Hypermetropia

Synonyms

Also known as Hyperopia, Long-sightedness, or Far-sightedness.

Overview

Hyperopia, commonly known as farsightedness, occurs when distant objects appear clearer than nearby objects. Symptoms include difficulty focusing on close objects, eyestrain, headaches, and blurred vision, especially during tasks requiring close attention. While genetics play a significant role, other factors, like environmental influences, like excessive screen time and near work, also play a role in myopia development. Regular eye exams are crucial for diagnosing, monitoring changes, and adjusting treatment. Hyperopia can be managed through prescription eyeglasses or contact lenses. Refractive surgeries like LASIK or PRK offer long-term correction options.

Key Facts

Loading keyFacts...

Symptoms

  • Eye strain, characterized by tired or sore eyes
  • Headaches, especially during reading
  • Blurry vision, particularly when focusing on nearby objects
  • Difficulty reading
  • Double vision while reading
  • Dull eye pain
  • Squinting when reading

Cause

Clear vision relies on light passing through the cornea (front of the eye) and eye lens to reach the retina (back of the eye). Hyperopia, or farsightedness, occurs due to:

  • Eye shape: Hyperopia often results from a shorter-than-normal eyeball or a flatter cornea.
  • Refraction issues: The eye's shape can hinder light bending correctly, causing it to focus behind the retina. This results in distant objects appearing clear while nearby ones seem blurry.

Hyperopia creates a significant disparity between where light focuses and the retina's location. This can lead to considerable difficulty in seeing nearby objects, impacting daily activities and quality of life.

RiskFactors

Several factors can increase the likelihood of developing hypermetropia:

  • Genetics: Family history plays a significant role. If parents or close relatives have hypermetropia, there is a higher chance of inheriting the condition. A family history of myopia (nearsightedness), amblyopia (lazy eye), strabismus (misalignment of the eyes), congenital cataracts, and metabolic or genetic diseases can also increase the risk of developing moderate to high hyperopia.
  • Age: Hypermetropia is known to worsen with age, particularly after 40, due to changes in the eye's lens elasticity. This is a natural part of the aging process.
  • Eye structure: The shape of the eye can contribute to hyperopia. Eyes that are shorter than average or have a flatter cornea may be more prone to hyperopia.
  • Environmental factors: Prolonged near work, such as reading or using electronic devices for extended periods, can significantly contribute to the development of hyperopia.
  • Medical conditions: Certain health conditions can increase the risk of hyperopia. For example, diabetes and other conditions that affect blood sugar levels can impact vision. Eye conditions like retinopathy or cataracts may also lead to hyperopia.

Diagnosis

Hyperopia, commonly known as farsightedness, is diagnosed through a comprehensive eye examination conducted by an optometrist or ophthalmologist. The examination encompasses various tests to evaluate different aspects of vision and eye health.

  • Visual acuity: An eye chart measures one's ability to see at various distances. Hyperopia may manifest as difficulty seeing objects up close, while distant vision remains clearer.
  • Diffuse light examination: Examines how light interacts with the eye, revealing physical characteristics associated with hyperopia.
  • Fundoscopy: Examines the back of the eye to detect changes related to hyperopia. Abnormalities like blurred disc margins and crowded vessels can indicate hyperopia or related conditions.
  • Examination of strabismus: Tests like the Alternate Cover-Uncover test detect subtle eye misalignments, revealing latent (hidden) or manifest (visible) strabismus, which can result from untreated hyperopia.
  • Retinoscopy: This procedure involves shining a light into the eyes and observing how it reflects off the retina to estimate refractive error, including hyperopia.
  • Refraction: This procedure uses a phoropter or trial frame and lenses to precisely determine the refractive error of the eyes by having you look through different lenses and provide feedback.
  • Eye health examination: In addition to vision evaluation, examines the health of the eyes using a slit lamp to assess structures like the cornea, lens, and retina, as eye health issues can accompany refractive errors like hyperopia.

