Hyperopia (Long-Sightedness) Treatment
Blurred near and distance vision · Prof. Dr. Fırat Helvacıoğlu, FEBOS-CR · Veni Vidi Eye Clinic, Caddebostan – Kadıköy, Istanbul
Hyperopia (long-sightedness) is a refractive error in which the eye focuses the image behind the retina, causing strain at near, eye fatigue and headaches. Glasses and contact lenses can correct it; permanent hyperopia treatment options are laser for low to moderate hyperopia in adults with a stable prescription, and refractive lens exchange with a smart lens over the age of 45 and in high hyperopia. In children, early examination is important because of the risk of strabismus and lazy eye.
What is hyperopia?
Hyperopia is a refractive error in which the eye focuses the image behind the retina because it is too short from front to back or the cornea and lens lack sufficient refractive power. Although people popularly describe it as “seeing far but not near”, distance vision also deteriorates as the degree increases.
In young people, the eye’s lens partly compensates for hyperopia through its focusing (accommodative) power; the prescription may therefore remain “latent”, and the person makes a constant effort even while seeing clearly. As this compensating power declines with age, people with hyperopia notice presbyopia earlier than their peers, often around the ages of 35–40; later in life, they also start to need glasses for distance.
- Low hyperopia: Up to +2.00 D; often causes no symptoms in young people.
- Moderate hyperopia: Between +2.00 and +5.00 D; eye strain and difficulty at near become pronounced.
- High hyperopia: Above +5.00 D; the condition affects both distance and near vision. Very high hyperopia can occur in conditions such as nanophthalmos, in which the eye is small.
Symptoms
- Tiring quickly during near work (reading, screens), burning and watering eyes
- Headaches in the forehead and temples, especially at the end of the day
- Blurring of near text; in higher degrees, blurred distance vision as well
- Early onset of reading difficulty around the ages of 35–40
- In children: inward turning of the eye (accommodative esotropia), lazy eye, avoidance of reading
Hyperopia treatment in children
Most babies and young children are mildly hyperopic, and this usually decreases with growth. However, high hyperopia, or hyperopia that differs between the two eyes, carries a risk of strabismus (especially an inward turn) and lazy eye (amblyopia). A pre-school eye examination is therefore important.
Because a child’s eye can mask hyperopia through its focusing power, we should measure the prescription with drops that dilate the pupil and temporarily relax focusing (cycloplegic examination). A recent meta-analysis showed that non-cycloplegic, instrument-based measurements systematically underestimate hyperopia and that a definitive diagnosis and spectacle prescription require cycloplegic examination. A Cochrane review of whether glasses prevent strabismus in hyperopic children found the level of evidence to be low; therefore, we decide individually whether to prescribe glasses, taking into account the degree of hyperopia, the difference between the two eyes, any eye turn and visual acuity. Children do not receive laser treatment.
Hyperopia treatment options
| Option | Suitable for | Description |
|---|---|---|
| Glasses | All ages | Plus (converging) lenses correct hyperopia; after 40, progressive lenses can help at both distance and near |
| Contact lenses | Adults who do not want glasses, and selected children | Options include soft, toric or multifocal lenses |
| Laser | Over 18, stable prescription, low to moderate hyperopia (generally up to about +4 D), suitable cornea | The laser steepens the central cornea to bring the focus forward (No Touch, Femto-LASIK, Q-LASIK, PRK) |
| Smart lens / refractive lens exchange | Usually over 40–45, moderate to high hyperopia, presbyopia | The surgeon removes the natural lens and implants a trifocal lens or EDOF lens targeting distance, intermediate and near vision; in eyes with astigmatism, the surgeon uses a toric lens |
| Phakic intraocular lens (ICL) | Selected young patients | Its use remains limited because the anterior chamber is often shallow in hyperopia; we consider it in patients with suitable anterior chamber measurements |
Hyperopic laser treatment may show more regression during healing than myopic laser treatment. In a study with three years of follow-up, most of the regression occurred in the first 12 months, after which results were more stable, and some eyes required a re-treatment. A Cochrane review comparing PRK and LASIK for hyperopia reported that, although no randomised trials were available, the efficacy of the two methods appeared similar. Therefore, we discuss the limits of hyperopic laser treatment and the near-vision changes after 40 in detail before surgery.
