What is hypermetropia?

Hypermetropia, or farsightedness, is a refractive error where the eye's focus falls behind the retina, making it difficult to see nearby objects clearly. With mild hypermetropia, the eye can compensate through accommodation (the eye's natural focusing mechanism). However, after age 40, accommodation diminishes (presbyopia), requiring corrective lenses.

Hypermetropia is measured in diopters and categorized by severity:

• Mild hypermetropia (+0.25 to +1.5);
• Moderate hypermetropia (+1.75 to +3.25);
• High hypermetropia (+3.25 to +6 or more);

Causes of Hypermetropia

The main causes include:

• An eyeball that is too short relative to the eye's refractive power;
• A cornea with reduced curvature;
• Excessive distance between the cornea and the lens;

Anatomically, hypermetropia can be considered a congenital defect, as the child's eyeball (and other body organs) hasn't fully developed. Around ages 6-7, when visual growth is complete, the condition often resolves spontaneously. If not, a vision exam is recommended to prevent complications (e.g., strabismus).

Symptoms of Hypermetropia

The primary symptom is blurry vision of near objects, despite the eye's accommodative effort. Hypermetropia is often accompanied by headaches, tearing, eye strain, and redness. These symptoms warrant an eye exam.

Diagnosis of Hypermetropia

Hypermetropia is diagnosed during a routine eye exam using diagnostic tests that determine the severity. A key test is cycloplegic refraction. Cycloplegic drops dilate the pupil, preventing accommodation, allowing for accurate measurement of the refractive error.

Treatment of Hypermetropia

Laser Surgery

Refractive surgery can correct hypermetropia, myopia, and astigmatism. Because each eye is unique, personalized refractive surgery delivers excellent results. It's a safe, reliable outpatient procedure, allowing patients to go home the same day.

LASIK Refractive Surgery

LASIK is considered one of the most advanced and reliable refractive surgeries. Its advantages include:

LASIK involves three main phases:

• Phase 1: A 3D map of the eye is created to precisely measure refractive errors (aberrometry);
• Phase 2: A corneal flap is created with a femtosecond laser, eliminating the need for a scalpel and minimizing higher-order aberrations;
• Phase 3: The inner curvature of the cornea is reshaped using an excimer laser;

Lens Extraction (Vitrectomy)

Lens extraction treats hypermetropia by removing the crystalline lens when its optical power is insufficient and implanting an artificial lens (intraocular lens). This is often used when accommodative focusing ability is lost.

Phacoemulsification is an outpatient procedure performed with topical anesthetic. The surgeon uses a micro-incision (2-2.4 mm) that self-seals and requires no sutures. Ultrasound breaks the lens into an emulsion, which is then aspirated. The intraocular lens is then implanted. The procedure takes 10-20 minutes.

After phacoemulsification, patients experience good vision within hours, with maximum visual acuity reached within 24-48 hours to 1 week. Recovery is minimal, with many patients returning to normal activities the next day.

Various treatments can correct hypermetropia permanently or partially. Prescription eyeglasses are commonly used, particularly for children and adolescents.

Contact lenses are another effective method, redirecting light rays to bypass the accommodation process.

High Hypermetropia Surgery

For severe hypermetropia, an intraocular lens can be implanted over the crystalline lens.

Lenses are only considered when refractive surgery isn't sufficient. Replacing the crystalline lens with an intraocular lens is also an option, but primarily when the patient also has cataracts requiring surgery.