Hyperopia

Nurchaliza Hazaria Siregar Departemen I K Mata Fakultas Kedokteran USU

Definition
The common name for this refractive error is far-sightedness Patients with hyperopia are known as hyperopes

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

Etiology
Axial length

The axial length of the eye is shorter than normal due to imperfect emmetropization

Etiology
Refractive power

The refractive power of the eye is too weak

Curvature hyperopia

Cornea or lens has a flat curvature Due to decreased density in some parts of the optical system of the eye Due to age, drug medications Due to cataract removal

Decreased index of refraction

Loss of accommodation

Aphakia (no lens)

Prevalence
Hyperopia is more common than myopia

Prevalence
Age

The mean refractive error is +2.00D in newborns The mean refractive error is +1.00 to +0.50D in children at age 6 The mean refractive error is plano in children at age 10 The mean refractive error is skewed toward myopia in children after age 10

Prevalence
Gender

Hyperopia is more common in females than in males

Prevalence
Ethnicity

Higher prevalence in American Indians, Blacks, Caribbean, South Sea Islanders, and Eskimos

Compensating Accommodation
Factors

Fatigue general and ocular

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

Illness (e.g., cold, fever) Mental state (e.g., stress) Alcohol Drugs and medications (e.g., antihistamines)
Antihistamines may relax accommodation and dilate the pupils

Facultative Hyperopia
Definition

The amount of hyperopia that can be overcome by accommodation

Absolute Hyperopia
Definition

The amount of hyperopia that cannot be overcome by accommodation

Manifest Hyperopia
Definition

The amount of hyperopia revealed with a noncycloplegic refraction (i.e., when no pharmacological drugs are used to dilate the eyes)

Latent Hyperopia
Definition

The amount of hyperopia revealed with cycloplegic refraction (i.e., when pharmacologic drugs are used to dilate the eyes)

Latent Hyperopia
Causes

Drugs and progressive near work, resulting in accommodative spasms so that accommodation may not be relaxed

Total Hyperopia
Definition

The sum of manifest hyperopia and latent hyperopia

Absolute Hyperopia and Visual Acuity

Uncorrected VA 20/30 20/40 20/60 20/80 Refractive Error (D) 0.50 0.75 1.00 1.50

20/120
20/200

2.00
2.50

Symptoms
Asthenopia or ocular fatigue Frontal headaches Avoidance of visual tasks, especially at near Blurry vision at distance and near Intermittent blurring of vision

Signs
Miotic pupil

Enables accommodation and increased depth of focus Inward deviation of the eyes With accommodation, eyes tend to converge

Esophoria

Decreased visual acuities at distance and near, especially the latter Occasional diplopia or double vision

Clinical Tests
Visual acuity tests distance and near Binocular vision tests (e.g., cover test) Accommodation tests Retinoscopy Subjective refraction

Management
Accommodation training (especially in young patients) Convergent or plus lenses in spectacles or contact lenses

Refractive surgery

Management
Spectacles

Single vision glasses

Management
Contact lenses

Soft contact lenses Rigid gas permeable contact lenses

Management
Refractive surgery

Photorefractive keratectomy (PRK) Laser in-situ keratomileusis (LASIK)