Understanding Hyperopia: A Deeper Dive

What Is Hyperopia?

Hyperopia is also known as farsightedness. It is very common and designated with a positive (+) power in glasses and/or contact lens prescriptions. In order to understand what it really is and how it affects our vision, we need to understand four concepts:
 

1. 1. Light Refraction: When light enters our eye, it bends (refracts) to focus at a certain point (the focal point). In an eye with no prescription (also called emmetropia or an eye with “perfect vision”), light focuses precisely on the back part of the eye called the retina (our eye sensors). When the focal point is precisely on the retina, the image is perfectly in focus and a clear image is sent to the brain.
    

2. 2. The Hyperopic Eye: Hyperopic eyes refract light in such a way that the focal point is behind the retina instead of directly on it. Some causes of this are a shorter eye axial length (distance from the front to back of the eye), a flatter cornea (the clear, front part of the eye), a combination of the two, and other less substantial factors. Since light is not focused directly on the retina, the image sent to the brain will be blurry if the eye does not take action to focus the light onto the retina.
    

3. 3. Accommodation: The action of the eye focusing light closer to the front of the eye is called accommodation. To do this, the muscles of the eye’s focusing system strain and cause light to bend at a steeper angle in the eye, which causes it to focus closer to the front of the eye. If the hyperopic eye accommodates at the perfect amount, it will move the focal point from behind the retina to directly on the retina. This results in sharp vision, but also may result in eyestrain from excessive use of the eye’s focusing system.
    

4. 4. Near Objects: Objects closer than 20ft are considered near objects. While light from distant objects (objects 20ft or further) focuses directly on the retina in an eye with no prescription, light from near objects focus behind the retina in an eye with no prescription. The emmetropic eye will have to accommodate to bring the near object into focus. The hyperopic eye, on the other hand, focuses light from distant objects behind the retina and near images even further behind the retina. This is why distant objects are much clearer to hyperopic eyes than near objects (hence the nickname, farsighted). The hyperopic eye must accommodate for distant objects, and even more for near objects to bring them into focus. This is why it is much more common for hyperopic eyes to experience eyestrain and blur for near objects compared to far objects.

Symptoms and Everyday Challenges

1. 1. Eye Strain: Engaging in prolonged near tasks like computer work or reading strains the eyes, leading to discomfort. o Because hyperopic eyes must accommodate to see clearly, they are usually always straining. As described above, hyperopic eyes must accommodate some for distant objects and even more for near objects. For patients with high prescriptions, they may feel significant strain just to see far away and even more when looking up-close.
    

2. 2. Blurry Near Vision: Reading a book, working on a computer, texting, or examining small details may be challenging due to blurred close-up vision. o When the eye cannot accommodate enough, the image is not focused on the retina and results in blurry vision. While this can happen for distant objects, it is much more common for near objects since the hyperopic eye must accommodate more for near than far. For some hyperopic eyes, the hyperopia is so high that near is always blurry. For others, near objects can be clear for the short term while the eye still has the stamina to strain. However, when the stamina runs out from prolonged accommodation, the eye cannot accommodate enough to keep the image clear.
    

3. 3. Headaches: Frequent headaches may result from the extra effort eyes exert to compensate for hyperopia. o Eyestrain can be considered a type of headache since it causes discomfort to the area around the eyes. Since the focusing muscles in the hyperopic eye are always straining, they get tired and cause eyestrain. While eyestrain can be considered a type of headache, it is important to differentiate the two since eyestrain is not a medical emergency while some other types of headaches may be. Eyestrain also may lead to other headaches due to the amount of tension in the eye muscles causing pain in other parts of the head.
    

4. 4. Double Vision: Double vision and crossed eyes are common when some hyperopes (people with hyperopic eyes) look at near objects and sometimes even distant objects o This occurs more commonly in patients with high hyperopic prescriptions. The muscles that turn the eyes as well as the muscles that accommodate are linked by nerves. All eyes have to turn in as well as accommodate to look at a near object, which is why the two muscle systems are linked. Since hyperopes must accommodate much more to look at a near object, sometimes their eyes turn in too much and lead to crossed eyes and double vision.

