Refractive Errors and Their Treatment
Myopia · Hyperopia · Astigmatism · Presbyopia · Prof. Dr. Fırat Helvacıoğlu, FEBOS-CR · Veni Vidi Eye Clinic, Caddebostan – Kadıköy, Istanbul
Refractive errors are myopia, hyperopia, astigmatism and presbyopia, the age-related loss of near vision. Glasses and contact lenses can correct them. In suitable people, laser eye surgery, a phakic intraocular lens (ICL) or a smart lens can also treat refractive errors permanently. Your age, prescription and corneal structure determine the right option.
What are refractive errors?
A refractive error is blurred vision that occurs because the eye cannot focus light precisely on the retina. In other words, the “prescription” corrected with glasses or contact lenses is the measure of this error. There are four main refractive errors:
| Error | What happens? | Typical complaint |
|---|---|---|
| Myopia | The eye focuses the image in front of the retina | Blurred distance vision |
| Hyperopia | The eye focuses the image behind the retina | Strain at near, eye fatigue; blurred distance vision in high degrees |
| Astigmatism | The cornea or lens curves more steeply in one direction; light does not focus at a single point | Blurred, shadowed vision at all distances; lights scatter at night |
| Presbyopia | With age, the eye’s lens loses the flexibility to focus at near | From the 40s onwards, inability to read up close; holding the phone further away |
These errors can occur alone or together; for example, a myopic person may also have astigmatism and, after their 40s, presbyopia.
How we measure refractive errors
First of all, the right treatment starts with the right measurement. At the examination, in addition to computerised measurement, we determine the subjective prescription from the letters the patient reads. Particularly in children and young adults, measurement with pupil-dilating (cycloplegic) drops eliminates the misleading effect of the focusing muscle. In patients considering surgery, we also perform corneal topography/tomography, corneal thickness, axial length and intraocular lens measurements. In addition, eye pressure and retinal examination are part of every assessment.
Treatment options for refractive errors: from glasses to surgery
| Option | How does it correct? | Suitable for |
|---|---|---|
| Glasses | Lenses correct the prescription; options include single-vision, bifocal or progressive (multifocal) lenses | All ages; the safest and simplest method |
| Contact lenses | A lens that sits on the cornea corrects the prescription; types include soft, toric (for astigmatism), multifocal or rigid lenses | People who do not want glasses or who play sports; specialty lenses for irregular corneas |
| Laser eye surgery | A laser reshapes the cornea (SMILE Pro, No Touch, Q-LASIK, Femto-LASIK, PRK) | Age 18–40, stable prescription, suitable cornea |
| Phakic intraocular lens (ICL) | The surgeon places a thin lens inside the eye and preserves the natural lens | Young adults whose prescription is too high for laser or whose cornea is unsuitable |
| Smart lens / refractive lens exchange | The surgeon removes the natural lens and replaces it with an intraocular lens targeting distance, intermediate and near vision | Usually over 45, with presbyopia or cataract |
Age, the type and degree of the prescription, corneal structure, eye health and lifestyle together determine the suitable method. However, surgery is not always necessary; glasses and contact lenses are also safe and effective options.
For contact lens wear, the doctor determines the suitable lens type and power at the examination; you then obtain the lens according to this recommendation. We also monitor lens fit and corneal health at regular check-ups.
Hyperopia and its treatment
Hyperopia occurs because the eye is shorter than normal or the cornea has too little curvature; as a result, the image falls behind the retina. In young people, the focusing power of the eye’s lens can partly compensate for this, so hyperopia may go unnoticed; however, it causes headaches, eye strain and difficulty at near. Uncorrected hyperopia in children can cause strabismus and lazy eye, so early examination is important.
- Glasses and contact lenses: The first option at any age.
- Laser: In suitable patients, laser can correct low to moderate hyperopia (No Touch, Femto-LASIK, Q-LASIK).
- Intraocular lens: In high hyperopia and over the age of 45, refractive lens exchange with a smart lens often gives better results; in suitable young patients, a phakic intraocular lens (ICL) is also an option.
More information: hyperopia treatment.
Refractive errors: a roadmap by age
- Childhood and adolescence: Glasses or contact lenses; myopia control methods for children whose myopia is increasing rapidly. However, we do not perform laser surgery in this age group.
- Age 18–40: Laser eye surgery if the prescription is stable; alternatively, a phakic intraocular lens (ICL) if laser is unsuitable.
- Age 40–45: Near vision begins to decline; therefore, you and your surgeon must discuss this stage when planning laser surgery (presbyopia treatment).
- Over 45: Glasses, multifocal contact lenses or refractive lens exchange with a smart lens; cataract surgery if a cataract has developed.
Frequently asked questions
Genetic predisposition is important in refractive errors, particularly myopia; for instance, myopia is more common in children whose parents are myopic. Environmental factors such as near work and spending little time outdoors also play a role.
Usually not. The prescription may increase in childhood and adolescence and then becomes stable in adulthood. With age, presbyopia also appears, and later in life cataract can change the prescription as well.
No. Glasses with the correct prescription do not increase it; an uncorrected error, on the other hand, can lead to lazy eye in children and eye strain and headaches in adults.
You must be at least 18 and, in addition, your prescription must have been stable for at least a year. After 40, near vision declines, so we plan the treatment accordingly.
After a detailed eye examination, refraction and corneal measurements, we decide by considering your age, prescription, corneal structure and expectations together.
References
- Holden BA et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–1042. doi:10.1016/j.ophtha.2016.01.006
- Fricke TR et al. Global prevalence of presbyopia and vision impairment from uncorrected presbyopia: systematic review, meta-analysis, and modelling. Ophthalmology. 2018;125(10):1492–1499. doi:10.1016/j.ophtha.2018.04.013
- Lawrenson JG et al. Interventions for myopia control in children: a living systematic review and network meta-analysis. Cochrane Database Syst Rev. 2025;2(2):CD014758. doi:10.1002/14651858.CD014758.pub3
- Barsam A, Allan BD. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database Syst Rev. 2014;(6):CD007679. doi:10.1002/14651858.CD007679.pub4
- Wen D et al. Postoperative efficacy, predictability, safety, and visual quality of laser corneal refractive surgery: a network meta-analysis. Am J Ophthalmol. 2017;178:65–78. doi:10.1016/j.ajo.2017.03.013
- Alvarado-Villacorta R et al. Surgical interventions for presbyopia. Cochrane Database Syst Rev. 2025;4(4):CD015711. doi:10.1002/14651858.CD015711.pub2
This page is for patient information and does not replace an examination or medical assessment. We determine the treatment that is right for you after an eye examination and measurements.
Prescription and treatment options assessment
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Caddesi No: 257, Caddebostan – Kadıköy, Istanbul, Türkiye