What is hyperopia? This, in simple terms, farsightedness. Surely many are familiar with this violation of visual function. It is quite common, but because now we should talk about the causes of its occurrence, pathogenesis, first symptoms, as well as the principles of diagnosis and treatment.
Briefly about the disease
Approximately 40% of people have healthy eyes - those that can correctly refract light and subsequently focus on the retina image. This is also called refraction.
What is hyperopia? A condition in which the image focuses directly behind the retina. This disorder occurs in approximately 30% of the population under the age of 20. Usually, two eyes are affected, but often the diopters on each of them are different.
As a rule, at the initial stage, special visual disturbances are not observed. Therefore, patients learn about their diagnosis only after having passed an examination by an ophthalmologist.
Causes
So, what is hyperopia, clearly. Because of what does it arise? The reason lies in the fact that the power of the refractive apparatus simply does not correspond to the anteroposterior size of the eye.
Why is that? With farsightedness, this occurs either due to the shortened axis of the eyeball, or due to a too weak refractive apparatus. Be that as it may, the result is the same no matter what the reason - the refracted rays are not focused as they should.
It is also important to make a reservation that some people suffering from this disease have insufficient optical power of the lens and cornea. And also the longitudinal axis of the eyeball is shortened.
About the premises
Hypermetropia of the eyes occurs behind the retina due to poor refraction and insufficient refractive power. There are certain reasons for this. Predisposing factors can be distinguished in such a list:
- Injuries.
- Surgery.
- Violations in the development of the visual apparatus.
- Short longitudinal axis of the eye.
- Weak curvature of the cornea.
- Hereditary predisposition (parameters of the eyeball are taken into account).
- Tumors
- Problems with the blood supply to the retina.
The severity of farsightedness also depends on these factors.
There are still risk factors. If a person has diabetes, he is over 40 years old, does not observe the regime of work and rest, and also irrationally eats, is physically overloaded and regularly overworkes his eyes, he may develop farsightedness.
Features of the disease
Talking about what is hyperopia, it must be noted that it is physiologically present in newborns (from +2 to +4 diopters). All due to the fact that they have a small longitudinal size of the eyeball. Its length is a maximum of 17 mm.
A more pronounced hyperopia is diagnosed with microphthalmos. This is called a decrease in the eyeball in size. This anomaly is usually combined with other pathologies, including:
- Cataract.
- Coloboma of the choroid and optic disc (optic nerve disc).
- Predisposition to glaucoma.
- Lenticonus.
- Aniridia
Also, the condition can be combined with anomalies of the toes, hands, ears, with a cleft palate and a cleft lip.
Classification
It should be noted that there are various degrees of hyperopia in children and adults. Also, this ailment is classified by the development mechanism. Axial and axial farsightedness are distinguished. It can also be hidden if a person compensates for his anomaly with the help of accommodation tension.
Hyperopia is also classified into congenital, age-related and natural physiological. And according to the degree of hyperopia is divided as follows:
- Weak (up to +2 diopters).
- Medium (up to +5).
- High (more than +5).
Symptoms
Until moderate hyperopia occurs, no signs of a person will be particularly disturbed. It just strains accommodation, and therefore good vision is maintained. And with a moderate farsightedness it is practically not broken. Only when working at close range are such manifestations observed:
- Eye fatigue too fast.
- Discomfort in the area of the eyebrow, nose bridge and forehead.
- Pain in the eyeballs.
- Visual discomfort.
- The feeling of merging letters and lines, vagueness.
- The felt need to move a little away to look at some object, the desire to add lighting.
With a high degree, others are added to these manifestations. The situation is complicated:
- Vision is reduced, both in the distance and near.
- Asthenopic symptoms appear. Fatigue occurs almost instantly, the head hurts indescribably severely, and the eyes seem to burst.
- The boundaries of the optic nerve disc become fuzzy, hyperemia forms.
Farsightedness is also often accompanied by halazion, conjunctivitis, blepharitis, and barley. This is due to the fact that many people rub their eyes reflexively to get rid of the feeling of discomfort. And this is fraught with infection. In people of advanced age, by the way, hyperopia is a provoking factor in glaucoma.
From farsightedness to myopia
The child grows, and hyperopia (according to ICD-10 code - H52.0) passes. Because the eyeball grows to its normal size (this is approximately 23-25 mm).
Because of this, hyperopia comes to naught. A proportionate refraction is formed. And then, as the growth of the eye progresses, many develop the very opposite phenomenon - myopia. It is also called myopia. If the growth of the eyeball is delayed, then mild hyperopia begins to progress.
By the time the body finishes growing, about 50% of people have hyperopia. Others have either myopia or normal vision, called emmetropia.
What happens with age?
It is not known exactly why the eyeball is stunted. However, many far-sighted people completely compensate for their inherent weakness of refraction. They constantly strain the ciliary muscle of the eye, thereby holding the lens in a convex state. So its refractive power increases.
