This document summarizes an optical treatment for a patient presenting with hyperopia and accommodative insufficiency. The patient's visual acuity and findings from slit lamp examination, funduscopy, and binocular vision assessment are presented. The patient was prescribed +0.75DS lenses in each eye with a +1.00DS add for near vision, which improved their acuity to N5. The document then reviews treatments for hyperopia including surgical and optical options like contact lenses and spectacles. It provides details on prescribing spectacles for hyperopia, including correcting the full amount of hyperopia and gradually increasing the prescription. Examples of calculating different types of hyperopia are also presented.

1. Optical treatment
Presented by Group 03
18th Batch
School of Ophthalmic Technology
National eye hospital Colombo

3. Visual Acuity
• DVA: Right Eye (RE): 20/30 Left Eye (LE): 20/30
• NVA: RE: N6 LE: N6 Both Eyes (BE): N5 (with difficulty)
Slit Lamp Examination
• Anterior and posterior segments of the eye
Funduscopy
• Optic disc ,Macula, Peripheral Retina
Binocular Vision Assessment
• Refraction,IPD,NPC,NFA,PFA,
• NRA-+2.5, PRA—1.25 , NPA-3D, AC/A
Extra Ocular Motility (EOM) Tests

4. 1st Visit – 05/09/2016

5. 2nd Visit – 19/09/2016

6. The Binocular Vision Assessment was then repeated…..

7. IMPRESSION (IMP)
Hyperopia and Accommodative Insufficiency
Rx
RE: +0.75DS 20/20
LE: +0.75DS 20/20
ADD: +1.00DS N5

9. TREATMENTS OF HYPERMETROPIA
1.Surgical
2.Optical
❖ Contact lenses
❖ Spectacles

10. SPECTACLES
Basic Principle
Prescribe convex
lenses (plus lenses),
so that rays are
brought to focus on
the retina.

11. Prescribing for Hyperopia: Quick Tips for New
Optometrists
O Children from infancy to 10-years-old
Be aware that prescribing the full amount of hyperopia for an infant can
interrupt the emmetropization process.

12. O Adults and children older than 10 years
If you feel that your patient needs a higher hyperopic prescription,
consider dispensing the glasses right after a cycloplegic dilation and
advise them to wear the glasses for the rest of the day.

13. O Pre-presbyopic adults 30 to 40-years-old
Consider prescribing a partial distance correction that can be
worn full-time in order to relieve their near visual symptoms.

14. Fundamental
rules of
prescribing
glasses in
hypermetropia

15. 1. Total amount of hypermetropia should always be measured
under complete cycloplegia.
2. The spherical correction given to patient should be acceptable
to patient, however astigmatism should be fully corrected.
3. Gradually increase the spherical correction at 6 month interval
till patient accepts manifest hypermetropia.
4. In presence of accommodative convergent squint full
correction should be given in first sitting.
5. If there is associated amblyopia full correction with occlusion
therapy should be started.

16. Example
Visual acuity of a patient is 6/18 unaided, dry
Retinoscopy values are +4.50D (OD) & +4.50D (OS),
acceptance is +2.00D (OD)-6/9 & +2.00 (OS)-6/9,
wet Retinoscopy using atropine is +6.00D (OD) &
+6.00D (OS). Find manifest hyperopia, latent
hyperopia, absolute hyperopia, facultative hyperopia &
total hyperopia.

17. Solution
Manifest = +4.50D
Latent = +6.00D-(+4.50D) = +1.50D
Absolute = +2.00D
Facultative = +4.50D-(+2.00D) = +2.50D
Total = +4.50D+(+1.50D) = +6.00D

18. Advantages of
glasses
• Suitable for all budgets.
• Can be an attractive fashion accessory.
• No risk of side effects like dry eyes.
• Comfortable.
• Easier method.
• Safe