Can Hyperopia Be Corrected with Laser Surgery?

What is Hyperopia?

Hyperopia is a vision defect, often asymptomatic, resulting in blurry vision when looking at nearby objects. Normally, light rays focus on the retina. This allows for clear vision without refractive defects, a condition called emmetropia. When light rays focus beyond the retina, near vision is impaired. This occurs in hyperopia, where the individual sees well from afar but experiences blurry and double vision up close. Hyperopia does not typically worsen over time.

How is Hyperopia Diagnosed?

What is Skiascopy?

Skiascopy is a method for measuring refractive errors that determines the eye's refractive power, i.e., its ability to correctly converge light rays.

A small mirror and light source direct a light beam onto the pupil, creating a sickle-shaped shadow at the pupil's edge. If the shadow's direction matches the light beam's movement, the eye is hyperopic, emmetropic, or myopic by less than one diopter.

This exam is particularly useful in young children as it provides an indication of hyperopia or other visual defects even with uncooperative patients.

What is Cycloplegia?

Cycloplegia is a technique used during eye exams to determine objective refractive values undistorted by accommodation. It's achieved by instilling eye drops containing substances that pharmacologically paralyze the ciliary muscle.

The exam duration depends on the medication's action speed. Active ingredients include tropicamide (rapid action, ~20 minutes, short duration, 30 minutes), cyclopentolate (rapid action, 20 minutes, short duration, one hour), and atropine (powerful, long duration, 12-24 hours). These pupil-dilating drops bypass accommodation's compensatory effect, enabling hyperopia detection.

Hyperopia: Different Surgical Techniques

PRK

PRK acts on the cornea's surface and is indicated for mild cases. It's an outpatient procedure under local anesthesia via anesthetic eye drops.

The procedure involves removing the corneal epithelium. An excimer laser then vaporizes corneal tissue, reshaping it for a more pronounced curvature.

A therapeutic contact lens is worn for a few days post-op. Redness and a foreign body sensation may occur. Healing is rapid, with epithelium regeneration within days.

Intrastromal Refractive Surgery

This involves incising and lifting a thin superficial corneal layer, exposing the deeper part for excimer laser reshaping.

The flap is repositioned, with tissue adhesion re-establishing within minutes, eliminating the need for stitches.

This is also an outpatient procedure under local anesthesia. Both eyes can be operated on simultaneously.

Customized Refractive Surgery

A major development is personalized surgery. Tailoring methods and procedures to the individual reflects the broader medical trend towards personalization and addresses individual variations.

Generally, more significant defects necessitate more personalized interventions. These techniques also allow for simultaneous surgery on both eyes.

Microsurgery

Excimer laser surgery is unsuitable for high hyperopia or corneal disorders. Thinning an already impaired cornea compromises its biomechanics.

Microsurgery is an option for patients with complete growth and stable visual defects. Both eyes are generally operated on after one to two weeks.

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Laser for Hyperopia

Hyperopia can be corrected via refractive surgery using an excimer laser. This can be done simultaneously with cataract correction. The laser beam's energy breaks molecular bonds, causing target tissue evaporation without damaging surrounding tissues. In laser hyperopia treatment, surgery aims to remove superficial corneal layers, increasing its curvature radius.

Laser surgery can enhance natural vision, reduce or eliminate the need for glasses and contacts, and improve quality of life. It's indicated for mild to moderate hyperopia in patients with complete growth and stable visual defects; it's not suitable for young people.

Laser surgery candidates should not have conditions like diabetes, collagen disorders, nervous system disorders, glaucoma, eye inflammation, or corneal diseases (including keratoconus). Hyperopia refractive surgery results are generally good, though less predictable than myopia correction.

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