Prevention

While there's no known method to prevent Hyperopia, adopting certain lifestyle practices can support overall eye health and potentially slow its progression:

  • Spend Time Outdoors: Encourage outdoor activities to increase exposure to natural light, which may help reduce the risk of Hyperopia.
  • Limit Screen Time: Minimize prolonged close-up activities and take frequent breaks to prevent eye strain.
  • Follow the 20-20-20 Rule: Every 20 minutes, look at something 20 feet away for at least 20 seconds to relieve eye strain.
  • Ensure Proper Lighting: Use adequate lighting when reading or doing close-up tasks to reduce eye strain and promote comfort.
  • Quit Smoking: Smoking increases the risk of several eye conditions, including cataracts and age-related macular degeneration.
  • Regular Eye Exams: Schedule routine eye check-ups, especially for children, to detect Hyperopia early and manage it effectively.

Eye Examination Frequency

  • Children: At birth, 6-12 months, 12-36 months, ages 3-5, before kindergarten, annually through high school.
  • Adults: Once in 20s, twice in 30s, every 2-4 years from 40-54, every 1-3 years from 55-64, and annually after 65.

Note: Frequent exams are vital for those with diabetes, a family history of eye issues, or previous vision corrections.

Maintain a Healthy Diet

A balanced diet rich in specific nutrients supports eye health:

  • Vitamin A: Found in carrots, sweet potatoes, cantaloupe, and apricots, it is essential for retinal health and clear vision.
  • Vitamin C: Acts as an antioxidant, protecting against cellular damage and supporting eye tissue repair. Sources include oranges, tangerines, grapefruits, red bell peppers, and tomatoes.
  • Vitamin E: Promotes cell health and combats oxidative stress. Sources include avocados, almonds, and sunflower seeds.
  • Omega-3 Fatty Acids: Reduce the risk of eye diseases and support overall eye health. Found in salmon, tuna, sardines, and trout.
  • Lutein and Zeaxanthin: Important for maintaining vision and reducing age-related vision disorders. Found in kale, spinach, romaine lettuce, and broccoli.
  • Zinc: Supports retinal health and protects the eyes from light-induced damage. Sources include beans, oysters, lean red meat, poultry, and fortified cereals.

If your diet lacks certain nutrients, consider supplements to ensure proper nutrition.

Treatment

Treatment options for hyperopia include:

  1. Prescription glasses
    Eyeglasses with convex lenses are the most common and non-invasive way to correct hyperopia. These lenses help focus light directly onto the retina, improving near vision while maintaining clear distance vision.
  2. Contact lenses
    Positive-powered contact lenses can also correct hyperopia, offering an alternative for those who prefer not to wear glasses or desire a more natural appearance. Avoid these common mistakes if you wear a contact lens.
  3. Refractive surgery
    Various surgical procedures can reshape the cornea or lens to correct hyperopia, including:
    • LASIK (Laser-Assisted In Situ Keratomileusis): This procedure reshapes the cornea with a laser, allowing light to focus properly on the retina.
    • PRK (Photorefractive Keratectomy): Similar to LASIK but involves removing the outer layer of the cornea before reshaping it with a laser. It's suitable for mild to moderate hyperopia.
    • LASEK (Laser Epithelial Keratomileusis): A procedure similar to PRK, but a flap is created using a special tool instead of removing the outer corneal layer.
  4. Conductive Keratoplasty (CK)
    CK is a non-laser treatment for mild to moderate farsightedness in older adults. It uses radio frequency energy to reshape the cornea temporarily, suitable for mild to moderate hyperopia in older adults.
  5. Phakic Intraocular Lenses (pIOLs)
    pIOL involves implanting an artificial lens in front of or behind the iris, leaving the natural lens intact. It's suitable for severe hyperopia and offers quick recovery and significant vision improvement.
  6. Refractive lens exchange (Clear lens extraction)
    RLE removes the natural lens and replaces it with an artificial one. It's used for significant hyperopia or combined with cataracts.
  7. Small Incision Lenticule Extraction (SMILE)
    A minimally invasive procedure involving creating a small lenticule within the cornea and removing it through a small incision, effective for correcting hyperopia. Note: Surgery may not be advisable for certain medical conditions like glaucoma or cataracts. Consulting an eye surgeon will help determine the best course of action.

