Hyperopia is a refractive error. In a healthy eye, light rays are refracted so that they converge on the retina, producing a sharp image. With this type of refractive error, however, the light rays do not converge sufficiently. As a result, the focal point falls behind the plane of sharp vision.
Medically, a distinction is made between different forms. If the eyeball is too short, specialists refer to axial hyperopia. If the cause lies more in insufficient optical power—for example, relative to the refractive power of the cornea or lens—it is referred to as refractive hyperopia. The cause of hyperopia therefore lies either in the axial length or in the optical power.
Many young people are only mildly affected at first. Those who are mildly farsighted can still compensate well for it at a young age. The eye’s lens then changes its shape and temporarily increases its refractive power. This accommodation helps restore sharp vision temporarily. Nevertheless, this vision defect still requires treatment if symptoms arise.
In young children, farsightedness can exacerbate an existing squint.
Figure: Schematic representation of a farsighted eye. A blurred image is formed on the retina.
The development of farsightedness is essentially genetically determined. Hyperopia is therefore usually inherited and thus typically congenital. Often, the eyeball is short; this means that the eyeball is usually congenitally slightly shorter than would be ideal for the eye’s optical power.
In infants, a mild form of hyperopia is often still considered physiological. As the eyeball grows, the ratio between its length and optical power can normalize. For this reason, a mild form of hyperopia in childhood may resolve on its own. If the anatomical condition persists, so does the hyperopia.
In addition, the optical quality of the anterior and internal structures plays a role. If the refractive power of the cornea and lens is too low overall, hyperopia also develops. Unlike with nearsightedness, light rays are focused behind the focal plane rather than in front of it. This is precisely why farsightedness makes it more difficult to see objects up close.
Symptoms also change with age. Over the course of a person’s life, the elasticity of the optical system decreases. In particular, the elasticity of the lens diminishes. With advancing age, and especially starting in one’s mid-40s, presbyopia often sets in. This additional presbyopia exacerbates problems with reading or working at a computer screen. As a result, many farsighted people notice the vision problem much later.
About half of the population has a refractive error, and of that group, half are farsighted (meaning a total of one-quarter of the population).
The severity of the symptoms depends on the degree of farsightedness. In cases of mild farsightedness, clear limitations may not be noticeable for a long time. With severe or pronounced farsightedness, symptoms appear earlier.
During school age or adulthood, farsightedness may manifest as headaches and problems—especially with near vision—such as difficulty recognizing nearby objects. Nearby objects often appear blurry, even though distance vision may still function well at first. Many people with farsightedness report a feeling of pressure, rapid eye fatigue, and difficulty concentrating on close-up tasks. Difficulty reading or a burning sensation in the eyes may also occur.
Hyperopia in children may be noticeable due to a squint. If the child has to constantly compensate, the eyes may turn inward. Therefore, a squint should always be evaluated early on.
For a long time, the eye can still compensate for the lack of sharpness. But then visual acuity declines, even though the problem went unnoticed for a long time. This is particularly evident with farsightedness in older adults.
The ophthalmologist diagnoses farsightedness using an eye exam. To do this, the ophthalmologist measures and refracts the eyes (by holding various lenses in front of the eye to determine the required refractive power). This must be done using a procedure known as cyclo-refraction. Beforehand, the patient is given eye drops to dilate the pupils. This allows doctors to temporarily suspend the eye’s ability to accommodate for the measurement.
Hyperopia is measured and expressed in diopters (dpt). A positive refractive power is indicated in dpt. A clinically significant degree of hyperopia can already be present at 3 diopters, especially if symptoms are present.
If necessary, the ophthalmologist also measures the length of the eyeball as well as the optical properties of the cornea and lens. This allows for the precise determination of the eye’s shape. This is particularly important when considering additional treatment options alongside conservative measures.
The first-line treatment for farsightedness is wearing glasses. For children, the glasses should be suitable for both everyday use and sports. The standard treatment is a convex lens that corrects the refractive error.
Alternatively, contact lenses can be used to correct hyperopia. In this case, patients must ensure they handle the contact lenses properly, especially with regard to cleaning and hygiene.
Whether glasses or contact lenses are more appropriate depends on the diagnosis, habits, and tolerance.
In addition, hard contact lenses are preferable to soft contact lenses. Hard contact lenses are gentler on the eyes than soft ones, even though getting used to them is significantly more difficult.
However, hard contact lenses are not suitable for occasional wear (e.g., for sports). In such cases, daily disposable lenses are the better choice.
Spherical contact lenses are the most common option for correcting farsightedness @ Kitreel /AdobeStock
Surgical Treatment of Hyperopia
In principle, surgical procedures to correct farsightedness can also be performed on the cornea or the lens. This is called refractive surgery. To determine whether such a procedure is an option, doctors must carefully examine the eyes.
Depending on the findings, the shape of the cornea is altered or an artificial lens is implanted. However, such a correction is only an option if the prescription is stable and the eye is anatomically suitable. The goal is to permanently correct the vision problem.
In infants and young children, farsightedness is normal to a certain extent. The eye is still developing.
Therefore, hyperopia in children may resolve on its own as the eye lengthens. In an adult eye, however, hyperopia no longer resolves spontaneously.
It can be effectively managed in daily life with corrective aids (glasses or contact lenses). Treatment is also possible through surgical intervention.
When choosing corrective aids or refractive surgery, it is essential to ensure they are suitable for sports. For glasses, this primarily involves the material of the lenses and the design of the temples and frame.
Specialized sports glasses are available; you can ask your optician for more information. When it comes to contact lenses, soft daily disposable lenses are particularly suitable.
When it comes to surgical procedures to correct farsightedness, there are differences in suitability for sports. Contact sports in particular (e.g., boxing) can pose a risk to the eyes following LASIK surgery.
What does farsightedness mean?
Farsightedness means that light is not properly focused within the eye’s optical system. The focal point is not on the retina, but behind it. This makes it particularly tiring to see objects up close.
Is hyperopia the same as farsightedness?
Yes, hyperopia is the medical term. Colloquially, the term “farsightedness” is also sometimes used.
How can you tell if you’re farsighted?
People who are farsighted often experience difficulty reading, eye strain, and blurred vision when working at close range. In children, strabismus may also occur.
What helps with hyperopia?
Contact lenses or glasses often help. In certain cases, surgical correction of farsightedness is also possible.
Is hyperopia congenital?
Yes, very often. Hyperopia is usually genetic and therefore congenital.
