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Effect of laser in situ keratomileusis for hyperopia on tear film and ocular surface.

PURPOSE: To examine the effects of laser in situ keratomileusis (LASIK) for hyperopia on the tear film and ocular surface. METHODS: A retrospective 12-month analysis of 88 eyes (88 participants) who had LASIK for hyperopia was performed. Participants were evaluated before and after (2 weeks, 1, 3, 6, and 12 months) surgery for dry eye symptoms (McMonnies Dry Eye Survey primary symptoms), tear film stability (fluorescein break-up time), tear volume (phenol red thread test), ocular surface staining (fluorescein), and conjunctival goblet cell density. RESULTS: Chronic dry eye was experienced by 32% of participants; symptoms were significantly associated with female gender, preoperative dry eye symptoms, lower tear film stability after surgery, greater ocular surface staining after surgery, lower tear volume before and after surgery, and lower goblet cell densities after surgery. Regression rate 12 months after surgery was 32% and significantly associated with female gender, chronic dry eye symptoms, lower tear film stability after surgery, greater ocular surface staining before and after surgery, and lower tear volume before and after surgery. CONCLUSIONS: Dry eye, particularly in females, is problematic after LASIK for hyperopia and is associated with refractive regression. Current methods for managing the tear film and ocular surface may not control LASIK-induced dry eye, particularly in some females during the first 6 months after surgery.

Adult↗

Laser in situ keratomileusis and diode thermal keratoplasty for correction of hyperopia from +5.00 to +10.00 diopters.

PURPOSE: To evaluate the effects and safety of laser in situ keratomileusis (LASIK) and diode thermal keratoplasty (DTK) for correction of moderate to high hyperopia (+5.00 to +10.00 D). METHODS: This prospective study included 30 eyes of 15 patients who had LASIK-DTK bioptics. The median age of the patients was 50.5 years. LASIK was performed using a Nidek EC-5000 excimer laser system and DTK by a Prolaser DTK laser, 2 months after LASIK. Follow-up ranged from 9 to 12 months (mean, 10.5 mo). RESULTS: The mean preoperative spherical equivalent refraction was +8.25 +/- 0.25 D and mean postoperative was +1.00 +/- 0.50 D. The preoperative best spectacle-corrected visual acuity (BSCVA) was < or = 20/40 in 10 eyes and > or = 20/25 in 20 eyes. Postoperatively, BSCVA was < or = 20/40 in 8 eyes and > or = 20/25 in 22 eyes. No significant intra- or postoperative complications occurred. CONCLUSION: LASIK-DTK bioptics for correction of moderate to high hyperopia (+5.00 to +10.00 D) was safe and effective. In this method, two different ablative and non-ablative laser systems were used to compensate for regression, which is the most important concern in the correction of hyperopia.

Adult↗

Excimer laser photorefractive keratectomy for hyperopia.

BACKGROUND AND OBJECTIVE: Photorefractive keratectomy (PRK) has been extensively evaluated for the correction of myopia. This study was undertaken to assess the safety, efficacy, and reliability of PRK in the correction of hyperopia. PATIENTS AND METHODS: There were 28 eyes with refractions of +1 to +7.75 D treated for hyperopia with the Chiron Technolas 217-C excimer laser. Thorough visual assessments were made before treatment and at regular follow-up to 18 months. Complications and patient satisfaction were noted. RESULTS: At 18 months the mean subjective refraction was +0.46+/-1.00 D with 26 eyes (92.8%) within 1 D of emmetropia. Thirteen eyes (46.4%) achieved uncorrected visual acuity (UCVA) of 20/20 or better and all patients had an UCVA of > or = 20/32 or better. Best corrected visual acuity (BCVA) remained unchanged in 26 eyes (92.8%) and improved in 2 eyes (7.2%). On the seventh day from treatment, 17 eyes (25%) had a loss of 2 or more lines of BCVA. At 15 days this was reduced to 8 eyes (14.3%) and at one month to 3 eyes (3.6%). There were no cases of loss of 2 or more lines of BCVA at 18 months of follow-up. All patients expressed a high degree of satisfaction. CONCLUSIONS: Photorefractive keratectomy safely and effectively reduced hyperopia in the patients studied. The technique was reliable and still offered good results at 18 months of follow-up.

Adult↗

Conductive keratoplasty for the correction of hyperopia.