Key Tips for a Smooth Recovery After Eye Surgery:

  1. Follow Medical Advice: Stick to your doctor's post-operative care instructions.
  2. Use Eye Drops: Apply lubricating drops as prescribed to ease discomfort.
  3. Protect Your Eyes: Wear non-prescription sunglasses or goggles if recommended, and always use UV-protective sunglasses outdoors.
  4. Maintain Cleanliness: Keep your hands clean and avoid dusty areas to prevent infection.
  5. Rest Well: Get plenty of rest and avoid strenuous activities to aid healing.
  6. Avoid Driving: Don’t drive on the day of surgery and wait for your doctor's clearance before resuming.
  7. Prevent Water Exposure: Take baths instead of showers to keep water out of your eyes.

HomeCare

Home care for hyperopia, while not a substitute for conventional treatments like glasses or contact lenses, may offer supportive benefits. These include:

  • Eye Exercises: Specific eye exercises, such as convergence and accommodative exercises, may help strengthen eye muscles and improve focusing ability, potentially alleviating symptoms of hyperopia.

Complications

Hyperopia, commonly known as farsightedness, can lead to several complications if left uncorrected or untreated:

  • Amblyopia: Hyperopia, particularly in children, can increase the risk of amblyopia (lazy eye) if not corrected early. Amblyopia occurs when the brain favors one eye over the other, leading to decreased vision in the weaker eye.
  • Strabismus (crossed eyes or squint): In some cases, untreated hyperopia can contribute to strabismus, a condition where the eyes are misaligned, causing one eye to turn inward, outward, upward, or downward.
  • Angle-closure disease: Hyperopia increases the risk of angle-closure disease, affecting the eye's drainage angle.
  • Anterior ischaemic optic neuropathy (AION): Hyperopia is a risk factor for developing AION, a condition causing sudden vision loss due to decreased blood flow to the optic nerve.
  • Retinal vein occlusion: While the association is debated, hyperopia may increase the likelihood of branch retinal vein occlusion, affecting blood flow in the retina.
  • Age-related macular degeneration (ARMD): Hyperopia may be linked to ARMD, a progressive eye condition affecting central vision in older adults.
  • Eyestrain and fatigue: Constantly straining to focus on nearby objects can lead to eye strain and fatigue, causing discomfort and headaches.
  • Increased risk of eye diseases: Long-term untreated hyperopia may increase the risk of certain eye conditions such as glaucoma, cataracts, and retinal detachment.

References

National Eye Institute
National Eye Institute
2020 October 01
American Optometric Association
American Optometric Association
National Center for Biotechnology Information
National Center for Biotechnology Information
American Academy of Ophthalmology
American Academy of Ophthalmology
Wen Q, Huang J, Guo Q, et al.
Chin Med J (Engl)
2015 July 05
Grzybowski A, Told R, Sacu S, et al.
J Ophthalmol
2018 August 22
American Academy of Ophthalmology
American Academy of Ophthalmology
Huang J, Wen Q, Guo Q, et al.
Chin Med J (Engl)
2015 July 05

Frequently asked questions

Yes, hyperopia that resolves in adolescence can return later in life, requiring optical correction.
Most newborns have hyperopia, which usually corrects itself as the eye matures.
No, hyperopia is difficulty seeing close objects due to eye shape, while presbyopia is an age-related condition where the lens becomes less flexible, affecting close focus, typically in those over 40.
Untreated infantile hyperopia can lead to visual issues like lazy eye or strabismus, where one eye turns inward.
Yes, individuals with hyperopia can also have astigmatism and may later develop presbyopia or eyestrain, but not both hyperopia and myopia in the same eye.
Yes, it's common. If someone has had hyperopia surgery and later develops a cataract, cataract surgery may be necessary. It's important to inform the ophthalmologist about the previous surgery for proper testing and lens calculation.