2. • The term hypermetropia is derived from
hyper meaning “In excess” met meaning
“measure” & opia meaning “of the eye”.
• Also called hyperopia / longsightedness
• First suggested in 1755 by KASTNER

3. DEFINITION
• It is the refractive state of eye where in
parallel rays of light coming from infinity
are focused behind the sentient layer of
retina with accommodation being at rest
• The posterior focal point is behind the
retina which receives a blurred image

5. ETIOLOGY
1) AXIAL
• Most common
• Total refractive power of eye is normal
• Axial shortening of eyeball
• 1mm short- 3 D of HM
• Physiologically more than 6D HM are
uncommon
• At birth +2.5 – 3 D of HM (physiologically)
• Pathologically seen in cases like orbital tumour,
inflammatory mass , oedema, coloboma and
microphthalmos.

6. 2) CURVATURAL
• Flattening of cornea, lens or both
• 1mm increase in Radius of curvature-
RESULTS IN 6D of HM
• Never exceed 6D HM physiologically
• Congenitally flattened (cornea plana)
• Result (trauma and disease )
3) INDEX
• Change in refractive index with age
• Physiologically in old age
• Pathologically in diabetics under treatment

7. 4)POSITIONAL
• Posteriorly placed crystalline lens
• Occurs as congenital anomaly
• Result of trauma or disease
5)ABSENCE OF LENS
• Seen in aphakia

8. CLINICAL TYPES
• SIMPLE HYPERMETROPIA,
• PATHOLOGICAL
• FUNCTIONAL HYPEROPIA

9. SIMPLE HYPERMETROPIA
• Commonest form
• Results from normal biological variations
in the development of eyeball
• Include axial and curvatural HM
• May be hereditary

10. PATHOLOGICAL HYPERMETROPIA
• Anomalies lie outside the limits of biological
variation
• Acquired hypermetropia
– Decrease curvature of outer lens fibers in old
age
– Cortical sclerosis
• Positional hypermetropia
• Aphakia
• Consecutive hypermetropia

11. FUNCTIONAL HYPERMETROPIA
• Results from paralysis of accommodation
• Seen in patients with 3rd nerve paralysis &
internal ophthalmoplegia

12. OPTICAL CONDITION
• Parallel rays focus behind retina
• Diffusion circles produce blurred & indistinct
images
• Retina is nearer to nodal point
• Image is smaller than in emmetropic
• Rays diverge from retina
• Formation of clear image is possible only when
converging power of eye is increased

15. NOMENCLATURE
TOTAL HYPERMETROPIA=
LATENT + MANIFEST
(facultative + absolute)

16. TOTAL HYPERMETROPIA
• It is the total amount of refractive
error,estimated after complete cycloplegia
with atropine
• Divided into latent & manifest

17. LATENT HYPERMETROPIA
• Corrected by inherent tone of ciliary
muscle
• Usually about 1D
• High in children
• Decreases with age
• Revealed after abolishing tone of ciliary
muscle with atropine

18. MANIFEST HYPERMETROPIA
• Remaining part of total hypermetropia
• Correct by accommodation and convex lens
• Measure by add strongest lens with max. vision
• Consists of facultative & absolute
FACULTATIVE HYPERMETROPIA
• Corrected by patients accommodative effort
ABSOLUTE HYPERMETROPIA
• Residual part not corrected by patients
accommodative effort
Absolute hypermetropia can be measured by the
weakest convex lens with which maximum visual
acuity

19. MANIFEST HYPERMETROPIA
CONT…
• Manifest HM – absolute HM = Facultative HM
(Strongest lens) – (weakest lens)
• Total HM – Manifest HM = Latent HM

20. NORMAL AGE VARIATION
 At birth +2+3D HM
• Slightly increase in one year of life,
• Gradually diminished untill by the age 5-10 years
 In old age after 50 year again tendency to HM
 Ton of ciliary muscle decreases
 Accommodative power decreases
 Some amount of latent HM become manifest
 More amount of facultative HM become absolute
 Practically after 65 year all of it become absolute

21. SYMPTOMS
• Principal symptom is blurring of vision for close
work
• Symptoms vary depending upon age of patient &
degree of refractive error
ASYMPTOMATIC
• small error produces no symptoms
• Corrected by accommodation of patient

22. ASTHENOPIA
• Refractive error are fully corrected by
accommodative effort
• Thus vision is normal
• Sustained accommodation produces symptoms
• Asthenopia increases as day progresses
• Increased after prolonged near work
SYMPTOMS
Tiredness
Frontal or fronto temporal headache
Watering
Mild photophobia

23. DEFECTIVE VISION WITH ASTHENOPIA
• Not corrected by accommodation
• Defective vision for near more than
distance
• Asthenopia due to sustained
accommodation
• Refractive error more(>4D)

24. DEFECTIVE VISION ONLY
• Refractive vision more than 4D
• Adults usually do not accommodate
• Marked defective vision for near and
distance

