1st year optometry students

1. HYPERMETROPIA
Presented by: Kajal Bhagat
2ND YEAR BOVS, NAMS

2. LAYOUT
EMMETROPIC EYE
REFRACTIVE ERROR
ANOMALIES OF REFRACTION
PERCENTAGE OF REFRACTIVE ERRORS
HYPERMETROPIA
 Introduction, definition, signs and symptoms,
diagnosis, etiology, classification, complications,
results and management

3. AN OPTICALLY NORMAL EYE

4. REFRACTIVE ERROR
 Refractive errors are disorders, not disease.
 Refractive error is a disorder in which the shape of the eye does
not bend light correctly, resulting in blurred image.

5. ANOMALIES OF REFRACTION
Myopia:
Hypermetropia
Astigmatism

6. PERCENTAGE OF TYPE OF REFRACTIVE
ERRORS AMONG PATIENTS

7. HYPERMETROPIA
INTRODUCTION:
• The term hypermetropia was suggested by Kastner in1755 for the
first time.
• It is derived from 3 words :
hyper- meaning “in excess”
met - meaning “measure”
opia - meaning “of the eye”
• Also called as Hyperopia / Long-sightedness.
• A person suffering from hyperopia cannot see near object clearly.
• The hyperopic eye is usually shorter than normal.

9. Definition :
Hypermetropia refers to the refractive state of the eye
wherein parallel rays of light coming from infinity are
focused behind the retina with accommodation being at
rest.

11. SIGNS AND SYMPTOMS:
SIGNS
• Smaller size of eyeball.
• Shallow AC.
• Small optic disc.
SYMPTOMS
• Asthenopia or ocular fatigue.
• Frontal headache.
• Avoidance of visual tasks,
esp. at near.
• Blurred near vision.

12. DIAGNOSIS:
 Visual acuity screening is recommended to detect
hyperopia as well as other eye conditions.
 retinoscopy

13. ETIOLOGY :
Etiologically, depending upon the mechanism of production ,
hypermetropia may be :
1. Axial Hypermetropia
2. Curvatural Hypermetropia
3. Index Hypermetropia
4. Positional Hypermetropia
5. Absence of crystalline lens(Aphakia)

14. 1. Axial Hypermetropia:
 Commonest form.
 Total refractive power of eye is normal but there is an
axial shortening of eyeball. (decrease in
anteroposterior length of the eyeball )
1mm shortening, +3D of hypermetropia.
At birth +2.5D to +3D of HM(Physiologically)
Physiologically more than +6D HM are uncommon.

15. 2. Curvatural Hypermetropia:
 The curvature of cornea, lens or both is flatter than the
normal.
 1mm decrease in radius of curvature ,+6D of
hypermetropia.
3. Index Hypermetropia:
 Change in refractive index of crystalline lens with age.
 May also occur in diabetes under treatment.

16. 4. Positional Hypermetropia:
 Crystalline lens placed posteriorly.
 May be congenital or due to trauma.
5. Absence of crystalline lens:
 May be congenital or acquired due to aphakia.

17. CLASSIFICATION:
1:ON THE BASIS OF DEGREE OF HYPEROPIA
2:ON THE BASIS OF CLINICAL APPEARANCE
3:BY ACCOMMODATIVE STAGE
1: ON THE BASIS OF DEGREE OF HYPEROPIA(ACCORDING
TO AOA) :
LOW HYPEROPIA = +2.00D OR LESS
MODERATE HYPEROPIA = +2.25D TO +5.00D
HIGH HYPEROPIA = +5.25D OR MORE

18. 2. ON THE BASIS OF CLINICAL APPEARANCE:
2.Pathological Hypermetropia
i. congenital ii. acquired

19. 1. Simple Hypermetropia:
Commonest form.
Results from normal biological variation in the
development of the eyeball.
May be hereditary.
Includes the following:
-Axial hypermetropia due to congenital/developmental short eyeball.
-curvatural hypermetropia due to congenital/developmental flatter cornea.

