What is hyperopia?
Hyperopia, also known as long-sightedness, is a condition in which objects at near and also at far distances look blurred. It usually appears in middle age, that is between 30 and 50, while in people with high hyperopia it is evident from childhood. Hyperopia often shows up as early presbyopia, meaning it causes symptoms only in near vision, and usually earlier than we would expect for the person’s age.
Page contents
- What is hyperopia?
- What are the symptoms of hyperopia?
- What is the right age to correct hyperopia with laser? Is treatment easy?
- What is LASIK laser surgery?
- Is LASIK painful?
- How soon can you see well after LASIK?
- How long does LASIK take?
- How a person with hyperopia sees
- Why hyperopia occurs
- Degrees of hyperopia and what they mean
- How hyperopia is diagnosed correctly: the importance of eye drops
- Hyperopia in children: when to be concerned
- Options for correcting hyperopia
- Hyperopia and angle-closure glaucoma
- Practical tips for everyday life
- How hyperopia changes with age
- Hyperopia and driving
- Myths and facts about hyperopia
- Frequently Asked Questions about Hyperopia
This is due to the ability of the eye’s lens to change its power depending on where we focus. Because of this ability, a small amount of hyperopia can be masked by the change in lens power and only show itself later in life. So although hyperopia may be present throughout a person’s life, it becomes apparent when, with age, the lens can no longer change its power and hide it. People who develop hyperopia have also usually had excellent vision all their lives, which is why they find it so hard to deal with.
In children it is very important to diagnose hyperopia early, to prevent a condition called amblyopia (lazy eye). In children, hyperopia tends to decrease, and in some cases they may end up not needing glasses at all.
Unlike myopia, it is a condition in which the length of the eye is shorter than average. Anatomically, the eye aims to bring all light rays to a focus exactly on the retina. So when the eye is shorter than average, the rays focus behind the retina and vision is blurred.
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An examination and clear advice on your case at our practice in Neo Psychiko.
What are the symptoms of hyperopia?
Hyperopia is a condition that makes it difficult to see objects up close. For example, you may struggle with everyday tasks such as reading, writing and many other activities done at close range. As a result, you may get fairly frequent headaches and your eyes may ache quite a lot. In any case, as soon as you notice the first symptoms, it is a good idea to see your ophthalmologist.
What is the right age to correct hyperopia with laser? Is treatment easy?
Ideally, the right time to correct hyperopia is when it starts to affect a person’s distance vision. Of course, after such a procedure the need for reading glasses will also be reduced significantly or may even disappear. We can therefore give the person clear distance vision without glasses and reduce, or in some cases eliminate, the need for reading glasses. We do not perform such procedures in childhood, except in exceptional cases where another condition is also present.
There are two well-established surgical methods for correcting hyperopia, as well as myopia and astigmatism: LASIK and PRK. In recent years a third method, called SMILE, has been developing. LASIK is the most common method, for reasons related to the outcome.
What is LASIK laser surgery?
LASIK is a procedure for removing refractive error in which a very thin cut (a flap) is first made in the cornea and then lifted. In the past this cut was made with a small blade called a microkeratome. This has now been replaced by a laser, the femtosecond laser, which makes the procedure even more precise, as each of its pulses lasts 0.000 000 000 000 001 of a second. Next, to correct the prescription, we use a second laser called an excimer laser, which changes the curvature of the cornea so that the refractive error is removed. The final step is to put the flap back in place. The lasers we use are among the most modern and technologically advanced in the world, and their combination gives us excellent results.
Book an appointment with the doctor
An examination and clear advice on your case at our practice in Neo Psychiko.
Is LASIK painful?
No. Anaesthetic drops are used during the procedure, so the patient feels only slight pressure on the eye and no pain at all. After the procedure, and over the following days, there is also no pain, although occasionally there may be a foreign body sensation on the first day.
How soon can you see well after LASIK?
Most patients realise as soon as the procedure is over that their prescription has been corrected, and from the very next morning their vision is almost perfect.
How long does LASIK take?
From the moment the patient lies down, the procedure takes no more than 10 minutes.
How a person with hyperopia sees
The long-sighted eye focuses light behind the retina rather than on it. To bring the image to the right place, the crystalline lens is constantly “working”, a process called accommodation. While the eye is young and the lens flexible, this effort covers a large part of the hyperopia. That is why a young person with mild hyperopia may see clearly in the distance and never suspect they have a refractive error.
