Farsightedness (Hyperopia): Symptoms, Causes & Treatment

Farsightedness, or hyperopia, occurs when the distance between the cornea and the retina is too short, causing incoming light to miss the retina altogether and strike the wall of tissue behind it instead. As a result of this refractive error, distant objects appear sharper than close objects.

Hyperopia is not a one-size-fits-all condition. It can vary in severity from person to person, occur due to a variety of anatomical irregularities, and potentially worsen over time.

While adults commonly experience presbyopia, which is age-related farsightedness, in their 40s and beyond, hyperopia can affect people of any age. It is the most common refractive error in children.

Hyperopia Symptoms

The primary symptom of hyperopia is that things up close appear blurry. Additional symptoms include the following:

• Eye strain
• Headaches
• Burning sensation in the eyes
• Irritability after focusing on near objects
• Discomfort while reading

People with mild hyperopia and some farsighted children may not experience symptoms. 

If the hyperopia is severe or accompanied by pain or other symptoms, it can be indicative of a more serious problem.

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Risk Factors for Farsightedness

There are many factors that can cause the eye to process light irregularly. Often, hyperopia occurs naturally due to irregularities in cornea shape, lens shape, or overall eyeball shape. 

Infants & Children

Most infants are born with some level of hyperopia that goes away as they grow.

Children who remain hyperopic may not experience symptoms until later in life because children’s eyes can naturally accommodate farsightedness by adjusting the shape of the lens. This ability stops or weakens as the child gets older, and they may begin to experience symptoms in adolescence or adulthood.

Smoking during pregnancy has been found to increase the child’s risk of moderate to high hyperopia. 

Adults

It is frequently estimated that over half of adults over the age of 50 experience aging-related hyperopia, known as presbyopia. As we age, the lens hardens and loses flexibility, making it more difficult to adjust for closer objects.

Presbyopia is so common that it is considered a normal part of aging and generally becomes symptomatic around the age of 40. 

Diagnosis of Hyperopia

Hyperopia is commonly detected during a standard vision test, in which the patient reads letters on a chart at different sizes and distances.

If a vision test indicates blurry vision, a retinoscope can be used to examine how the light is processed in the eye and whether the blurry vision is due to farsightedness or nearsightedness. A phoropter measures the refractive error.

If LASIK surgery is desired, the ophthalmologist will use corneal topography and other tests to examine the condition of the eye. The results of this examination will determine the patient’s eligibility for LASIK or other surgeries.

Treatment for Farsightedness

Farsightedness can be easily corrected through various means.

• Corrective lenses: Glasses and contact lenses are the most common and cost-effective means of addressing farsightedness. Many adults begin wearing reading glasses or “readers” as they get older in order to clearly see things up close.
  
  Glasses and contacts require consistent use. You’ll need regular eye exams to ensure your prescription remains current.
  
• Surgical options: Surgery offers a more permanent solution to hyperopia. Keratorefractive surgeries (also known as refractive keratoplasties or corneal refractive surgeries) involve laser remodeling of the cornea. Options include:
  
  • PRK. Also known as photorefractive keratectomy, this laser surgery involves surface ablation techniques, which remove the outer layer of the cornea in order to reshape it. 
  • LASIK. With LASIK, a laser creates an opening in the cornea to reach lower tissues for reshaping.
    
• Phakic intraocular lens (pIOL): Though primarily used to treat myopia, pIOL can treat hyperopia as well. Implantation involves surgical insertion of an artificial lens. The natural lens typically does not need to be removed.

Different surgeries may be preferable depending on the specific nature of the hyperopia in question. Each surgery comes with its own set of risk factors.

In cases of extreme or high hyperopia, for example, some studies have indicated that PIOL may be the optimal refractive surgery of choice.

Consulting with an ophthalmologist who is familiar with the patient’s compressive eye history will aid in determining which option is best if surgery is desired. Before any decision regarding surgery is made, the patient will undergo a thorough examination to ensure that the eye is fit for the chosen procedure. 

Complications of Hyperopia

In many cases, hyperopia is an isolated condition. However, in some cases and especially if the hyperopia is severe, painful, or accompanied by other symptoms, it can indicate another eye problem or disease.

Children with high hyperopia are at an increased risk of developing strabismus (eyes that do not look in the same direction), anisometropia (eyes of unequal refractive power), and even permanent visual decline. The likelihood of developing these conditions is significantly lower with earlier detection and treatment. 

Farsighted FAQs

What is the main cause of hyperopia?

Hyperopia occurs when the eye processes incoming light behind the retina instead of directly on it. This can occur for a variety of reasons.

Many people are naturally born with eye irregularities (such as irregularly shaped corneas, eyeballs, or lenses) that result in irregular light processing. Infants are naturally farsighted, which goes away as the child grows.

Can hyperopia be cured?

Hyperopia can be “cured” with surgeries that alter the shape of the cornea or lens shape in order to redirect incoming light onto the retina.

Glasses and contacts also work to correct the vision without having to undergo surgery. LASIK offers a permanent solution to hyperopia since vision will only remain corrected as long as glasses or contacts are worn.

How common is hyperopia?

Hyperopia is common. Age-related hyperopia, or presbyopia, occurs in roughly half of all adults over 40. It is also common in children. If left untreated in children, hyperopia can lead to more severe vision issues.

If I get LASIK to correct nearsightedness, will it also correct hyperopia/farsightedness?

No, these are separate issues that require separate procedures. Many people get LASIK to correct nearsightedness and then begin to develop presbyopia (aging-related farsightedness) later in life. 

What is the difference between hyperopia, presbyopia, and myopia?

Hyperopia (farsightedness) and myopia (nearsightedness) are essentially opposites. Hyperopic people have trouble seeing up close, while myopic people have trouble seeing farther away.

Presbyopia is a specific type of late adulthood-onset hyperopia that occurs as a normal part of aging in many people.

References

1. Farsightedness: What Is Hyperopia? (March 2014). American Academy of Ophthalmology.

2. Hyperopia (Farsightedness). American Optometric Association.

3. Refractive Errors. (October 2015). American Academy of Ophthalmology.

4. Hyperopia. (February 2022). StatPearls.

5. Development of the Presbyopia Impact and Coping Questionnaire. (October 2021). Ophthalmology and Therapy.

6. Development of Vision and Strabismus in Childhood: Prevalence and Risk Factors. (February 2020). University of Technology Sydney.

7. Prevalence, Characteristics, and Risk Factors of Moderate or High Hyperopia among Multiethnic Children 6 to 72 Months of Age: A Pooled Analysis of Individual Participant Data. (July 2019). Ophthalmology.

8. Retinoscopy 101. (May 2015). American Academy of Ophthalmology.

9. Phoropter. (March 2022). American Academy of Ophthalmology.

10. Hyperopia and Lens Power in an Adult Population: The Shahroud Eye Study. (October–December 2015). Journal of Ophthalmic & Vision Research.

11. Phakic Intraocular Lens Implantation for the Correction of Hyperopia. (October 2019). Journal of Cataract & Refractive Surgery.

12. Refractive Surgery for Hyperopia. (March 2000). Journal of Refractive Surgery.

13. Refractive Errors & Refractive Surgery Preferred Practice Pattern. (2017). American Academy of Ophthalmology.