TYPES DEFINATION ETIOLOGY TREATMENT help full for optometry students @optometry @ophthalmology

1. HYPERMETROPIA
SY . B.OPTOM,
AYUSHI PATEL

2. The word hypermetropia is derived from the
words
 Hyper- excess
 Met-measure
 Opia –of the eye
The hypermetropia is also known as hyperopia
And long-sightdness.

3. Defination
•When the parallel rays of light coming from infinity
are focused behind the retina with accommodation
being at rest

4. ETIOLOGY
1) AXIAL
 Most common
 Axial length is short
 1mm shorting of AP dia  3 D of HM
 At birth +2.5 – 3 D of HM (physiologically)
 Phyiologically more than 6D HM are uncommon

5. 2) CURVATURAL
 Flattening of cornea, lens or both
 1mm increase in Radius of curvature 6D of HM
 Never exceed 6D HM physiologically
 Congenitally flattened is c/a cornea plana
 Result (trauma and disease )
3) INDEX
 Change in refractive index with age
 Physiologically in old age
 Pathologically in diabetics under treatment

6. 4)POSITIONAL
 Posteriorly placed crystalline lens
 Occurs as congenital anomaly
 Result of trauma or disease
5)ABSENCE OF LENS
 Seen in aphakia

7. CLINICAL TYPES
 SIMPLE HYPERMETROPIA,
 PATHOLOGICAL
 FUNCTIONAL HYPEROPIA

8. SIMPLE HYPERMETROPIA
 Commonest form
 Results from normal biological variations in the
development of eyeball
 Include axial and curvatural HM
 May be hereditary

9. PATHOLOGICAL HYPERMETROPIA
 Results due to either congenital or acquired conditions
of the eyeball which are outside the normal biological
variations of the development.
• There are two types of pathological hypermetropia
1 congenital hypermetropia
2 acquired hypermetropia

10. Congenital
pathological
•Is seen in following conditions
•Microphthalmos,
•Microcornea,
•Congenital posterior subluxation of the lens and
•Congenital aphakia

11. Acquired
pathological
1 senile hypermetropia or frequently designated as
acquired hypermetropia , occurs in old age due to
two causes
•Curvatural hypermetropia
•Index hypermetropia
2 poistional hypermetropia may occur due to
acquired posterior subluxation of the lens
3 aphakia due to acquired absence of lens

12. 4 consecutive hypermetropia due to surgically
overcorrected myopia or pseudophakia with
undercorrection
5 retrobulbar orbital tumors may sometime
manifest as hypermetropia by anteriorly pushing
the posterior wall of the eyeball

13. FUNCTIONAL HYPERMETROPIA
 Results from paralysis of accommodation
 Seen in patients with 3rd nerve paralysis & internal
ophthalmoplegia

14. NOMENCLATURE
 TOTAL HYPERMETROPIA= LATENT +
MANIFEST (facultative +
absolute)

15. TOTAL HYPERMETROPIA
 It is the total amount of refractive error,estimated
after complete cycloplegia with atropine
 Divided into latent & manifest

16. LATENT HYPERMETROPIA (Hl)
 Amount of hyeropia corrected by inherent tone of
ciliary muscle (Usually about 1D)
 Degree of Hl High in children
 Decreases with age
 Revealed after abolishing tone of ciliary muscle
with atropine

17. MANIFEST HYPERMETROPIA
 Remaining part of total hypermetropia
 Correct by accommodation and convex lens
 Consists of facultative & absolute
FACULTATIVEHYPERMETROPIA
Corrected by patients accommodative effort
ABSOLUTE HYPERMETROPIA
 Residual part not corrected by patients
accommodative effort

18. Manifest HM – absolute HM = Facultative HM
(Strongest lens) – (weakest lens)
 Total HM – Manifest HM = Latent HM

19. SYMPTOMS
 Principal symptom is blurring of vision for close
work
 Symptoms vary depending upon age of patient &
degree of refractive error
1.ASYMPTOMATIC
 small error produces no symptoms
 Corrected by accommodation of patient

