3. Defination
Hypermetropia ( long sightedness ) is a
refractive state of eye where in parellel rays
of light coming from infinity are focus
behind the retina with accomodation being
at rest
4.
5. Etiology
Axial hypermetropia – 1 mm shortening - 3D of
hyperopia
Curvature hypermetropia – flat cornea
Index hypermeropia – old age & DM on tretment
Positional hypermetropia – Dislocation of lens
Absence of crystalline lens - Aphakia
Loss of accomodation – d/t age & medication
6. Clinical types
Simple hypermetropia – axial or curvatural type
Pathological hypermetropia – Maldevelopment of eye
- k & lens changes
- chorioretinal & orbital
inflamation / neoplasma
Functional hypermetropia – 3rd nerve palsy / internal
ophthalmoplegia
10. Components of hypermetropia
Total hypermetropia
Latent hypermetropia – corrected by inherent tone of
cilliary muscle
Manifest hypermetropia – Facultative hypermetropia
( corrected by accommodation)
- Absolute hypermetropia
(does not corrected by
accommodation)
11. Normal Age Variation
At birth - 2 to 3 diopter of hypermetropia
At adolesence - it becomes emmetropic
B/C in youth – cortex refractive index is less than that
of nucleus – formation of combination
of a central lens surrounded by two
menisci - refractive power increase
12. 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
13. Compensating Accommodation
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
14. Clinical features
Symtoms-
Asymptomatic
Asthenopic symtoms
Defective vision with asthenopic symoptom
Defective vision only
The effect of ageing on vision
Intermittent sudden blurring of vision
15. SIGNS
Size of eye ball – small
Cornea - smaller
A/C - shallow & narrow angle
Pupil
Enables accommodation and increased depth of
focus
Esophoria
Inward deviation of the eyes
With accommodation, eyes tend to converge
Visual acuity – depend upon degree of hypermetropia
& power of accomodation
-Decreased visual acuities at distance and near,
especially the latter
16. Fundus examination :
retina- whole may shine due to greater brillince of
light reflection(Shot silk appearance)
Optic disc - small , more vascular with ill defined
margins resembles optic neuritis
(pseudopapillitis)
17. Diagnosis of hypermetropia
(1) Patients history
- watering of eye
- eyeache / frontal headache
- actual / suspected crossing of eyes
- difficulty with clarity / comfortability
- presbyopic pt c/o difficulty in near vision
- family history
18. 2) Occular examination
a) Visual acuity
- In young pt
- In presbyopic pt
- In older age
- In pt with never corrected high deree of hyperopia
19. b) Refraction
# retinoscopy – useful in children , accomodative
esotropia, latent hyperopia
- atropine has max. cycloplagia
# Autorefraction- validity & reliability lower
20. c)Occular motility , binocular vision &
accomodation
- anomalies in any of them detected by
- cover uncover test
- near point of convergence
- accomodative amplitude
21. (d) Occular health assurance & systemic
heath screening
- colour vision
- pupillary response
- confrontation visual fied test
- IOP
- occular media & post. Segment evalution
22. Management of hypermetropia
(1) Basis of treatment – depends on following
- magnitude of hypermetropia
- presence of astigmatism / anisoconia
- patient ‘ age
- presence of associated esotropia / amblyopia
- status of accomodation & convergence
- demands placed on the visual symtoms
23. (2) Available treatment
A) Optical correction-spectacles & contact lens most
wildly used
- Plus power / spherocylindrical lens prescribed
- absolute hyperopia to accept nearly full correction
- young patient with accomodative esotropia &
hyperopia require short period of adaptation to
tolerate full correction
25. Contact lens beneficial in case of
- resist to wear spectacles
- improve cosmosis
- reduce aniseikonia & anisophoria in persons with
anisometropia
- accomodative esotropia beneficial
- Unilateral high hypermetropia
26. (3)Management strategies hyperopic
correction
# Older children & pre – presbyopic adults (10 -
40 yrs)
Low degree of hypermetropia – optical correction with
fogging
Hypermetropia of moderate degree with / without
associated astigmatism – optical correction with
fogging after cycloplegic retinoscopy
27. Uncorrected hypermetropia lead to near vision
problem in early age (30 to 35 yr) as accomodation
