Treatment for hypermetropia
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Treatment of Hypermetropia (Hyperopia)
Hypermetropia (farsightedness) is a refractive error where the focal point of parallel light rays falls behind the retina, corrected by convex (plus) lenses. Treatment depends on the degree of refractive error, age, symptoms, and the presence of complications like strabismus.
1. Optical Correction (Non-Surgical)
Spectacles
- The primary treatment, using convex (plus) lenses to converge light onto the retina.
- In children, up to 4 D of hypermetropia generally should not be corrected if there is no squint and the child has no symptoms with near vision.
- With hypermetropia >4 D, a two-thirds correction is typically prescribed.
- In the presence of esotropia, the full cycloplegic correction must be prescribed, even in children under 2 years of age.
Contact Lenses
- An alternative to spectacles for motivated patients.
- Offer cosmetic and optical advantages (less image magnification than spectacles).
2. Surgical / Refractive Correction
Surface Ablation (e.g., PRK)
- Can correct low degrees of hypermetropia.
LASIK
- Can correct up to 4 D of hypermetropia.
- The preferred refractive surgery for hyperopia, myopia, and astigmatism.
Conductive Keratoplasty (CK)
- Uses radiofrequency energy applied to the corneal stroma via a micro-needle high-frequency probe.
- Burns placed in one or two rings in the corneal periphery cause thermally induced stromal shrinkage, increasing central corneal curvature.
- Corrects low-to-moderate hypermetropia and hypermetropic astigmatism; may also help presbyopia.
- Disadvantages: early over-correction, significant regression, and induced astigmatism.
Clear Lens Extraction (Refractive Lens Exchange)
- Removal of the natural crystalline lens with implantation of an intraocular lens (IOL) of appropriate power.
- Used for high degrees of hypermetropia where corneal procedures are insufficient.
Phakic Lens Implants
- Intraocular lenses implanted without removing the natural lens.
- Reserve for high degrees of refractive error.
- Options include anterior chamber (iris-claw) and posterior chamber implants (ICL).
Key principle: Intraocular surgical procedures are the only options for high degrees of hypermetropic refractive error.
3. Management of Hypermetropia in Children
| Situation | Approach |
|---|---|
| Mild hypermetropia (≤4 D), no squint, asymptomatic | Observation; correction generally not needed |
| Hypermetropia >4 D | Two-thirds correction |
| Esotropia present | Full cycloplegic correction mandatory (even <2 years) |
| Amblyopia present | Refractive correction + occlusion therapy |
For refractive accommodative esotropia, full correction of hypermetropia often eliminates or reduces the deviation; some cases may additionally require bifocals for residual near deviation, and surgery for any residual angle.
Summary
| Method | Indication |
|---|---|
| Spectacles (convex lens) | All ages; first-line |
| Contact lenses | Motivated patients as alternative to spectacles |
| LASIK | Up to 4 D, adults |
| Surface ablation (PRK) | Low hypermetropia |
| Conductive keratoplasty | Low–moderate hypermetropia; presbyopia |
| Clear lens extraction + IOL | High hypermetropia |
| Phakic IOL | High hypermetropia, preserve accommodation |
— Kanski's Clinical Ophthalmology: A Systematic Approach, 10th ed. | — Textbook of Family Medicine, 9th ed.
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