BACKGROUND/PURPOSE: Conductive keratoplasty (CK) is a surgical technique that delivers radio frequency (350 kHz) current directly into the corneal stroma through a Keratoplasty tip inserted into the peripheral cornea at 8 to 32 treatment points. A full circle of CK spots produces a cinching effect that increases the curvature of the central cornea, thereby decreasing hyperopia. We report here the 12-month results of a 2-year, prospective, multicenter US clinical trial conducted to evaluate the efficacy, safety, and stability of CK. METHODS: A total of 233 patients (401 eyes) with preoperative hyperopia of +0.75 to +3.00 D and < or = 0.75 D of astigmatism (mean preoperative manifest refractive spherical equivalent = +1.76 D +/- 0.60) were enrolled into the study at 13 centers and underwent CK treatment. RESULTS: Twelve-month postoperative data are available on 203 eyes for safety and stability and 171 eyes for safety, stability, and efficacy. A total of 91% had uncorrected visual acuity (UCVA) of 20/40 or better, and 51% had UCVA of 20/20 or better. Manifest refractive spherical equivalent was within +/- 0.50 D in 58%, within +/- 1.00 D in 91%, and within +/- 2.00 D in 99%. The mean change in residual refraction was 0.26 D +/- 0.49 between 3 and 6 months, 0.09 D +/- 0.37 between 6 and 9 months, and 0.13 D +/- 0.39 between 9 and 12 months. CONCLUSIONS: One-year data show safety and efficacy of CK in the treatment of hyperopia. Changes in residual refractive error after CK appeared to be small, suggesting that a stable refraction could be achieved by 6 months.

Adult↗

Circular and interrupted suture technique for correction of hyperopia following radial keratotomy.

BACKGROUND: Hyperopia is a possible complication following radial keratotomy. In this article, we describe a circular and interrupted corneal compression suture technique for the correction of hyperopia induced by radial keratotomy. METHODS: A retrospective study was performed to evaluate the effectiveness of this procedure in nine consecutive patients. RESULTS: The procedure achieved an average of -1.70 diopters change in spherical equivalent refraction. This accounted for an overall correction of 68% of the hyperopia caused by radial keratotomy after a minimum 3-month follow up. Seven of nine eyes (78%) were within 1.00 D of emmetropia after surgery. Uncorrected visual acuity of 20/40 or better was present in only two eyes (22%) preoperatively, and nine eyes (100%), after the corneal suturing procedure. The mean improvement of uncorrected visual acuity was 4.0 Snellen lines (P = .0004). All patients were pleased with their visual outcomes. CONCLUSIONS: We found that this technique is an easy, safe, and reasonably successful treatment for radial keratotomy overcorrection.

Adult↗

Consecutive exotropia after correction of hyperopia.

A study was done of 22 children in whom exotropia developed following correction of hyperopia because of accommodative esotropia that had not been corrected surgically. The early onset of esotropia and high degree of hyperopia seemed to predispose to the spontaneous development of exotropia. Reduction of the hyperopia by 50% to 60% resulted in satisfactory realignment of the eyes and some form of binocularity.

Accommodation, Ocular↗

Hyperopia correction by noncontact holmium:YAG laser thermal keratoplasty. United States phase IIA clinical study with a 1-year follow-up.

PURPOSE: This study was performed to evaluate the safety and effectiveness of noncontact holmium: YAG (Ho:YAG) laser thermal keratoplasty (LTK) for correcting low to moderate hyperopia. METHODS: Twenty-eight patients were treated unilaterally to correct low to moderate hyperopia (up to +3.88 diopters [D] refractive error) using simultaneous noncontact delivery of Ho:YAG laser energy. Treatment parameters included one or two symmetric octagonal rings of eight spots per ring with centerline diameters of 6 mm (1 ring) or 6 and 7 mm (2 rings), ten pulses of laser light at 5-Hz pulse repetition frequency, and variable pulse energy, ranging from 208 to 242 mJ. Follow-up was 1 year in 26 (93%) of the 28 patients. RESULTS: At 1 year postoperatively, uncorrected distance visual acuity was improved in all patients. The mean change in subjective manifest refraction (+/- spherical equivalent [SE]) was -0.55 +/- 0.33 D and -1.64 +/- 0.61 D for one and two-ring treatment groups, respectively, with good stability in the refractive change after approximately 6 months. In the one-ring treatment group (17 eyes), refractive corrections of -0.50 to -1.13 D were achieved in ten eyes (59%), and seven eyes (41%) were unchanged (within +/- 0.25 D) relative to their preoperative measurements. In the two-ring treatment group, all eight eyes (100%) had substantial refractive corrections (range, -0.75 to -2.50 D). Mean induced refractive astigmatism was 0.25 +/- 0.29 D and 0.47 +/- 0.53 D for one- and two-ring treatments, respectively. None of the eyes lost two or more lines of spectacle-corrected distance visual acuity. These was no clinically significant change in endothelial cell density with respect to preoperative values. Glare and contrast sensitivity testing indicate that peripheral corneal opacities produced by LTK do not degrade vision. The amount of refractive change in each group was correlated with the amount of laser pulse energy. CONCLUSIONS: This initial United States clinical study with 1-year follow-up indicates that noncontact LTK treatment of low hyperopia is safe and effective, providing persistent, though modest, refractive corrections in 59% of the one-ring group and larger, persistent, refractive corrections in 100% of the two-ring group.

