Hyperopia (Farsightedness)

What Is Hyperopia?

Hyperopia is a vision condition in which you have difficulty seeing things at near. Other names for hyperopia include hypermetropia and farsightedness

Hyperopia is one type of refractive error. Refractive error is a term to describe how your eyes do not focus images properly onto the back of your eye, where there is a tissue called the retina. A refractive error causes you to see blurry.

There are three general types of refractive errors:

  • Hyperopia (farsightedness) is when your eye focuses images behind your retina. As a result, you see blurry up close.
  • Myopia (nearsightedness) is when your eye focuses images in front of your retina. People with myopia see blurry at a distance.
  • Astigmatism is when your eye focuses images at multiple points. Some points could be in front of your retina, some behind the retina. If you have astigmatism, you see blurry at distance and near.

You can have one type or a combination of refractive errors. For example, you can have hyperopia and astigmatism in the same eye. You can also have hyperopia in one eye and myopia in the other eye.

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Hyperopia should not be confused with presbyopia. Presbyopia is an age-related change in which your eyes lose the ability to focus up close, but for different reasons. Hyperopia can occur at any age, while presbyopia usually occurs over age 40. 

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Causes of Hyperopia

There are a few reasons why your eyes may focus images too far behind your retina. From an anatomy standpoint, hyperopia occurs because:

  • You have a shorter eyeball length than average. 
  • Your cornea, which is the clear covering over your eye, is too flat.

There is a genetic component involved with farsightedness. Studies show that hyperopia, along with other refractive errors, has a multifactorial inheritance. This means refractive errors are primarily influenced by multiple genes, but also by external factors such as lifestyle. 

Hyperopia affects approximately 10 percent of people in the United States.

Research also shows that multifactorial conditions such as hyperopia tend to run in families. If a direct family member (such as a parent or sibling) is farsighted, you are more likely to be farsighted. You may have a lower risk if the family member is more distant, such as a cousin.

Hyperopia in Children

Many children are farsighted at birth because their eyes are smaller. As they get older, their eyeballs lengthen, and they may grow out of their hyperopia. Children can go from being hyperopic to myopic as their eyes develop. 

If a child is only mildly farsighted, they may not show any symptoms of blurry vision. Younger people generally have stronger focusing ability, a process called accommodation. Children can often accommodate well enough to compensate for moderate amounts of farsightedness.

Adults lose the ability to accommodate with age, so hyperopic patients tend to complain about blurry vision up close as they get older.

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Symptoms of Farsightedness

General symptoms of farsightedness include headaches, eye aches, tired eyes, blurry vision, and squinting. These problems tend to be more pronounced after doing near work, such as reading, computer work, or sewing.

With hyperopia, symptoms can vary depending on the strength of your prescription. We can break down hyperopia into different categories based on your prescription. For reference, diopters (D) are the units your eye doctor uses when measuring your eyesight. These are the same numbers you see on your eyeglass prescription.

  • Low hyperopia is +2.00 D or less. 
  • Moderate hyperopia ranges between +2.25 to +5.00 D.
  • Severe hyperopia is anything above +5.25 D.

In general, people with lower amounts of hyperopia do not notice problems seeing at a distance, and may only need to wear reading glasses on occasion. With moderate or severe amounts of hyperopia, you may notice your vision is blurry at near and at far. These patients tend to need their glasses full-time.

Hyperopia tends to worsen with age, so older patients will find that they need to wear glasses more often. This is especially true when presbyopia begins after age 40.

Additionally, farsighted patients who spend large amounts of time working up close may experience more symptoms than someone who does not. For example, someone who sits at a computer all day may complain of headaches and blurry vision more often than someone who drives for a living.

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How to Correct Hyperopia

The most common treatment for hyperopia is either glasses or contact lenses. Your eye doctor can advise you whether you should wear your corrective lenses full-time or only for certain activities.

There are some other treatment options to consider if you do not wish to wear glasses or contact lenses:

Orthokeratology (ortho-k)

Ortho-k lenses are rigid, gas permeable contact lenses you wear overnight. While you sleep, the lenses temporarily reshape your corneas. When you wake up, you remove the contacts. You will be able to see reasonably well for the day, without any glasses or contacts. Since your cornea will start returning to its normal shape after a day or so, you will typically need to use the lenses every night. Orthokeratology can only correct lower amounts of hyperopia.

Refractive Lens Exchange

Similar to cataract surgery, this procedure involves removing the natural lens in your eye. The surgeon then implants an artificial lens that corrects your hyperopia. This surgery is an excellent option for patients with high hyperopia and who may develop cataracts soon. If you have a refractive lens exchange, you will not need cataract surgery later in life.

Laser Refractive Surgery

Laser eye surgery is an excellent option for patients with hyperopia, including both PRK and LASIK. Generally, PRK and LASIK can treat up to about +5.00 D of hyperopia. If your prescription is higher, your surgeon may recommend a refractive lens exchange instead.

Author: Melody Huang, O.D. | UPDATED April 22, 2020

Resources

Carpenter, Nathan, and A Paula Grigorian. “Hyperopia.” EyeWiki, 6 Jan. 2015, eyewiki.aao.org/Hyperopia.

Gifford, Paul, and Helen A. Swarbrick. “Time Course of Corneal Topographic Changes in the First Week of Overnight Hyperopic Orthokeratology.” Optometry and Vision Science, vol. 85, no. 12, Dec. 2008, pp. 1165–1171., doi:10.1097/opx.0b013e31818e8d13.

Harvey, Thomas M, and Brad H Feldman. “Refractive Surgery for Hyperopia.” EyeWiki, 19 Jan. 2015, eyewiki.aao.org/Refractive_Surgery_for_Hyperopia.

Legault, Gary, and Preeya K Gupta. “Choosing the Right Treatment for Hyperopia.” Cataract & Refractive Surgery Today, July 2014, crstoday.com/articles/2014-jul/choosing-the-right-treatment-for-hyperopia.

Nanavaty, Mayank A., and Sheraz M. Daya. “Refractive Lens Exchange versus Phakic Intraocular Lenses.” Current Opinion in Ophthalmology, vol. 23, no. 1, Jan. 2012, pp. 54–61., doi:10.1097/icu.0b013e32834cd5d1.

Stambolian, Dwight. “Genetic Susceptibility and Mechanisms for Refractive Error.” Clinical Genetics, vol. 84, no. 2, 10 June 2013, pp. 102–108., doi:10.1111/cge.12180.

Young, Terri L., et al. “Complex Trait Genetics of Refractive Error.” Archives of Ophthalmology, vol. 125, no. 1, Jan. 2007, pp. 38–48., doi:10.1001/archopht.125.1.38.

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