20. 2. Pathological Hypermetropia:
 Results from either congenital or acquired condition of the
eyeball (Prenatal maldevelopment of eye).
Anomalies lies outside the limits of biological variation.
Neurologic or pharmacologic based causes.
It includes:
i. Congenital pathological hypermetropia:
It is usually seen in following conditions:
Microphthalmos, microcornea, congenital posterior subluxation of
lens and congenital apakia.

21. ii. Acquired pathological hypermetropia:
It may occur as follows:
 Senial hypermetropia, occurs in old age due to curvatural or
index hypermetropia.
 Positional hypermetropia, occurs due to acquired(traumatic or
spontaneous) posterior subluxation of lens.
 Aphakia, occurs due to acquired (traumatic or surgical) absence
of lens.
 Consecutive hypermetropia, occurs due to surgically
overcorrected myopia or pseudophakia with undercorrection.
 Axial hypermetropia, occurs due to anterior placement of the
posterior wall of the eyeball.

22. 3. Functional Hypermetropia:
Results from paralysis of accommodation.
Seen in patient with third nerve paralysis and internal
ophthalmoplegia.

23. 3. BY ACCOMMODATIVE STAGE:
Total Hypermetropia:-
 It is amount of refractive error,
estimated after complete cycloplegia
with atropine.
 It is divided into 2 categories:
a. Latent and
b. manifest
Total Hypermetropia= latent + facultative + absolute

24. a) Latent Hypermetropia:
 Corrected by inherent tone of cilliary muscle.
 Usually about 1D.
 High in children.
 Decreases with age.

25. b):Manifest Hypermetropia:
 Remaining part of total hyperopia .
 Corrected by accommodation and convex lens.
 Further divided into 2 categories:
I. Facultative hypermetropia :
 Corrected by patients accommodative effort.
II. Absolute hypermetropia:
 Residual part not corrected by patients accommodative effort .

26. EXAMPLE:
Suppose the visual acuity of a patient is 6/24(OU)unaided dry retinoscopy values are
+4.50D(OD)and +4.50D(OS),acceptance is +2.50D (OU)-6/6,wet retinoscopy using
atropine is +6.00D(OD) and +6.00D(OS).Find manifest, latent ,absolute and faculatative
hyperopia ?
solution,
Absolute hypermetropia = +2.50D
Facultative hypermetropia = +4.50D-(+2.50D)
= +2.00D
Manifest hypermetropia = absolute +facultative
= (+2.50+2.00) D
= +4.50 D
Latent hypermetropia = +6.00D-(+4.50D)
= +1.5D
Total hypermetropia = +4.50+1.50 = +6.00D

27. COMPLICATIONS:
If hypermetropia is not corrected for a long time ,the following
complications may occur:

28. RESULTS OF UNTREATED HYPERMETROPIA:
• Low education
• Impaired quality of life
• Low employment opportunities

29. MANAGEMENT:
1. Optical Management:
 Appropriate plus (convex)lenses are used to correct hyperopia.
Modes of prescription of convex lenses:
i. Spectacles:
-Spectacles are most comfortable, safe and easy method of correcting refractive error.
ii. Contact lenses:
-Soft or rigid contact lenses are an excellent alternative for some patient who result
wearing spectacle.
-It reduces aniseikonia in person with anisometropia improving binocularity.
-Eliminate esotropia at near to a greater extent than spectacles.

30. 2.Refractive surgery:
Refractive surgery is typically not preferred until the refractive error of the eye has stabilized
and growth of the eye has stopped. Therefore,refractive surgery are not preferred until
adulthood.
 Surgical treatment for hypermetropia are:
i. Non- contact Holmium:YAG laser thermokeratoplasty
ii. Hypermetropic photorefractive keratectomy (H-PRK)
iii. Conductive keratoplasty
iv. Hypermetropic laser assisted in- situ keratomileusis (LASIK)
v. Phakic intraocular lens (IOL) implants
Vi. Refractive lens exchange

