What are the treatment options for hyperopia (farsightedness)?

Treatment Options for Hyperopia (Farsightedness)

The primary treatment options for hyperopia include eyeglasses, contact lenses, and refractive surgery, with eyeglasses being the first-line treatment due to their simplicity, effectiveness, and safety profile. 1

Eyeglasses

Eyeglasses are the cornerstone of hyperopia management:

• Prescription considerations:

  • For young and middle-aged individuals, slight undercorrection may be desirable due to physiologic accommodative tone
  • As patients age, full correction becomes necessary to provide optimal distance vision and minimize difficulties with near vision 1
  • For children with esotropia (inward eye turning), eyeglasses are generally prescribed for +1.00 D or more of hyperopia 1

• Types of eyeglasses:

  1. Single vision lenses - correct hyperopia for distance vision
  2. Bifocals - provide correction for both distance and near vision
     • Available in flat-top, round-top, and executive styles
     • Segment height typically set 3-5 mm below the optical center of the distance lens
  3. Trifocals - helpful for patients with specific intermediate-vision needs
     • Particularly useful for computer users
  4. Progressive addition lenses - provide gradual change in power without visible lines
     • Best for individuals with early presbyopia who haven't worn bifocals before
     • Limitations include peripheral distortion, smaller reading zone, higher cost, and fitting challenges 1, 2

Contact Lenses

Contact lenses are an effective alternative to eyeglasses:

• Require less accommodative effort than eyeglasses for hyperopic patients 1

• Options include:

  • Soft contact lenses
  • Rigid gas-permeable lenses
  • Multifocal contact lenses (for presbyopia)
  • Monovision contact lenses (one eye corrected for distance, one for near) 2

• Important safety note: Patients whose primary correction is contact lenses should have a backup pair of eyeglasses to reduce risk of contact lens overwear and avoid lens use when the eye is inflamed 1

Refractive Surgery

Surgical options for hyperopia include:

1. Corneal refractive procedures:

   • LASIK (Laser-Assisted In Situ Keratomileusis)
   • PRK (Photorefractive Keratectomy)
   • LASEK (Laser Epithelial Keratomileusis)
   • Epi-LASIK 2, 3

2. Lens-based procedures:

   • Clear lens extraction/Refractive lens exchange
   • Phakic intraocular lens implantation 2, 3

3. Special considerations for hyperopic surgery:

   • Anatomical challenges include small corneal diameter, short axial length, narrow anterior chamber, and large kappa angle
   • Large optical ablation zones now allow correction of high hyperopia with reduced risk of optical aberrations and regression 3

Treatment Selection Algorithm

1. Initial assessment:

   • Determine degree of hyperopia: low (≤2.00D), moderate (2.00-4.00D), or high (>4.00D) 3
   • Assess patient age, visual needs, lifestyle, and occupational requirements
   • Evaluate ocular health including retinal examination 2

2. First-line approach:

   • Begin with eyeglasses for most patients, especially children and those with newly diagnosed hyperopia 1, 2
   • For children with esotropia, prescribe glasses for +1.00D or more of hyperopia 1

3. Consider contact lenses when:

   • Patient desires freedom from eyeglasses
   • Significant anisometropia (difference in refractive error between eyes)
   • Cosmetic concerns
   • Active lifestyle incompatible with eyeglasses 1, 2

4. Consider refractive surgery when:

   • Patient is intolerant to contact lenses
   • Patient has specific lifestyle needs not met by non-surgical options
   • Patient is an adult with stable refraction
   • No contraindications exist (thin corneas, keratoconus, etc.) 2, 3

Special Considerations

Children with Hyperopia

• Hyperopia is the most common refractive error in children 4
• Moderate-to-high hyperopia significantly increases risk for amblyopia and strabismus 4, 5
• Early detection and treatment may prevent complications 4
• For children with esotropia, the threshold for prescribing hyperopic eyeglasses is lower (generally +1.00D or more) 1
• Impact-resistant lenses are preferable for children, especially those with amblyopia 1

Presbyopia and Hyperopia

When hyperopia coexists with presbyopia:

• Options include bifocals, trifocals, progressive lenses, or separate glasses for different distances 1, 2
• Multifocal or monovision contact lenses can be effective 2
• Surgical options include monovision correction or multifocal intraocular lenses 2

Monitoring and Follow-up

• Regular comprehensive eye examinations are recommended:
  • Every 5-10 years for patients under 40 years
  • Every 2-4 years for patients 40-54 years
  • Every 1-3 years for patients 55-64 years
  • Every 1-2 years for patients 65 years or older 1
• Contact lens wearers should have examinations every 1-2 years to monitor for adverse effects 1

Remember that hyperopia management should focus on optimizing visual acuity, preventing complications like amblyopia and strabismus, and enhancing quality of life through appropriate correction of refractive error.