Walter Huang, OD
Yuanpei University
Department of Optometry

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

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

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

Refractive power

The refractive power of the eye is too weak
Curvature hyperopia

Cornea or lens has a flat curvature
Decreased index of refraction

Due to decreased density in some parts of the optical system of the eye
Loss of accommodation

Due to age, drug medications
Aphakia (no lens)

Due to cataract removal

Hyperopia is more common than myopia

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

Gender

Hyperopia is more common in females than in males

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

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

Definition

The amount of hyperopia that can be overcome by accommodation

Definition

The amount of hyperopia that cannot be overcome by accommodation

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

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

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

Definition

The sum of manifest hyperopia and latent hyperopia

Uncorrected VA Refractive Error (D)
20/30
20/40
20/60
20/80
20/120
20/200
0.50
0.75
1.00
1.50
2.00
2.50

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

Miotic pupil

Enables accommodation and increased depth of focus
Esophoria


Inward deviation of the eyes
With accommodation, eyes tend to converge
Decreased visual acuities at distance and near, especially the latter
Occasional diplopia or double vision

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

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

Spectacles

Single vision glasses

Contact lenses

Soft contact lenses

Rigid gas permeable contact lenses

Refractive surgery

Photorefractive keratectomy (PRK)

Laser in-situ keratomileusis (LASIK)