25. SIGNS
• VISUAL ACUITY : Defective
• EYEBALL: small or normal in size
• CORNEA : may be smaller than normal.
There can be CORNEA PLANA
• ANTERIOR CHAMBER : may be shallow
• LENS: could be dislocated backwards
• A Scan ultrasonography (biometry) reveal
short axial length

26. FUNDUS:
B) DISC: Dark reddish color, irregular
margins ,confused with Papillitis so
termed as PSEUDO-PAPILLITIS
C) MACULA: Situated further from the disc
than usual, large positive angle alpha,
apparent divergent squint
D) BLOOD VESSELS: Show undue
tortuosity & abnormal branchings
E) BACKGROUND: SHOT- SILK RETINA

27. COMPLICATION
• Recurrent styes m blepharitis or chalazia
• Accommodative convergent squint
• Amblyopia
– Anisometropic
– Stravismic
– Uncorrective bilateral high hypermetropia
• Predisposition to develop primary narrow
angle glaucomas
Care should be taken while instilling
mydriatics

28. TREATMENT
BASIS FOR TREATMENT
• No Treatment
Error is small
Asymptomatic
Visual acuity normal
No muscular imbalance

29. Young children(<6 or 7yrs)
 Some degree of hypermetropia is physiological so
no correction
 Treatment required if error is high or strabismus is
present
 working in school small error may require
correction
 In children error tends normally to diminish with
growth so refraction should be carried out every six
month and if necessary the correction should be
reduced, ortherwise a lens which is overcorrecting
their error may induce an artificial myopia
 No deduction of tonus allowance in strabismus

30. ADULTS
If symptoms of eye-strain are marked,we
correct as much of the total
hypermetropia as possible,trying as far as
we can to relieve the accommodation
When there is spasm of accommodation
we correct the whole of the error
Some patients with hypermetropia do not
initially tolerate the full correction
indicated by manifest refraction so we
undercorrect them
Exophoria hyperopia should be under
correct by 1 to 2D

31. Patients with absolute hypermetropia
are more likely to accept nearly the
full correction because they typically
experience immediate improvement
in visual acuity
In pathological hypermetropia the
underlying cause rather than the
hypermetropia is chief concern

32. MODE OF TREATMENT
• SPECTACLES
OPTICAL TREATMENT
• CONTACT LENS
• SURGICAL

33. SPECTACLES
Basic principle
Prescribe convex lenses(Plus lenses) so
that rays are brought to focus on the retina
Advantages
• Comfortable
• Easier method
• Less expensive
• Safe idea

35. CONTACT LENS
ADVANTAGES
Cosmetically good
Increased field of view
Less magnification
Elimination of aberrations & prismatic effect

36. REFRACTIVE SURGERY
• Refractive surgery is not as effective as in
myopia
TYPES:
(1)HEXAGONAL KERATOTOMY(HK)
• Low to moderate degrees of hypermetropia
• Its risk /benefit ratio is not low enough to warrant
its continued use

38. LASER THERMAL
KERATOPLASTY(LTK)
• Procedure done using laser energy to
heat the cornea (contraction of collagen)
and increase its curvature
• Central heating of cornea results in central
corneal flattening thereby resulting in
hyperopic shift

39. PHOTOREFRACTIVE
KERATECTOMY(PRK)
• Direct laser ablation of corneal stroma
after removal of corneal epithelium
mechanically
• Done using EXCIMER LASER

40. LASER IN SITU
KERATOMILEUSIS(LASIK)
• Anterior flap of cornea lifted with keratome
and excimer laser is used to sculpt the
stromal bed to change the refractive error
of eye
• It can correct up to 4D of hypermetropia
and 8D of astigmatism

41. PHAKIC IOL AND CLEAR LENS
EXTRACTION
• Done by Phaco technique
• Clear lens extraction with the implantation of an
IOL-----Preferably foldable IOL or a Piggyback
IOL is implanted

42. VISUAL HYGIENE
• While reading or doing intensive near work take
a break about every 30 min
• When reading maintain proper distance that is
the book should be at least as far from your
eyes as your elbow when you make a fist and
hold it against your nose
• Sufficient Illumination
• Place a limit spent watching television &
watching videogames
• Sit 5-6 feet away from the television

43. • Appropriate optical correction almost
always leads to clear and comfortable
single binocular vision
• Younger children who have significant
hyperopia associated with amblyopia,
strabismus,or anisometropia require
treatment, starting as early as 3-6 months
of age

44. CONCLUSION
• Hyperopia is a common refractive disorder that
has been overshadowed by myopia in public
perception,vision research & the scientific
literature
• Although uncorrected myopia has a greater
adverse effect on visual acuity than uncorrected
hyperopia,the close association between
hyperopia,amblyopia & strabismus,especially in
children,makes hyperopia a greater risk factor
for more permanent vision loss than myopia

45. • The early diagnosis & treatment of
significant hyperopia & its consequences
can prevent a significant amount of visual
disability in the general population

46. For Further Queries Contact :
Ms. Priyanka Singh
Head – Optometry Service
Email – optometry@venueyeinstitute.org