reserve approaches to presbyopia
Neeeds subjective correction after cycloplegic
retinoscopy & require higher near addition than age
28. Presbyopic correction depends on - patients age
- patient ‘ s job
- habit of patient
Unilateral high hypermetropia > 3 D then contact lens
advice
> 2.5 D difference in both eyes then undercorrection is
given to eye having more hypermetropia
29. In high hypermetropia if not accepting high /
strongest lens
- in that case it is well to undercorrect at
first then strengthen the lens at interval of few
months ( in which weaker lens for distant & full
correction for near is given )
-untill the full correction is comfertably
borne
30. # Younger children (birth to 10 yrs of age)
Treatment not require in case of –
Treatment needed in case of – binocular anomalies
- decrease visual acuity
- learning difficulties
< 5 yrs of age - >3 D of hyperopia - early optical
correction on basis of full atropinized retinoscopy with
other intervention like occlusion / active vision
therapy if require
& follow up periodically
31. Partial hyperopic correction in infants given b/c that
does not interfere with emmetropization of infants
Concurrent amblyopia – patching & active vision
therapy & full time spectacle wear
B/L high hyperopia – if uncorrected may lead to
isometropic amblyopia without esotropia -
- full correctionn require & careful
follow up made as previously nonexisting esotropia
may present after correction
32. Occlusion therapy is given in which 6 hrly alternate
use of both eyes advice & initial follow up after 15 days
to 1 month
Small children always prescribe plastic frame & plastic
glasses with full frame & 3 monthly follow up require
33. # Presbyopic patient
- optical correction to distant correction with near
addition
# Pathological hyperopia
- underlying cause is chief concern – limited to need
to correct hyperopia in best manner possible
- reffer to eye care provider for special services
35. The basic idea is to reshape the cornea using the
laser to remove a very thin layer. The reshaped
cornea allows the refraction of the eye to be
corrected.
LASIK®
LASIK stands for Laser-Assisted In situ
Keratomileusis. This is the most popular form of
laser eye surgery. The laser is used to lift and
remove a very thin layer of the cornea. The shape
of the cornea is altered to be more curved, so that
the light rays can be focused further forward, and
on to the retina.
36. Epi-LASIK
Similar to LASEK, Epi-LASIK is a newer type of
refractive surgery in which an epithelial flap is created
with a super-fine blade, instead of an alcohol solution.
With Epi-LASIK, the chance of the cells becoming too
unstable to be replaced is reduced.
This hyperopia treatment is suitable for people with
thin corneas as well as those who have a relatively high
degree of farsightedness.
37. PRK®
PRK stands for Photo-Refractive Keratectomy. It is
an older surgical operation, that has mostly been
replaced by newer techniques.
LASEK®
LASEK stands for LAser Sub-Epithelial
Keratomileusis. It is an improved form of PRK with
some similarities to LASIK. Most of the outer layer
of the cornea (the epithelium) is left intact. The
LASEK procedure tends to be more painful, and
discomfort can last longer than with LASIK.
39. Conductive keratoplasty
The CK radio waves , guided by rinse – away dye - it
change the shape of the cornea by shrinking targeted
areas of collagen in the eye.
Quick (about 3 minutes per eye) and painless & both
eyes will be treated the same day.
Do not have side effects such as dry eyes, “halos” and
light sensitivity
Also used to correct presbyopia - reduces dependence
on reading glasses
40. (b) Vision therapy
Effective in accomodative & binocular dysfunction
resulting from hyperopia
(c) Modifications of patient ‘ s habit &
environment
- improving light / reduces glare
- using better quality of printed material
- decreasing visual demands
- ergonomic condition at computer terminal
41. (4) Patient education
- Avoid stress or eye strain
- Use appropriate lens
- Use good light at work
- Avoid prolong period of short distant approach
- Maintain proper diet
(5)Prognosis & follow up
Physiological hyperopia - not progressive
Children with hyperopia – 3 to 6 monthly follow up
For adults (asymtometic) 1 to 2 yr follow up
Frequent follow up require in –
