What is the treatment for distance vision problems?

Treatment for Distance Vision Problems

Eyeglasses are the first-line treatment for distance vision problems, as they represent the simplest and most cost-effective strategy to improve vision and should be considered before contact lenses or refractive surgery. 1

Primary Treatment Approach

Eyeglasses (First-Line)

• Provision of appropriate spectacles is the most cost-effective and simplest intervention for correcting distance vision problems 1
• Optimal eyeglass correction for higher refractive errors requires precision in fitting, particularly regarding the position of the optical center of each lens relative to the pupil 1
• High-index lenses reduce lens thickness and weight, providing increased comfort and better cosmetic appearance for high refractive errors 1

Specific Refractive Error Corrections

For Myopia (Nearsightedness):

• Individuals with low myopia may not need correction except for distance activities such as driving or school work 1
• Avoid overcorrecting myopic patients, as this causes excessive accommodation and may create symptoms 1
• Some patients require increased minus correction for night driving due to night myopia that occurs at low illumination levels 1

For Hyperopia (Farsightedness):

• Slight undercorrection may be desirable in young and middle-aged individuals due to physiologic accommodative tone 1
• As patients age, full correction becomes necessary to provide optimal distance vision 1

For Astigmatism:

• Full correction may not be needed for individuals with regular astigmatism 1
• Adults may not accept full cylindrical correction in their first pair of eyeglasses, particularly if their astigmatism has been only partially corrected previously 1
• Substantial changes in axis or power are generally not well tolerated 1

Alternative Treatment Options

Contact Lenses (Second-Line)

• Contact lenses are an alternative for patients who prefer them over eyeglasses 1
• Contact lens wearers should have examinations every 1 to 2 years to monitor for adverse effects 1
• All contact lens wearers should maintain a pair of eyeglasses to decrease the risk of overwear and avoid using contact lenses when the eye is red or inflamed 1

Refractive Surgery (Third-Line)

• Surgical options include corneal procedures (LASIK, photorefractive keratectomy) and lens surgery (clear lens extraction, phakic intraocular lenses, cataract surgery) 1
• Surgery should only be considered after eyeglasses and contact lenses have been evaluated 1

Diagnostic Requirements Before Treatment

Essential Evaluation Components

• Distance visual acuity must be measured in a dimly lit room at 20 feet (6 meters) with the patient looking at high-contrast characters 1
• Each eye should be evaluated independently using objective methods (retinoscopy, autorefractor, or wavefront analyzer) or subjective refinement with a phoropter or trial lens set 1
• Distance refraction should be performed with accommodation relaxed using manifest refraction with fogging techniques, avoiding excess minus power correction 1

When Cycloplegic Refraction Is Needed

• Cycloplegic refraction is indicated when accommodation cannot be relaxed or when symptoms are inconsistent with manifest refractive error 1
• In adults, tropicamide provides rapid onset and shorter duration, while cyclopentolate provides greater cycloplegia but longer duration 1

Important Clinical Considerations

When Correction May Not Be Needed

• Patients with low or monocular refractive errors may not require correction 1
• Small changes in refractive corrections in asymptomatic patients are generally not recommended 1

Special Circumstances

• When hyperopia is accompanied by esotropia, eyeglasses may be required to control strabismus or improve fusion 1
• If minus lenses improve fusion in intermittent exotropia, eyeglass correction may be indicated even if the patient is not myopic 1

Monitoring Requirements

• Screening examinations including visual acuity are recommended every 1 to 2 years for children and adolescents due to progressive myopia 1
• Adult comprehensive eye examinations should occur every 5-10 years under age 40, every 2-4 years for ages 40-54, every 1-3 years for ages 55-64, and every 1-2 years for ages 65 and older 1

Common Pitfalls to Avoid

• Do not overcorrect myopia, as this causes excessive accommodation and symptoms 1
• Avoid making substantial changes in astigmatic axis or power, as these are poorly tolerated 1
• Always seek a pathologic basis for reduced best-corrected visual acuity, as excellent visual acuity does not preclude serious eye disease 1
• A suddenly acquired refractive change may signal systemic or local disease or drug effects and requires investigation 1