Prescription for Hypermetropia in Children
For a child with hypermetropia (farsightedness) who cannot see the board clearly, prescribe convex lenses (plus lenses) to correct the refractive error. 1
Understanding Hypermetropia and Lens Correction
Hypermetropia is a refractive error where parallel light rays focus behind the retina, causing blurred vision, particularly for distant objects like a classroom board. 2 Convex lenses (plus lenses) are the correct optical correction because they converge light rays to bring the focal point forward onto the retina, restoring clear vision. 1
- Concave lenses (minus lenses) are used for myopia (nearsightedness), not hypermetropia, and would worsen this child's vision. 1
- The American Academy of Ophthalmology guidelines emphasize that correction of significant refractive errors should be the initial treatment for children with hyperopia. 1
Prescription Guidelines for Pediatric Hypermetropia
The threshold for prescribing corrective lenses depends on the degree of hyperopia and associated conditions:
- For children with esotropia (eye turning inward), eyeglasses are generally prescribed for +1.00 D or more of hyperopia. 1
- For children without strabismus, higher degrees of hyperopia (typically +5.00 D or greater) warrant correction due to increased risk of amblyopia. 3
- The full cycloplegic refractive error should typically be prescribed to restore alignment and optimize visual acuity. 1
Important Clinical Considerations
Cycloplegic refraction is essential to determine the true refractive error, as children can mask hyperopia through accommodation. 1
- In older children, a manifest (non-cycloplegic) refraction may be needed to optimize visual acuity, as full cycloplegic correction may blur distance vision. 1, 4
- Improvement in alignment and vision may take several weeks after prescribing eyeglasses. 1
Common pitfalls to avoid:
- Do not undercorrect significantly, as this risks continued amblyogenic stimulus and poor academic performance. 4
- Ensure proper fitting with impact-resistant lenses for safety, especially in children. 1
- Monitor compliance closely, as poor eyeglass wear leads to poor motor and sensory outcomes. 1
Long-term Management
Children with mild hypermetropia (less than +3.00 D) often experience reduction in refractive error over time and may outgrow the need for correction. 5 However, children with high hypermetropia (greater than +5.00 D) typically will not experience significant reduction and require long-term correction. 5