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Long Sight - Hypermetropia

The medical name for long-sightedness is hypermetropia, sometimes called hyperopia. Eyesight
problems, such as hypermetropia, are also known as refractive errors. Long sight leads to problems
with near vision, and the eyes may commonly become tired. Distance vision (long sight) is, in the
beginning, often clear. Long sight can be corrected by glasses or contact lenses, or sometimes
'cured' with laser eye surgery.

What is a refractive error?

A refractive error is an eyesight problem. Refractive errors are a common reason for reduced level of eyesight
(visual acuity).
Refraction refers to the bending of light. In terms of the eye. A refractive
error means that the eye cannot focus light on to the retina properly.
This usually occurs either due to abnormalities in the shape of the
eyeball, or because age has affected the workings of the focusing
parts of the eye.
There are four types of refractive error:

Myopia (short sight).

Hypermetropia (long sight).
Astigmatism (a refractive error due to an unevenly curved
cornea).

Presbyopia (age-related long sight).

In order to understand refractive errors fully, it is useful to know how we see.
When we look at an object, light rays from the object pass through the eye to reach the retina. This causes nerve
messages to be sent from the cells of the retina down the optic nerve to the vision centres in the brain. The brain
processes the information it receives, so that in turn, we can see.

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The light rays have to be focused on a small area of the retina; otherwise, what we look at is blurred. The cornea
and lens have the job of focusing light. The cornea partly bends (refracts) the light rays which then go through the
lens, which finely adjusts the focusing. The lens does this by changing its thickness. This is called
accommodation. The lens is elastic and can become flatter or more rounded. The more rounded (convex) the
lens, the more the light rays can be bent inwards.
The shape of the lens is varied by the small muscles in the ciliary body. Tiny string-like structures called the
suspensory ligaments are attached at one end to the lens, and at the other to the ciliary body. This is a bit like a
trampoline with the middle bouncy bit being the lens, the suspensory ligaments being the springs, and the ciliary
muscles being the rim around the edge.
When the ciliary muscles in the ciliary body tighten, the suspensory ligaments slacken, causing the lens to fatten.
This happens for near objects. For looking at far objects, the ciliary muscle relaxes, making the suspensory
ligaments tighten, and the lens thins out.
More bending (refraction) of the light rays is needed to focus on nearby objects, such as when reading. Less
bending of light is needed to focus on objects far away.

What is long sight (hypermetropia)?

Hypermetropia occurs when light is focused behind the retina. In reality,
light cannot actually be focused behind the retina. So, the lens changes
its thickness (becomes fatter or more rounded) which aims to bring the
light into focus on the retina - a process called accommodation.
But, people with long sight cannot accommodate fully and so the light
does not focus sharply and vision is blurred. This occurs because either
the eyeball is too short, the cornea is too flat, or the lens cannot become
round enough.
People with a minor degree of long sight can usually see at distance,
and their near sight is clear. However, a person with long sight may get
tiring of the eyes, often with a headache and vision discomfort. People
with more severe hypermetropia are not able to see near objects clearly
in focus. Long sight means exactly what the term suggests. You are
sighted (you can see) distant (long) objects.
The diagram shows the differences in focusing between a normal and a
long-sighted (hypermetropic) eye:

What causes long sight (hypermetropia)?

The causes of hypermetropia are usually genetic (hereditary). Longsightedness can occur at any age but it tends to become more
noticeable above the age of 40 years.
In rare cases, hypermetropia is caused by other conditions such as
diabetes, small eye syndrome (microphthalmia), cancers around the
eye and problems with the blood vessels in the retina.
Many babies and very young children tend to be slightly hypermetropic
but usually grow out of this by about 3 years of age.
A particular type of age-related long-sightedness called presbyopia occurs because the lens of the eye becomes
more stiff with age. (See separate leaflet called Age-related Long Sight (Presbyopia) for more information.)

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What are the symptoms of long sight (hypermetropia)?

The main symptom is a difficulty with near vision. 'Tiring' of the eyes (asthenopia) is common and long-sighted
people may have headaches and uncomfortable vision.
There may be difficulties with seeing with both eyes (binocular vision), as the brain will tend to ignore signals
coming from the most long-sighted eye. Lazy eye (amblyopia) or squint (strabismus) can also occur in
hypermetropia. Long-sighted people may have difficulty with depth perception (3-dimensional vision). (See
separate leaflets called Amblyopia and Squint (Strabismus) in Children for more information.)

Are there any complications?

In severe cases of hypermetropia present from a very young age, lazy eye (amblyopia) can develop. The affected
eye(s) does not learn how to see because the brain ignores the signals it receives. Amblyopia can be treated with
eye patching if diagnosed early enough, before the vision pathways in the brain are fully developed.