The price is fatigue. After reading, screen use or driving at night, the following appear:
- blurred near vision that gets worse as the day goes on
- headache in the forehead or around the eyes
- stinging, redness and a feeling of heaviness in the eyelids
- difficulty concentrating, especially in children who are reading
- needing more light to read comfortably
Over the years the ability to accommodate decreases. The hyperopia that was “hiding” starts to show, first at near and later at distance as well. That is why many people feel that “suddenly”, after 35 to 40, they need glasses for all distances.
Why hyperopia occurs
In most cases hyperopia is due to the eyeball being slightly shorter than normal. Less often, the cornea is flatter or the lens has less refractive power. Heredity plays an important role: if one or both parents have hyperopia, the child is more likely to have it too.
More rarely, hyperopia may be the result of other conditions, such as certain retinal diseases that “push” the macula forwards, or previous eye surgery. That is why hyperopia that changes quickly in an adult needs a full eye examination and not just new glasses.
Degrees of hyperopia and what they mean
Hyperopia is measured in dioptres with a plus sign. In general terms:
- Mild hyperopia (up to +2.00): often masked by accommodation in young people. It may cause only eye strain with close work.
- Moderate hyperopia (+2.25 to +5.00): usually needs correction, at least for reading and screen use.
- High hyperopia (over +5.00): affects vision at all distances and, in children, is linked to a higher risk of amblyopia and squint.
Ophthalmologists also talk about latent and manifest hyperopia. Latent hyperopia is the part that is permanently covered by accommodation and does not show up on a simple measurement. Manifest hyperopia is what we measure without drops. The difference matters a great deal, because if glasses are prescribed based only on the manifest hyperopia, the symptoms of eye strain may continue.
How hyperopia is diagnosed correctly: the importance of eye drops
An automated measurement at an optician’s or during a brief examination often underestimates hyperopia, because the eye “accommodates” while it is being measured. For an accurate result, especially in children and young adults, we perform a cycloplegic refraction. We put in drops that temporarily relax the focusing muscle and measure again. This reveals the full amount of hyperopia.
The drops dilate the pupil and blur near vision for a few hours, so it is best not to drive straight after the examination. During the same visit we also check the back of the eye, the eye pressure and the angle of the anterior chamber, which is particularly important in long-sighted people, as we will see below. You can find out more about the process on our page about the comprehensive eye examination.
Do your eyes get tired when reading or using a screen?
A full examination with cycloplegic refraction shows the true degree of hyperopia. Book an appointment in Neo Psychiko.
Hyperopia in children: when to be concerned
Almost all babies are born with mild hyperopia, because their eyes are still small. As they grow, the eye develops and the hyperopia decreases. This process is called emmetropisation and is usually complete by the age of 6 to 8.
We become concerned when the hyperopia is high for the child’s age or when it differs a lot between the two eyes. In that case the brain may “ignore” the image from one eye and amblyopia, the so-called “lazy eye”, may develop. In addition, the intense focusing effort can make the eye turn inwards, known as accommodative esotropia, a form of squint (strabismus). Both conditions are treated much more successfully when diagnosed early, ideally before school.
Signs that should prompt you to book an appointment with a paediatric ophthalmologist: your child often rubs their eyes, avoids reading, tires quickly with schoolwork, complains of headaches or one eye seems to “turn” inwards.
Options for correcting hyperopia
Glasses
Glasses with plus (converging) lenses are the simplest and safest solution at any age. In children they are often a treatment too, because they relax accommodation and help vision develop properly. In adults they may be needed only for reading and screen use, or all day, depending on the degree.
Contact lenses
Contact lenses offer a more natural field of view and are a good option for athletes or people who do not want to wear glasses. However, they require proper hygiene and regular check-ups, because incorrect use can lead to corneal infections.
Refractive laser surgery
Laser techniques such as LASIK and surface photorefractive keratectomy change the curvature of the cornea so that light focuses correctly. In hyperopia, laser treatment is more demanding than in myopia, because it has to make the cornea steeper. That is why it gives the best and most stable results in mild and moderate degrees. We assess suitability after corneal topography and pachymetry. Read more on our page about laser eye surgery and the comparison of LASIK, PRK and TransPRK.
Lens replacement after 45 to 50
At older ages, when hyperopia is combined with presbyopia or an early cataract, a good solution may be to replace the natural lens with an intraocular lens. The intraocular lens is chosen to correct the hyperopia and, depending on the type, to reduce the need for glasses for near vision as well. The decision is tailored to each person and discussed in detail at the clinic.
