Long-sightedness treatment: What is the best treatment for hyperopia?

What is the best treatment for hyperopia?

Hyperopia is another name for long-sightedness and the answer is, as often, it just depends. It depends on the amount of the long-sightedness and it depends on the age of the patient.

If we are dealing with a young patient, then their natural crystalline lens is still functioning beautifully and they’ve got that lovely seamless range of focus and we never want to throw that away. So with those patients, we’re either going to look at corneal laser eye surgery or adding a lens. Interestingly, there’s a large proportion of patients who are long-sighted, but whose eyes are quite large enough to accept an intraocular contact lens. And so, this is well worth looking at as an option in patients for who – for example, – their cornea might be a bit too thin for laser eye surgery, or the prescription may be a bit too large.

Now the size of prescription you can treat with corneal laser eye surgery for long-sightedness is a controversial area. It depends on the laser platform and it depends on surgeon’s preference. There are surgeons who – on certain platforms – will treat up to plus 6 of long-sightedness and this can work very effectively. But you need a pretty thick cornea for that and also a cornea that’s starting off a little bit flatter than average ideally or at least average. Otherwise, we can end up with a cornea that is really very steep by the time you’ve completed that treatment. So again we want to undertake a really careful assessment of the patient and their eye in order to work out what’s gonna be the very best method of treating their long-sightedness in that younger age group.

Once we are dealing with long-sightedness in the presbyopic age group, (these are let’s say over 50 and they’ve lost that ability to shift focus) again we still have laser eye surgery as an option and PRESBYOND blended vision laser eye surgery can work brilliantly if the patient’s own natural lens is clear and is not showing signs of cataracts, they have good tear film and also if it’s not too big of a prescription.

But those patients, after about plus 2, you start to do quite a lot of treatments on the reading eye; the eye that’s going to undertake the intermediate to near vision, because we want that eye to end up around about minus one and a half short-sighted.

So if they’re starting out plus 2, well that’s a plus three and a half treatment. Plus 3, that is plus 4 and a half treatment. Beyond plus 3, that’s really starting to get quite a lot of laser eye surgery. For these patients, lens replacement can become an extremely elegant option. And certainly for this group of patients, if they’re showing signs of cataract change or the lens inside the eye is losing quality, got some cloudiness causing light scatter, and also if you have significant dry eye, because we know that lens replacement surgery has less impact in causing temporary dryness symptoms than laser eye surgery.  So all of those factors are going to steer me towards lens replacement surgery as an option.

As I said, it depends on the size of the prescription and the age of the patient and we can be moving from laser eye surgery for just reading distance, laser eye surgery with PRESBYOND blended vision and either intraocular lens implantation, or lens replacement.