20. 2.ASTHENOPIA
 Refractive error are fully corrected by
accommodative effort
 Thus vision is normal
SYMPTOMS
Tiredness
Frontal or fronto temporal headache
Watering
Mild photophobia

21. 3.DEFECTIVE VISION WITH ASTHENOPIA
 Not fully corrected by accommodation
 Defective vision for near more than distance
4.DEFECTIVE VISION ONLY
 Refractive vision more than 4D
 Adults who usually do not accommodate
 Marked defective vision for near and distance

22. 5. The effect of aging on vision :
 Progressive loss of accomodative power with
ageing  progressive loss of vision.
6. Intermittent sudden blurring of vision:
 May occur due to spasm of accomodation inducing
pseudomyopia
 Cycloplagic refraction reveals the underlying
hyperopia

23. SIGNS
 VISUAL ACUITY : Defective
 EYEBALL: small or normal in size
 CORNEA : may be smaller than normal.
 ANTERIOR CHAMBER : may beshallow
 LENS: could be dislocated backwards
 A Scan ultrasonography (biometry) reveal short
axial length

24. FUNDUS:
A) DISC: which may look small and more reddish
in colour with ill-defined margins and even
simulate papillitis.
B) MACULA: foveal reflects may be situated at
greater distance from the disc margins.
C) BLOOD VESSELS: Show undue tortuosity &
abnormal branchings
D) BACKGROUND: SHOT- SILK RETINA (shiney)

25. COMPLICATION
 Recurrent styes blepharitis or chalazia
 Accommodative convergent squint
 Amblyopia
 Anisometropic
 Strabismic
 Uncorrective bilateral high hypermetropia
 Predisposition to develop primary narrow angle
glaucomas.
(small eye ball , shallow AC)

26. BASIS FOR TREATMENT
 No Treatment
Error is small
Asymptomatic
Visual acuity normal
No muscular imbalance
TREATMENT

27. Young children(<6 or 7yrs)
Children younger than 4 years who require
hypermetropic correction can usually accept the full
cycloplegic measurement
Once a child reaches school age, consider reducing the
plus for the refractive prescription by about one-third
but the child is not required to accommodate more
than 2.5 continually for the distance

28. Adults
 The older children may not accept full cycloplegic
refraction because of blur distance .
So always first undercorrect and prescribe the glasses
that the child accepts comfortably.
Gradually increase the spherical correction at 6-
month interval till the patient accepts ,manifest
hypermetropia
Exophoria hyperopia should be under correct by 1 to
2D

29. In the presence of accommodative convergent
squint, full correction should be given at the first
sitting.
If there is associated amblyopia, full correction
with occlusion therapy should be started.
It is important to remember that hypermetropia
may diminish with the growth of the child. So,
refraction should be carried out every 6 months,
and if necessary the correction should be
reduced.

30. MODE OF TREATMENT
 SPECTACLES
 CONTACT LENS
 SURGICAL
OPTICAL TREATMENT

31. SPECTACLES
Basic principle
Prescribe convex lenses (Plus lenses) so that
rays are brought to focus on the retina
Advantages
 Comfortable
 Easier method
 Less expensive
 Safe

32. CONTACT LENS
ADVANTAGES:
 Cosmetically good
 Increased field of view
 Less magnification
 Elimination of aberrations & prismatic effect

33. Surgical
treatment
•Conductive keratoplasty also known as corneal
refractive therapy
•Laser thermal keratoplasty
•Phakic IOLs

34. VISUAL HYGIENE
 While reading or doing intensive near work take
a break about every 30 min
 When reading maintain proper distance that is
the book should be at least as far from your eyes
as your elbow when you make a fist and hold it
against your nose
 Sufficient Illumination
 Place a limit spent watching television &
watching videogames
 Sit 5-6 feet away from the television

35.  Appropriate optical correction almost always leads
to clear and comfortable single binocular vision
 Younger children who have significant hyperopia
associated with amblyopia, strabismus,or
anisometropia require treatment, starting as early
as 3-6 months of age