For contact lens wear, the doctor determines the suitable lens type and power at the examination; the patient then obtains the lens according to this recommendation. We monitor lens fit and corneal health at regular check-ups.
A roadmap for hyperopia treatment by age
- Childhood: Cycloplegic examination and glasses if needed; monitoring for strabismus and lazy eye.
- Age 18–40: Glasses or contact lenses; laser for low to moderate hyperopia if the prescription is stable and the cornea is suitable.
- Age 40–45: Near-vision problems quickly become noticeable; laser monovision or presbyopia treatment options are considered.
- Over 45: For hyperopic people who wear glasses for both distance and near, refractive lens exchange with a smart lens is often the most lasting hyperopia treatment; if a cataract has developed, the prescription is also corrected during cataract surgery.
Hyperopia and the risk of narrow angles (glaucoma)
Because hyperopic eyes are usually small, the angle through which fluid drains from the eye may be narrower, and the natural lens, which thickens with age, can narrow it further. Eyes with narrow angles are at risk of a sudden rise in eye pressure (acute angle closure). Therefore, we assess anterior chamber depth and angle width in every hyperopic patient. In middle-aged and older hyperopic patients with narrow angles, lens exchange can also reduce this risk by widening the angle; the treatment decision takes these measurements into account.
Prof. Dr. Fırat Helvacıoğlu’s research related to hyperopia
Research
Prof. Dr. Fırat Helvacıoğlu and his team examined macular folds with optical coherence tomography (OCT) in a case of bilateral nanophthalmos — a condition in which the eye is unusually small, causing very high hyperopia — and published it in Case Reports in Ophthalmological Medicine (2014). The authors also presented the study at the 46th National Ophthalmology Congress of the Turkish Ophthalmological Association (2012). This is why a detailed assessment of the retina and macula is part of the examination in high hyperopia.
Frequently asked questions
Mild hyperopia in children may decrease with growth. In adults it does not go away; on the contrary, latent hyperopia becomes apparent as focusing power declines, and after the 40s the need for glasses for both near and distance may increase.
Yes. Laser can correct low to moderate hyperopia in adults with a stable prescription and a suitable cornea. In high hyperopia and over the age of 45, refractive lens exchange with a smart lens is often the more suitable option.
No. Hyperopia is a refractive error arising from the structure of the eye and can occur at any age. Presbyopia is the near-vision problem that appears in the 40s as the eye’s lens loses its flexibility. People with hyperopia notice presbyopia earlier.
If high hyperopia, or hyperopia that differs between the eyes, remains uncorrected, an eye turn (strabismus) and lazy eye may develop. A paediatric ophthalmologist determines the need for glasses after a cycloplegic examination.
Yes. Options include soft, toric or multifocal contact lenses. The doctor determines the suitable lens type and power at the examination.
References
- Roque BJ et al. Instrument-based, non-cycloplegic versus cycloplegic refraction in pediatric and young adult populations (≤25 years): a systematic review and meta-analysis. Adv Ophthalmol Pract Res. 2025. doi:10.1016/j.aopr.2025.11.004
- Jones-Jordan L et al. Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children. Cochrane Database Syst Rev. 2020;4(4):CD007738. doi:10.1002/14651858.CD007738.pub3
- Plaza-Puche AB et al. Three-year follow-up of hyperopic LASIK using a 500-Hz excimer laser system. J Refract Surg. 2015;31(10):674–682. doi:10.3928/1081597X-20150928-06
- Settas G et al. Photorefractive keratectomy (PRK) versus laser assisted in situ keratomileusis (LASIK) for hyperopia correction. Cochrane Database Syst Rev. 2012;(6):CD007112. doi:10.1002/14651858.CD007112.pub3
- Karam M et al. Extended depth of focus versus trifocal for intraocular lens implantation: an updated systematic review and meta-analysis. Am J Ophthalmol. 2023;251:52–70. doi:10.1016/j.ajo.2023.01.024
- Helvacıoğlu F, Kapran Z, Şencan S, Uyar OM, Çam O. Optical coherence tomography of bilateral nanophthalmos with macular folds and high hyperopia. Case Rep Ophthalmol Med. 2014;2014:173853. doi:10.1155/2014/173853
This page provides patient information and does not replace an examination or medical assessment. We determine the right hyperopia treatment for you after an eye examination and measurements.
Hyperopia treatment assessment
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Caddesi No: 257, Caddebostan – Kadıköy, Istanbul, Türkiye