Treatment of Hypermetropia (Farsightedness)
Eyeglasses should be the first-line treatment for hypermetropia, as they represent the simplest and most cost-effective strategy to improve vision, and should be considered before contact lenses or refractive surgery. 1
Treatment Hierarchy
The American Academy of Ophthalmology's 2023 guidelines establish a clear treatment algorithm for hypermetropia:
Primary Treatment: Eyeglasses
- Eyeglasses are the preferred initial correction for all patients with symptomatic hypermetropia 1
- For young and middle-aged individuals, slight undercorrection may be desirable because of physiologic accommodative tone 1
- As patients age, full correction becomes necessary to provide optimal distance vision and minimize near vision difficulties 1
- High-index lenses should be used for high refractive errors (≥3.00 D) to reduce lens thickness, weight, and improve cosmetic appearance 1
Critical caveat for strabismus: When hyperopia is accompanied by esotropia (inward eye turn), eyeglasses may be required to control the strabismus or improve fusion, and full cycloplegic correction should be prescribed 1, 2, 3
Secondary Treatment: Contact Lenses
Contact lenses are appropriate after eyeglasses have been considered 1:
- Soft hydrogel or silicone hydrogel lenses are most commonly used (93% of contact lens wearers) 1
- Rigid gas-permeable lenses represent an alternative option 1
- Important safety consideration: Individuals with hyperopia must exert more accommodative effort when using eyeglasses than contact lenses 1
- All contact lens wearers should maintain backup eyeglasses to decrease risk of overwear and avoid lens use when eyes are red or inflamed 1
Tertiary Treatment: Surgical Options
Surgical correction should only be considered after non-surgical options 1:
Corneal refractive surgery:
Lens-based surgery:
When Treatment Is NOT Required
Not all hypermetropia requires correction 1:
- Patients with low refractive errors may not need correction 1
- Asymptomatic patients should generally not receive small changes in refractive corrections 1
- The decision depends on the patient's symptoms and visual needs 1
Special Populations
Children with Hypermetropia
High hypermetropia (≥5.00 D) in young children requires optical correction due to increased risk of amblyopia and strabismus 2, 4:
- Full cycloplegic refractive correction should be prescribed when hyperopia is associated with esotropia 2, 3
- Hypermetropia is one of the most frequent amblyogenic factors in children and represents a significant public health problem 4
- Children with hyperopia >5.00 D will not experience significant reduction in refractive error over time and require long-term correction 5
- Children with mild hypermetropia (<3.00 D) often experience reduction over time and may outgrow the need for corrective lenses 5
Presbyopic Patients with Hypermetropia
For patients with both hypermetropia and presbyopia, multiple eyeglass options exist 1:
- Bifocals (flat-top, round-top, or executive styles) 1
- Trifocals for specific intermediate-vision needs 1
- Progressive addition lenses for cosmetic appeal and increased range of vision 1
- Separate eyeglasses for distance, intermediate, and reading 1
Common Pitfalls to Avoid
Undercorrection in older adults: While slight undercorrection is appropriate for younger patients, failing to provide full correction in older patients compromises both distance and near vision 1
Missing esotropia: Failure to recognize and fully correct hypermetropia associated with esotropia can result in persistent strabismus 1, 2
Inadequate correction in children: Undercorrecting high hypermetropia in children prevents proper differentiation between accommodative, partially accommodative, and nonaccommodative esotropia, each requiring different management 3
Overcorrection: Unlike myopia, overcorrecting hypermetropia in young patients is generally not problematic due to accommodative reserve, but precision in fitting remains important for optimal visual outcomes 1