What is the treatment for long sight (hypermetropia)?

Glasses
The simplest, cheapest and safest way to correct long-sightedness is with glasses. Convex prescription lenses
(called plus lenses) are used to bend light rays slightly inwards. The light rays then have a lesser angle to bend
back to focus when travelling through the cornea and lens. As a result, the light rays focus further forward - on the
retina. There is an enormous choice of spectacle frames available, to suit all budgets. Glasses are seen as more
acceptable these days, and younger people may even regard them as a fashion accessory.

Contact lenses
These do the same job as glasses. Many different types of contact lenses are available. Lenses may be soft or
rigid gas-permeable. Contact lenses can be daily disposable, extended wear, monthly disposable, or nondisposable. Your optometrist can advise which type is most suitable for your eyes and your long-sight
prescription. Contact lenses often work out more expensive than glasses and they require more care, and
meticulous hygiene. They are suitable for older teenagers and adults, rather than for children.

Surgery
Surgery is an option for some people to 'cure' their long sight. Generally these operations are not available on the
NHS, and so are a private option. Laser eye surgery is expensive but offers the chance to restore normal sight
permanently. The procedure is generally painless.
There is the potential for complete and permanent resolution of the refractive error in a number of people. Others
may have a significant improvement but will still need glasses or contact lenses for minor correction of vision.
However, a small number of people develop complications after surgery to correct hypermetropia. Some people
develop hazy vision, a problem with night vision, or problems with bright light haloes in their peripheral vision.
Many private companies aggressively market their laser eye surgery. Before embarking upon this type of
treatment you need to do some research. Try to go with personal recommendations, preferably a
recommendation by an NHS eye surgeon (ophthalmologist). It is important that you know your facts - the failure
rate, the risk of complications, level of aftercare and what the procedure involves, before submitting yourself to an
irreversible, costly treatment.
Several types of laser surgery have been developed. These include: LASIK, PRK and LASEK. They are similar
because the basic idea is to reshape the cornea using the laser to remove a very thin layer. The reshaped cornea
allows the refraction of the eye to be corrected.

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LASIK
LASIK stands for Laser-Assisted In situ Keratomileusis. This is the most popular form of laser eye
surgery.
The laser is used to lift and remove a very thin layer of the cornea. The shape of the cornea is altered
to be more curved, so that the light rays can be focused further forward, and on to the retina.

PRK
PRK stands for Photo-Refractive Keratectomy. It is an older surgical operation, that has mostly been
replaced by newer techniques.

LASEK
LASEK stands for LAser Sub-Epithelial Keratomileusis. It is an improved form of PRK with some
similarities to LASIK.
Most of the outer layer of the cornea (the epithelium) is left intact.
The LASEK procedure tends to be more painful, and discomfort can last longer than with LASIK.

How often do I need an eyesight test?

This depends on your age, your family history and any pre-existing medical conditions.
People at high risk of sight problems need more frequent eyesight checks. If you have diabetes, raised pressure
in the eye (glaucoma), macular degeneration, or a family history of these conditions, you should check to see
what your optician recommends about regular check-ups. As a guide, if you fall into the high-risk group, you
should have at least a yearly (annual) eye examination if you are over 60 years of age. If you are over 50 years of
age it should be every two years, and over 40 years, with risk factors, then an eyesight check is recommended at
least every three years.
Low-risk people with no symptoms of an eyesight problem, do not need to have their eyes tested so frequently. If
you fall in this group and are aged between 19 and 40 years, an eye test is needed every 10 years. Between the
ages of 41 and 55 years, it is recommended that you see an optician five-yearly. At any age between 56 and 65
years, two-yearly checks are needed, dropping to annual checks in low-risk people who are 65 years old or more.

Further reading & references

Cochrane GM, du Toit R, Le Mesurier RT; Management of refractive errors. BMJ. 2010 Apr 12;340:c1711. doi:
10.1136/bmj.c1711.
Settas G, Settas C, Minos E, et al; Photorefractive keratectomy (PRK) versus laser assisted in situ keratomileusis (LASIK)
for hyperopia correction. Cochrane Database Syst Rev. 2012 Jun 13;6:CD007112. doi:
10.1002/14651858.CD007112.pub3.
Photorefractive (laser) surgery for the correction of refractive error; NICE (2006)

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its
accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
For details see our conditions.
Original Author:
Dr Katrina Ford

Current Version:
Dr Colin Tidy

Peer Reviewer:
Dr Olivia Scott

Document ID:
13456 (v2)

Last Checked:
11/11/2013

Next Review:
10/11/2016

View this article online at www.patient.co.uk/health/long-sight-hypermetropia.

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