Hyperopia and angle-closure glaucoma
Because the long-sighted eye is smaller, the space between the cornea and the iris, the anterior chamber, is often shallower. With age the lens grows and the space narrows even further. In some people this can lead to closure of the angle through which fluid drains from the eye and a sudden rise in pressure: acute angle-closure glaucoma.
The symptoms are severe eye pain, redness, blurred vision, haloes around lights, headache and sometimes nausea. This is an emergency. The good news is that at a routine check-up we can detect a narrow angle and treat it preventively, usually with a short laser treatment. That is why long-sighted people over 40 need regular examinations even if they see well with their glasses.
Practical tips for everyday life
- Wear your glasses as your ophthalmologist has advised. Glasses do not “ruin” your eyes or increase hyperopia.
- When working at a computer, follow the 20-20-20 rule: every 20 minutes, look at something 6 metres away for 20 seconds.
- Make sure you have good lighting for reading and sit at the right distance from the screen.
- If headaches keep coming back despite your glasses, ask for your prescription to be rechecked.
- Have a full eye examination every one to two years, and more often if there is a family history of glaucoma.
Dr. Vasileios Skouteris sees adults and children with hyperopia at his practice in Neo Psychiko, Athens, and recommends the solution that suits each person’s age, degree of hyperopia and needs. To book an appointment, call +30 210 677 0007.
How hyperopia changes with age
Hyperopia does not stay the same throughout life. What changes is not so much the size of the error as the eye’s ability to compensate for it.
- Infancy and pre-school age: mild hyperopia is normal. The first eye examination at around 3 to 4 years shows whether development is on track.
- School age: the need for a lot of close reading often reveals hyperopia that had not caused problems until then. Fatigue, headaches and poor concentration can be mistaken for learning difficulties.
- Ages 20 to 35: most people with mild or moderate hyperopia see well in the distance and get tired with close work. This is also the age at which laser correction is most often considered.
- Ages 35 to 45: accommodation weakens and hyperopia becomes more noticeable. Long-sighted people need reading glasses earlier than others of the same age.
- After 45 to 50: hyperopia coexists with presbyopia, and progressive lenses are often needed or lens replacement is considered. At the same time, checking for a narrow angle and glaucoma becomes more important.
Hyperopia and driving
Many long-sighted people pass the driving licence eye test without glasses, because accommodation helps at the moment of measurement. In practice, however, when driving at night or on long journeys, fatigue increases, refocusing from the road to the dashboard becomes slower and vision may blur. If you feel your eyes getting tired or you struggle to read road signs in the evening, a pair of driving glasses can make a big difference to your safety.
Myths and facts about hyperopia
- “If I wear glasses, my eyes will get lazy.” Not true. Glasses simply focus light correctly. The feeling that “I can’t see without them any more” is because the eye gets used to a relaxed, clear image, not because it has got worse.
- “Hyperopia means I see well in the distance, so I don’t need anything.” Good distance vision is often achieved through constant effort by the eye. Eye strain and headaches are the sign that this effort comes at a cost.
- “Hyperopia and presbyopia are the same thing.” Hyperopia is due to the shape of the eye and is present from birth. Presbyopia is the normal loss of flexibility of the lens with age. They can coexist, but they are different things.
- “Eye exercises correct hyperopia.” Exercises may help with certain problems of how the eyes work together, but they do not change the length of the eyeball or the curvature of the cornea.
Frequently Asked Questions about Hyperopia
Does hyperopia go away with age?
In children, a small amount of hyperopia is normal and usually decreases as the eye grows. In adults, however, hyperopia does not go away. On the contrary, it becomes more noticeable after 40, because the eye loses its ability to compensate for the error by accommodating, and many people then need glasses for both near and distance.
What is the difference between hyperopia and presbyopia?
Hyperopia is a refractive error that is present from birth, because the eye is shorter or the cornea flatter than normal. Presbyopia affects everyone after 40 to 45, because the natural lens loses its flexibility. Both make near vision difficult and they often coexist, but they have different causes.
Can hyperopia be corrected with laser?
Yes, low and moderate hyperopia can be corrected with LASIK or PRK, provided the cornea is suitable. At higher degrees the result of laser treatment is less predictable, so alternative solutions are considered. After 45 to 50, replacing the lens with an intraocular lens can correct hyperopia and presbyopia at the same time.
How can I tell if my child has hyperopia?
Children rarely complain about their vision. Signs worth watching for are tiredness or headaches when reading, avoiding close-up activities, rubbing the eyes and a squint, which can be linked to hyperopia. In children, hyperopia is often only revealed by an examination with cycloplegic drops at the clinic.
Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO