Health Library Farsightedness (Hyperopia)From Healthwise

What is farsightedness?

People who are farsighted can see clearly objects that are far away, but they have trouble seeing objects up close. If you are farsighted, close objects may be so blurry that you can't do tasks such as reading or sewing.

This common vision problem is also called hyperopia.

See a picture of what a farsighted eye sees.

Around middle age, your eyes begin to lose the ability to focus on close objects. This vision problem is called presbyopia. It makes being farsighted a more obvious problem.

What causes farsightedness?

Farsightedness occurs when your eye is too short lengthwise and does not bend light correctly. This causes an image to focus behind the retina instead of directly on it, so the image is blurry.

See a picture of how an eye with farsightedness focuses.

Farsightedness often starts in early childhood. But normal growth corrects the problem. If a child is still a bit farsighted when the eye has stopped growing (at around 9 years of age), the eye can usually adjust to make up for the problem. This allows the child to see clearly. But as we age, our eyes can no longer adjust as well, and farsightedness becomes more obvious.

Farsightedness often runs in families. In rare cases, some diseases such as retinopathy and eye tumors can lead to farsightedness. So can a problem with the lens of the eye.

What are the symptoms?

Symptoms of farsightedness can include:

• Blurred vision, especially at night.
• Trouble seeing objects up close.
• Aching eyes, eyestrain, and headaches.

Children with this problem may have no symptoms. A child with more severe farsightedness may:

• Have headaches.
• Rub his or her eyes often.
• Have trouble reading or show little interest in reading.

Farsightedness also increases the risk for crossed eyes (strabismus). If your child has crossed eyes, call an eye specialist ( ophthalmologist or optometrist).

How is farsightedness diagnosed?

Your doctor can tell if you are farsighted by doing an eye exam. He or she will also ask about your past health.

For young children who may have trouble with a normal test, the doctor may use a special camera to make a film or video of the eyes. This is called photoscreening.

During the exam, your doctor may use eyedrop medicine that makes the pupil larger and prevents focusing. This allows the doctor to better examine the eye.

How is it treated?

Mild farsightedness often doesn't need treatment. Your eyes can usually adjust to make up for the problem. But as you age, your eyes can't adjust as well, and you will need eyeglasses or contact lenses. Glasses or contact lenses can also help if your farsightedness is more than a mild problem.

Surgery may be an option in some cases. For severe farsightedness, surgery can also replace the clear lens of your eye with an implanted lens.

Frequently Asked Questions

Farsightedness (hyperopia) occurs when light entering the eye through the lens is focused behind the retina instead of directly on it (refractive error). This is caused by an eye that is too short, whose cornea is not curved enough, or whose lens sits farther back in the eye than normal. Farsightedness is usually inherited: a person with one or more parents who are farsighted is likely to be farsighted as well.

See information about eye anatomy and function.

Many people are born farsighted. Some outgrow it as their eyes grow and develop. Children who do not outgrow farsightedness are often able to accommodate for the condition—their eyes work harder to focus and make up for the refractive error.

With age, the eyes lose their ability to accommodate for refractive errors, and farsightedness becomes more apparent. Everyone slowly loses the ability to focus his or her lens, usually around age 40. People who are nearsighted (myopic), farsighted (hyperopic), or perfectly focused for distance (emmetropic) will all eventually lose the ability to focus on near objects. This is called presbyopia.

In rare instances, diseases such as retinopathy, eye tumors, and lens dislocation can also contribute to the development of farsightedness.

The main symptom of farsightedness (hyperopia) is blurred vision, especially when viewing near objects. If you are farsighted, you may have trouble focusing when performing close-up tasks such as reading or sewing. You may also experience:

• Blurred vision, particularly at night.
• Frequent headaches.
• Aching eyes or eyestrain.
• Difficulty tracking from one line to the next while reading, or a tendency to read the same line over and over again.

Children with mild farsightedness may have no symptoms. A child with severe farsightedness may:

• Complain of frequent headaches.
• Rub his or her eyes often.
• Have a lack of interest in reading.
• Have difficulty reading.
• Have "crossed" eyes (strabismus).

Farsightedness (hyperopia) most commonly starts in early childhood, but normal development and lengthening of the eyeball during early childhood corrects the condition. If the child is still slightly farsighted when the eye has finished growing, around 9 years of age, the eye can usually make up ( accommodate) for the remaining refractive error, allowing the child to see clearly.

If a child who is farsighted is not able to accommodate for the refractive error and has problems with vision, eyeglasses or contact lenses may be necessary. In adults, surgery that either changes the shape of the cornea or replaces the lens in the eye may be used to restore normal vision.

Farsightedness can often go unnoticed until middle age. Around age 40, the muscles controlling the lens become too weak to compensate for farsightedness. At the same time, the loss of flexibility in the lens limits your ability to focus. This stiffening of the lens and change in how well the muscles work is called presbyopia. As presbyopia occurs, decreasing the eyes' ability to compensate for a refractive error, farsightedness becomes apparent. A farsighted person will begin to have trouble with close work. As presbyopia increases, near and distance vision will become blurred, until glasses or contacts are required for both.

Eyeglasses or contact lenses will improve farsightedness but will not halt the progression of the condition. Symptoms of farsightedness will still likely get worse as you grow older.

Farsightedness increases the risk for strabismus, or crossing of the eyes, and amblyopia, which occurs when one eye is not used enough and the visual system does not develop properly.

You are at risk for farsightedness (hyperopia) if you have a:

• Sibling who is farsighted.
• Family history of farsightedness in one or both parents.

Many people in their 50s and 60s go through changes in their vision that make them more farsighted. When people in this age group develop presbyopia, farsightedness that they had not noticed before becomes apparent and causes symptoms.

If you have a sudden change, loss, or disturbance in your vision, pain in your eye, or yellow or greenish discharge from your eye, see the topic Eye Problems, Noninjury to evaluate your symptoms. You may need immediate care.

Call your doctor for a routine eye exam at recommended intervals throughout life (see Early Detection in the Exams and Tests section of this topic) or if:

• A child or teenager has symptoms of farsightedness (hyperopia) or any complaints of blurry vision.
• Existing farsightedness in an adult suddenly becomes worse.
• You have a change in your ability to tolerate your contact lenses (for example, you can no longer wear them for usual periods of time).

Watchful Waiting

Identifying and treating farsightedness early may prevent children from having trouble in school and in social settings. Farsightedness also increases the risk for crossed eyes (strabismus) in children. Proper glasses can correct this and prevent vision loss (amblyopia). If you think you or your child is farsighted, see an eye specialist.

Who To See

Health professionals who can perform screening exams to detect vision problems and refer you to an eye care provider include:

• Pediatricians.
• Family medicine doctors.
• Internists.
• Nurse practitioners.
• Physician assistants.

Eye care specialists who can diagnose eye problems, including refractive errors, and prescribe corrective lenses include:

• Ophthalmologists.
• Optometrists.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

A routine eye exam can detect farsightedness (hyperopia) and other refractive errors, eye disease, and other diseases that can affect the eyes. A complete exam takes 30 to 60 minutes.

A routine eye exam includes:

• Medical history and physical exam. Your health professional will ask questions about your health, lifestyle, medicines you are taking, and past eye problems. Questions about your family members may help determine whether you may have inherited eye problems.
• Vision tests (visual acuity, visual fields, and refraction).
• Slit lamp exam, an exam of the eye using a microscope.
• Tonometry, a measure of the pressure inside the eye, or intraocular pressure (IOP).
• Ophthalmoscopy, which allows a doctor to see inside the back of the eye (fundus) and other structures using a magnifying instrument (ophthalmoscope) and a light source.

Cycloplegic drops are often used in the diagnosis of farsightedness. They dilate the eye and make accommodation impossible so that the doctor can tell whether you are farsighted.

Early Detection

Routine testing of visual acuity (the ability to see details and shapes clearly) is usually a part of every general physical exam during childhood. The U.S. Preventive Screening Task Force recommends screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years.¹

• Eye exams for infants
• Eye exams for children and teenagers
• Eye exams for adults

In young children, photoscreening can be useful in diagnosing farsightedness. Photoscreening uses images captured from film or video and does not require cooperation from the child being examined.

Most people with farsightedness (hyperopia) don't require treatment. Farsightedness is not a disease, and a farsighted eye is otherwise normal and healthy. Glasses or contacts can improve vision if needed.

Corrective lenses refocus light on the retina. Eyeglasses and contact lenses are the treatment of choice for most people with farsightedness. Both are safe and effective, and both are less risky and less expensive than surgery. Prescriptions for eyeglasses and contact lenses specify both the shape and power of the lens. Some people find that eyeglasses do not provide the same quality of central or peripheral (side) vision as contact lenses.

If your eyes are able to accommodate for farsightedness, you may experience headaches or eyestrain from the effort of accommodation. Eyeglasses that correct for farsightedness may not change your vision, but they may relieve your other symptoms.

Surgery for farsightedness aims to change the shape of the cornea so that light is focused directly on the retina. Procedures available to correct farsightedness include H-LASIK, photorefractive keratectomy for hyperopia (H-PRK), thermal keratoplasty, and conductive keratoplasty (CK). Farsightedness can also be corrected by intraocular implants. See the Surgery section of this topic for more information.

See a general listing of the advantages and disadvantages of:

• Eyeglasses. While eyeglasses are the simplest and safest way to correct farsightedness, eyeglasses can be easily broken or lost. But they also provide eye protection.
• Contact lenses. Contact lenses provide predictable vision correction, but they can increase the risk of corneal scratches and infections and can also be easily lost or damaged.
• Surgery. Although you may no longer need to wear glasses or contacts after surgery, some people do still need enhancements or corrective lenses after surgery. Surgery also carries risks, such as infection. Laser surgery for farsightedness is not as easy as laser surgery for nearsightedness.

What To Think About

Most people who are farsighted don't need treatment. Whether you treat farsightedness depends on how bad your symptoms are and whether your eyes can accommodate for them.

Other considerations may affect your choice of treatment.

• Will the treatment affect your work or career? Some jobs (aircraft pilot, for example) may not allow certain corrective treatments. Be sure to check with your employer, or a professional organization or society in your field, before making a decision.
• If you actively participate in contact sports—such as boxing, football, wrestling, or martial arts—in which blows to the head, face, and eyes can occur, talk to your doctor about which treatment will work best for you.
• Certain health conditions and medications may affect the outcome of surgical treatments. For example, diseases that impair the immune system and some medications may prevent proper healing after surgery. Other conditions, such as pregnancy, diabetes, or the use of steroid medications, may cause changes in vision (refractive instability).
• Certain conditions in the eyes may affect your choice of treatment. For example, people who have a history of glaucoma, keratoconus, inflammatory eye diseases, herpes simplex keratitis, or past eye injuries or surgeries should avoid laser surgery to correct farsightedness.

Farsightedness (hyperopia) cannot be prevented.

Early screening can prevent years of eyestrain. Early screening can also identify other conditions such as strabismus or amblyopia that can harm vision.

You cannot prevent or cure farsightedness (hyperopia). But if your vision requires correction, you can work with your eye specialist to make corrective treatment as safe and comfortable as possible.

• Tips for general good vision include taking periodic breaks from close work and visually demanding tasks and wearing proper eye safety equipment for hazardous tasks.
• Tips on contact lens care include following your lens-cleaning instructions carefully and rinsing the lens storage case and letting it air-dry to avoid contamination.

After refractive surgery to correct farsightedness:

• You may need to wear an eye shield, a bandage, or special contact lenses for a few days after surgery.
• Your doctor may prescribe eyedrops to reduce inflammation and the risk of infection. You may need to use them for several days or months after surgery.
• You should avoid vigorous sports, eye makeup, and any activities during which water may get in your eye. The surgeon may recommend that you shower before the surgery, then avoid showering for a day or two afterward to avoid getting water in the eye.
• Depending on the type of surgery, your vision may be reduced for several days afterward. Do not drive until your vision has cleared.
• Dry-eye symptoms are common but usually temporary.

Medications are not used to correct farsightedness (hyperopia).

Several types of surgery are available to treat farsightedness (hyperopia). Surgery is done to reshape the cornea so that light is refocused directly on the retina.

The goal of surgery is to allow people who are farsighted to see clearly without corrective lenses or to be less dependent on them. Most doctors consider 20/40 vision or better after surgery a satisfactory result. People with 20/40 vision or better are allowed to drive a car without corrective lenses.

Laser surgery for farsightedness is not as common as surgery to correct nearsightedness (myopia). This is because the cornea must be reshaped and steepened to correct farsightedness, which is more difficult than it is to flatten it, as is done to correct nearsightedness. Therefore, LASIK is done for lower degrees of farsightedness. Other options are also available, such as thermal keratoplasty (including conductive keratoplasty). But these options can cause corneal scarring which cannot be fixed.

Other procedures used to treat farsightedness include phakic intraocular lenses and clear lens extraction with intraocular lens implant. These options can correct high degrees of farsightedness. Both of these procedures involve implanting an intraocular lens (IOL) into the eye. As clear lens extraction leads to the loss of the ability to accommodate, this may be the best option for older people with severe farsightedness who have already naturally lost this ability.²

Surgery Choices

There are several types of surgery used to treat farsightedness.

• Hyperopic laser in-situ keratomileusis (H-LASIK), which uses a laser to steepen the central cornea, is becoming the most commonly used surgery to treat farsightedness. H-LASIK is about as effective as H-PRK, but H-LASIK is associated with less postoperative pain and quicker stabilization of vision. H-LASIK corrects mild to moderate hyperopia more predictably than more severe cases.
• Excimer laser photorefractive keratectomy (H-PRK) and laser epithelial keratomileusis (H-LASEK) are similar procedures that also use a laser to change the shape of the central cornea, making it steeper. This changes the refractive power of the lens and focuses light that enters the eye on the retina. H-PRK requires no cutting or flap, but the procedure is painful and heals more slowly than H-LASIK. With H-LASEK, the surface layer of the cornea is loosened with alcohol and pushed to the side. After the laser reshapes the cornea, the surface layer is replaced. Both procedures can correct mild to moderate hyperopia more predictably than more severe cases.
• Thermal keratoplasty is a technique that uses heat to change the shape of the cornea by shrinking the collagen fibers in the cornea. There are two types of thermal keratoplasty: noncontact (laser thermokeratoplasty, or LTK) and contact (conductive keratoplasty). A risk involved in either type is the possibility of inducing astigmatism.
• Clear lens extraction with an intraocular lens (IOL) implantation is a procedure where the clear lens is removed from the eye and an IOL is implanted in its place. This procedure is used to correct severe farsightedness. The surgery provides predictable results and rehabilitation is quick, but an eye that receives this treatment loses the ability to accommodate, and there is a risk of retinal detachment. Phakic intraocular lenses, in which an IOL is placed in the eye with the natural lens left in place, have been used with good results in early trials and have been approved by the United States Food and Drug Administration (FDA).

What To Think About

Most farsighted people do not require treatment for the condition. Of those who do, most get satisfactory results from using eyeglasses and contact lenses.

For some people who find glasses or contact lenses inconvenient, surgery to correct farsightedness may be appropriate. But farsightedness is not a disease, and a farsighted eye is otherwise normal and healthy. Some eye specialists question whether these procedures are appropriate for anyone, because most people can have good vision with eyeglasses or contacts.

Weigh your desire to have clear vision without glasses or contacts against the risks of surgery. Surgery is most successful for low degrees of farsightedness. Surgery is more risky and less successful if you have a high degree of farsightedness. Ask your eye doctor any questions about surgery that you have (for example, what are the risks, benefits, possible outcomes, and alternatives to surgery) so you have a balanced understanding and can make the best decision.

No other treatment (such as alternative or complementary therapies, diet, eye exercises, or other self-help measures) has been shown to reverse farsightedness (hyperopia).

Online Resource

Organizations

• Eye Problems, Noninjury
• Nearsightedness (Myopia)

Citations

1. U.S. Preventive Services Task Force (2004). Screening for visual impairment in children younger than age 5 years: Recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/uspstf/uspsvsch.htm.

2. Ge J, et al. (2001). Surgical correction of hyperopia: Clear lens extraction and laser correction. Ophthalmology Clinics of North America, 14(2): 301–313.

Other Works Consulted

• American Academy of Ophthalmology (2002). Refractive Errors (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology.

• Lempert P (2003). Axial length-disc area ratio in esotropic amblyopia. Archives of Ophthalmology, 121(6): 821–824.

Author:	Jeannette Curtis	Last Updated: November 23, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Christopher J. Rudnisky, MD, FRCSC - Ophthalmology
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