1. Hyperopia, also known as farsightedness, is a refractive error where parallel rays of light focus behind the retina when the eye is at rest. There are several types of hyperopia including axial, curvatural, and aphakia hyperopia. 2. Hyperopia is more common than myopia and prevalence varies by age, gender, and ethnicity. The most common form is simple or developmental hyperopia resulting from normal biological variations in eyeball development. 3. Symptoms of hyperopia include blurred vision, asthenopia, and eye strain with near work. Treatment involves prescribing convex lenses to fully or partially correct the refractive error.

1. Dr Sidesh Hendavitharana[Registrar-
ophthalmology]

2.  Long sightedness,is a type of refractive error
in which parallel rays of light coming from
infinity are focused behind the retina when
accomodation is at rest.

3. 1. Axial hypermetropia-decrease in
anteroposterior length of eye ball[1mm=3D]
2. Curvatural hypermetroia-decreased curvature of
cornea,lens or both[1mm=6D]
 -coneal:cornea plana,following corneal injury
 -lens-lens plana
3. Positional hypermetropia-posterior
displacement of crystalline lens
4. Index hypermetropia-decrease in ref. index of
crystalline lens eg:old age ,diabetes
5. Aphakia hypermetropia-congenital or acquired
absence of crystalline lens

4.  Hyperopia is more common than myopia
 Age ,
Mean ref. error +2.00D in newborn
Mean ref. error is +1-+0.5Din children at age
6,plano at age 10

5.  Gender-more common in female than male
 Ethnicity-higher prevelance in
American,Indians,Blacks,caribean and
Eskimos

6.  Simple or developmental hypermetropia
◦ Commonest form
◦ Results from biological variation in development of
eyeball
◦ Includes axial and curvatural hypermetropia

7.  Pathological hypermetrpia
Results due to congenital or acquired conditions of
eyeball beyond normal biological variations
Includes
Index hypermetropia
Positional hypermetropia
Aphakia
 Conservative hypermetropia[due to surgically
overcorrected myopia]

8.  Functional hypermetropia
Results due to paralysis of accommodation
Seen in patients with 3rd nerve palsy and internal
ophthalmoplegia

9.  Low hyperopia-consists of an error of
+2.00D or less.
 Moderate hyperopia-includes a range of error
from +2.25 to +5.00D
 High hyperopia-consists of an error over
+5.00D

10.  Refractive error estimated after complete
cycloplegia is called total hypermetropia and
it consists of latent and manifest
hypermetropia
◦ Latent hypermetropia
 Amount of hypermetropia normally corrected by
inherent tone of cilliary muscle
 Is usually about 1D
 High in children and gradually decreases with age
 Estimated only after cycloplegia.

11.  Manifest hypermetropia
Amount of hypermetropia not corrected by cilliary
tone
 Consists of
 Facultative hypermetropia-part of hypermetropia
corrected by patient”s accommodation effort
 Absolute hypermetropia-part of hypermetropia can not
be corrected by patient”s accommodative effort

12.  Symptoms
Asymptomatic in young pts if ref.error is small.
Blurred vision[more for near than distant]
Asthenopic symptoms with near work[eye
strain,frontotemporal headache,watering and mild
photophobia]

13.  Signs
◦ Small eye ball in all directions
◦ Small cornea
◦ Shallow ant.chamber
◦ Apparent divergent squint

14.  Fundus picture
Optic disc-smaller,hyperemic with less defined
adges
 Simulates papillitis[pseudopapilitis]
Retina-degenerative retinoschisis[splitting of
sensary retina into outer choroidal and inner vitreal
layer]
Blood vessels-undue tortuosity and abnormal
branching
 A –scan-short A-P length of eyeball.

15.  Prescription of convex lenses
 Fundamental rule
1. Discover total amount of hyperopia by performing
refraction under cycloplegia
2. Prescribe spherical correction providing maximum
comfortbut fully correct astigmatism
3. Gradually,increase spherical correction at 6 month
interval till pt accepts manifest hypermetropia
4. Full correction if accomodativeconvergent squint is
present
5. Full correction with occlusion therapy if associated
with amblyopia.

16.  Modes of prescription
Spectacles are most comfortable,safe,easy and
cheap method
Contact lenses indicated in unilateral
hypermetropia or for cosmetic reasons but only
after stabilization of prescription

17.  Holmium laser thermoplasty-application of
laser spots in a ring at periphery to produce
central steepening
Indication
Low degree of hypermetropia
Disadvantages ,
Induced astigmatism

18.  Hyperopic photorefractive keratectomy
 Hyperopic LASIK
 Conductive keratoplasty
 Secondary IOL implantation

19.  [A]amblyopia-may be anisometropic(in
unilateral hypermetr to opia),strabismus(in
children developing accomodative squint)or
ametropic(in children with uncorrected
bilateral high hypermetropia)
 [B]blepharitis,recurrent styes or chalazion-
due to infection introduced by repeated
rubbing of eye to relieve eye fatigue

20.  [C]convergent squint(accomodative)-due to
excessive use of accomodation in children by
2 to 3 years of age
 [D]disposition to primary narrow angle
glucoma-due to small eye and shallow
anterior chamber
 [E]early onset presbiopia