31. • NON- CONTACT HOLMIUM:YAG LASER THERMOKERATOPLASTY: Non- contact holmium:yag laser
thermokeratoplasty is suitable for hypermetropia of about + 1 d to + 2.5 d. with this, multiple
radially distributed spots are produced in the para-central cornea, which leads to shrinkage of the
collagen in the mid- peripheral stroma and consequent steepening of the central cornea.
• HYPERMETROPIC PHOTOREFRACTIVE KERATECTOMY (H- PRK): the principle of this procedure is to
steepen the anterior corneal curvature. the cornea is sculpted in to a steeper convex lens by
creating a furrow- like ring zone in the corneal periphery.
• CONDUCTIVE KERATOPLASTY: conductive keratoplasty is a non-invasive procedure in which
radiofrequency is used to correct low hypermetropia with or without astigmatism. it may also be
used to correct residual refractive error after cataract surgery or laser assisted in- situ
keratomileusis.
• HYPERMETROPIC LASER ASSISTED IN- SITU KERATOMILEUSIS (LASIK): it is used to correct mild- to-
moderate hypermetropia varying from + 1 d to + 4 d.
• PHAKIC INTRAOCULAR LENS (IOL) IMPLANTS: phakic intraocular lens (iol) implants are used to
correct HIGHER degrees of hypermetropia, varying from about + 4 d to + 10 d. phakic iols are
especially designed, foldable, convex, thin lenses implanted in the posterior chamber behind the
iris and in front of the normal crystalline lens.
• REFRACTIVE LENS EXCHANGE: Extraction of clear lens with implantation of an iol, preferably
foldable iol or a piggyback iol. in piggyback iol, two iols are placed in the eye one on top of the
other. this is done if the biometry is + 40 d or so, and one does not have a lens of high power to
implant. moreover, there is high level of spherical aberration with thick lenses.

32. 3.Visual Hygiene:
While reading or doing intensive near work ,take a
break about every 30 min.
While reading maintain proper distance from book.
Sufficient illumination.
5 to 6 feet distance should be maintained while
watching television or playing videogames.

33. REPORT:The pattern of refractive errors
among school children of rural and urban
areas
INTRODUCTION: The uncorrected refractive error is an important cause of
childhood blindness and visual impairment.
SUBJECTS AND METHODS: A total of 440 school children of urban and rural schools within
the age range of 7-15 years were selected for this study using multi-stage
randomization technique.
RESULTS: The overall prevalence of refractive error in school children was 19.8 %. the commonest
refractive error among the students was myopia (59.8 %), followed by hypermetropia (31.0
%). the children of age group 12-15 years had the higher prevalence of myopia as compared
to the younger counterparts (42.5 % vs. 17.2 %). the prevalence of myopia was 15.5 % among
the urban students as compared to 8.2 % among the rural ones (rr = 1.89, 95 % ci = 1.1-
3.24). the hypermetropia was more common in urban students than in rural ones (6.4 %) vs.
5.9 %, rr = 1.08 (95 % CI: 0.52-2.24).
CONCLUSION: The prevalence of refractive error in the school children of Nepal is 19.8 %. THE
students from urban settings are more likely to have refractive error than their rural

34. GLOBAL PREVALENCE OF HYPERMETROPIA:
Hyperopia is a common refractive error, particularly in
young children. although its prevalence has not been
studied to the same extent as myopia, knowledge of its
rates among the world population, its early detection and
treatment is a matter of vital importance, since moderate
or high degrees of this refractive error may lead to other
visual impairment conditions. this review provides a
summary of hyperopia prevalence rates in the young and
adult population worldwide.

37. REFERENCE:
• THEORY AND PRACTICE OF OPTICS AND REFRACTION -A.K
KHURANA
• INTERNET:
-HTTP://EYEWIKI.AAO.ORG/HYPEROPIA
-NEPALESE JOURNAL OF OPHTHALMOLOGY
-
HTTP://ONLINELIBRARY.WILEY.COM/DOI/10.1111/OPO.1216
8/PDF
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