Causes and Risk Factors

1. 1. Genetics: Hyperopia tends to run in families. If a person’s parents or siblings have it, they are more likely to have been born with it.
    

2. 2. Eye Shape: The shape of the cornea and eyeball affects how light refracts. In hyperopia, the cornea may be flatter (flatter cornea bends light to a lesser degree) or the eyeball may be shorter.
    

3. 3. Age: As we age, the eye slowly loses its ability to accommodate, which exacerbates the symptoms of hyperopia.

Corrective Measures

1. 1. Eyeglasses: Correctly prescribed glasses help to focus light onto the retina without the eye having to accommodate much if at all. This gives much needed relief from blur, eyestrain, headaches, and double vision. Glasses also allow patients to comfortably perform prolonged near tasks such as studying, working with computers, and working with finely detailed objects.
    

2. 2. Contact Lenses: Correctly prescribed contact lenses also help to focus light onto the retina without the eye having to accommodate much if at all. They perform the same task as glasses while usually giving more comfort. Glasses for hyperopia are usually heavier and bulkier. Contact lenses do not have any of these drawbacks.
    

3. 3. Refractive Eye Surgery (LASIK/PRK/ICLs): If a hyperopic patient seeks a more permanent solution, laser surgeries such as LASIK and PRK reshape the cornea to improve focus. Implantation of an ICL improves focus by implanting a synthetic lens in front of the natural lens. There are pros and cons to each surgery, so consult an ophthalmologist to determine if you’re a suitable candidate for any of these surgeries.

Monitoring and Lifestyle Tips

1. 1. Regular Eye Exams: Symptoms of hyperopia may subtly worsen over time. Routine eye exams help track changes and adjust prescriptions.
    

2. 2. Good Lighting: Adequate lighting reduces eye strain during close work.
    

3. 3. Rest Your Eyes: Follow the 20-20-20 rule: Every 20 minutes, look at something 20 feet away for 20 seconds.

How iCare Optometry Can Help

1. 1. Optimal Glasses/Contact Lens Prescriptions: Hyperopia is trickier than myopia (nearsightedness) to prescribe for. o Since hyperopes are usually used to straining their eyes all the time, they actually can hide their full prescriptions. This is most common in children and young adults because they are able to strain their eyes much more than older adults. Dilated eye exams can reveal a hyperopic eye’s full prescription. Patients may still experience eyestrain and other symptoms with glasses and/or contacts if they are not given their full prescription. o To complicate things even more, many hyperopes are not able to relax their eyes to see clearly through their full prescription. We balance eyestrain with clear vision to give our patients the most comfortable and sharpest prescriptions possible.
    

2. 2. Ideal Glasses Options: Glasses lenses for hyperopia become bulkier, heavier, and magnify the patient’s eyes the more the prescription increases. High Index lens material or smaller frames may be recommended to reduce the inconvenience of these issues.
    

3. 3. Refractive Eye Surgery Information: Taking into account the magnitude of the prescription, patient age, and patient goals, we can provide personalized information to help our patients decide if seeing an Ophthalmologist for refractive surgery is the best course of action. We can also go into more detail on the differences between LASIK, PRK, and ICLs.
    

4. 4. Ruling Out Eyestrain: Some patients with chronic headaches are referred to us by their primary care providers (PCPs) to rule out more benign causes of headaches such as hyperopia. Before more costly and invasive procedures such as MRIs and CT scans are performed, most PCPs and patients want to see if simple glasses and/or contacts can alleviate headaches. We have helped many patients resolve their headaches caused by eyestrain with our glasses and contact lens prescriptions.

For more information on hyperopia, please visit iCare Optometry at our office in Idaho Falls, Idaho. We work with our patients to understand their visual needs and help them in the best way possible. Please call (208) 522-2839 to discuss any questions with our team of experts or to schedule an appointment today.