adolescents who are at risk should be regularly screened by their pediatricians [9].

References

Article

  1. Wen G, Tarczy-Hornoch K, McKean-Cowdin R, Cotter SA, Borchert M, Lin J, Kim J, Varma R. Prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white and Asian children: multi-ethnic pediatric eye disease study. Ophthalmology. 2013; 120(10):2109-16 
  2. Sundin OH, Leppert GS, Silva ED, Yang JM, Dharmaraj S, Maumenee IH, Santos LC, Parsa CF, Traboulsi EI. Extreme hyperopia is the result of null mutations in MFRP, which encodes a Frizzled-related protein. Proc Natl Acad Sci U S A. 2005; 102(27):9553-8 
  3. Krause HK. Pitfalls in the prescription of reading glasses. Ophthalmologe. 2011; 108(4):324-30
  4. Donnelly AB, Agius RM. The Distance Learning Courses in Occupational Medicine--20 years and onwards. Occup Med (Lond). 2005; 55(4):319-23 
  5. Monaco A, Spadaro A, Sgolastra F, Petrucci A, D'Andrea PD, Gatto R. Prevalence of hyperopia and strabismus in a paediatric population with malocclusions. Eur J Paediatr Dent. 2011; 12(4):272-4 (ISSN: 1591-996X)
  6. Sankaridurg P, Holden B, Smith E, Naduvilath T, Chen X, de la Jara PL, Martinez A, Kwan J, Ho A, Frick K, Ge J. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest Ophthalmol Vis Sci. 2011; 52(13):9362-7 (ISSN: 1552-5783)
  7. Waring GO 3rd. Development of a system for excimer laser corneal surgery. Trans Am Ophthalmol Soc. 1989; 87: 854-983.
  8. Dausch D, Klein R, Schroder E. Excimer laser photorefractive keratectomy for hyperopia. Refract Corneal Surg. Jan-Feb 1993; 9(1):20-8.
  9. Borchert MS, Varma R, Cotter SA, Tarczy-Hornoch K, McKean-Cowdin R, et al. Risk factors for hyperopia and myopia in preschool children the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology. 2011; 118(10):1966-73 
  10. Latorre-Arteaga S, Gil-González D, Enciso O, Phelan A, García-Muñoz A, Kohler J. Reducing visual deficits caused by refractive errors in school and preschool children: results of a pilot school program in the Andean region of Apurimac, Peru.Glob Health Action. 2014; 7:22656 

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Last updated: 2019-07-11 22:41