But then the ability to accommodation is reduced. By about 60 years old, people with hyperopia (ICD-10 code above) are exhausting their compensatory abilities. Because of this, the clarity of vision is steadily declining. And both in the distance and near.
There is a development of senile farsightedness, more correctly referred to as presbyopia. It is characterized by the inability of a person to consider some small objects or read tiny letters at close range. With such a pathology, vision can be restored only through the use of glasses on which collecting lenses are installed.
Diagnostics
Hyperopia is determined by an ophthalmologist during a routine visual acuity test. Everyone is familiar with visometry - a method that involves the diagnosis of a violation using special tables. In the case of farsighted patients, they conduct it without correction. The use of positive lenses is not necessary in this case.
Also required is the study of refraction. To do this, there is computer refractometry, as well as skioscopy.
To identify latent hyperopia, the procedure must be carried out in conditions of mydriasis and cycloplegia. It's simple: atropine sulfate is instilled into the eyes of a person.
But to examine the anteroposterior axis of the eyeball, echobiometry and ultrasound are required. It is imperative to identify whether any pathology is associated with farsightedness. Therefore, the patient will have to undergo such events as biomicroscopy with a Goldman lens, perimetry, tonometry, ophthalmoscopy, gonioscopy, etc.
If a person has strabismus, a biometric study is performed.
Therapy
The most common treatment is conservative. Implies wearing contact lenses or glasses. Also, a person can be offered a laser correction or surgery. Today, many operations are performed - hyperphakia, thermokeratoplasty, hyperarthyphakia, lensectomy, etc.
There is no need for treatment if a person has no complaints, and visual acuity does not deviate from +1 diopters.
Preschool children who are diagnosed with hyperopia in excess of +3 are shown to wear glasses continuously. By 6-7 years, they can be removed if there is no tendency to the formation of amblyopia and strabismus.
Lenses and glasses are always selected, taking into account concomitant pathologies and individual characteristics of the body. In some cases, if farsightedness does not exceed +3, use the so-called orthokeratological lenses for night wear. With severe hyperopia, complex glasses are prescribed. Sometimes two pairs are for working at long and short distances.
And they often recommend hardware treatment, physiotherapy, vitamins and biological supplements. It is recommended that you watch TV while wearing perforation glasses.
Hypermetropic astigmatism
This disease must be described separately. With it, there is no single focus of light rays on the retina, and the reason for this is the different radius of curvature of the optical systems of the eye.
Astigmatism combined with hyperopia is an anomaly. It can be either congenital or acquired. Correction lends itself very hard. In addition, the phenomenon is quite rare. Most often, in children with hyperopic astigmatism, parents also suffer from this or other visual impairment.
And the reasons for its formation are as follows:
- Autosomal dominant inheritance.
- Pathology of the lens. For example, cataract, pseudoexfoliation syndrome or coloboma.
- Corneal diseases, membrane damage (ulcer, thorn, endothelial dystrophy, keratitis).
- Intervention of iatrogenic character. If a surgical operation was performed on the eye, then due to the uneven tension of the sutures, the pathology in question may well develop.
- Injuries. Especially penetrating wound. Due to injuries, dense scars and synechia are formed. And they deform the lens and cornea.
The symptoms, in addition to those characteristic of farsightedness, are added to the sensation of "sand" in the eyes, pain and blurred vision. And working at a computer, spending time with gadgets and reading cause great fatigue.
Often patients complain of a headache, which becomes only more intense in the evening. As a rule, discomfort is localized in the superciliary region.
If astigmatism is pronounced, then the image that a person sees looks vaguely, deformed. Sometimes there is pain and diplopia in the area near the orbits.
Complications of Astigmatism
This is a very serious disease. Hypermetropia in both eyes, accompanied by astigmatism, often leads to asthenopia and strabismus. And if a child is ill with this disease, then meridional amblyopia cannot be avoided. With this pathology, visometric disorders can be noted only on certain meridians.
With age, the degree of the disease increases. In especially severe cases, there is a total decrease in visual acuity. And with the illiterate use of lenses in the epithelial layer, point defects can form, which in the future will form entire sections of ulceration.
It is also worth remembering that people with this ailment are at great risk of xerophthalmia.
Treatment
Tactics is selected taking into account the age of the patient, as well as the degree of hyperopia combined with astigmatism. Here are some options:
- Medium and mild illness in children can be corrected by assigning points. But with developed pathology, this will only lead to complications. Therefore, only toric and spherical hard lenses can be used.
- The disease, combined with high degree hyperopia, can be corrected with soft lenses. Also toric.
- Anyone over 14 years old can wear both lenses and glasses.
Surgical treatment is indicated if all of the above tactics fail. The operation can be carried out after 18-20 years - at this point the visual system is fully formed. There are several types of interventions:
- Arcuate keratotomy.
- Laser keratomileusis.
- Photorefractive keratotomy.
- Implantation of a toric intraocular lens.
The technique is chosen individually. If you start treatment in time, then you can not only stop the deterioration of vision - even completely return the lost functions.