Adult↗

Chalazion-induced hyperopia as a cause of decreased vision.

This article presents three cases of decreased vision due to acquired hyperopia, which were caused by a chalazion of the upper eyelid. Through manifest refraction and computerized corneal topographic analysis, acquired hyperopia associated with central corneal flattening was revealed. These findings were responsible for the blurred vision that was reversed by chalazion resolution or removal. Although not usually considered a risk factor for refractive disorders other than astigmatism, chalazia of the upper eyelid can present as a decrease in vision associated with reversible central corneal flattening and acquired hyperopia.

Aged↗

LASIK correction of spherical hyperopia, hyperopic astigmatism, and mixed astigmatism with the LADARVision excimer laser system.

OBJECTIVE: To assess the safety and effectiveness of the LADARVision active tracking narrow beam excimer laser system (Alcon Surgical, Orlando, FL) using laser in situ keratomileusis (LASIK) for correction of spherical hyperopia, hyperopic astigmatism, and mixed astigmatism. DESIGN: A multicenter, prospective non-randomized (self-controlled) comparative trial. PARTICIPANTS: A total of 360 eyes, including 152 spherical hyperopic, 143 hyperopic astigmatic, and 65 mixed astigmatic, were treated for up to +6.00-diopter (D) sphere with up to -6.00-D cylinder. INTERVENTION: Treatments were performed at six sites in the United States using a 6-mm optic zone with a 1.5-mm peripheral blend zone for a maximum ablation zone diameter of 9 mm. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), manifest refraction, vector analysis, best spectacle-corrected visual acuity (BSCVA), complications and adverse reactions, subjective symptoms, and patient satisfaction. RESULTS: Six and 12 months of follow-up, respectively, were available on 143 and 117 spherical hyperopic eyes, 124 and 74 hyperopic astigmatic eyes, and 57 and 38 mixed astigmatic eyes, respectively. For spherical hyperopes at 6 and 12 months, UCVA was 20/40 or better in 93.4% and 93.9% of eyes, respectively. The manifest refraction spherical equivalent (MRSE) was within 0.50 D of intended in 65.0% and 74.1% of eyes, respectively, and within 1.00 D in 87.4% and 91.4%, respectively. Refractive stability was demonstrated in 94.2% or more of eyes between the intervals of 1 to 3 months and 3 to 6 months and in 95.3% or more of eyes to 12 months. A loss of two lines of BSCVA occurred in 3.5% and 3.4%, respectively, and no eyes lost more than two lines. For hyperopic astigmats at 6 and 12 months, UCVA was 20/40 or better in 90.9% and 93.8% of eyes, respectively. The MRSE was within 0.50 D of intended in 60.5% and 73.0% of eyes, respectively, and within 1.00 D in 88.7% and 89.2% of eyes, respectively. Refractive stability was demonstrated in 96.5% or more of eyes, respectively, between the intervals of 1 to 3 months and 3 to 6 months and 95.5% or more to 12 months. A loss of two lines of BSCVA occurred in 5.8% and 1.4% of eyes, respectively, and no eyes lost more than two lines. For mixed astigmats at 6 and 12 months, UCVA was 20/40 or better in 92.6% and 94.4% of eyes, respectively. The MRSE was within 0.50 D of intended in 64.9% and 73.7% of eyes, respectively, and within 1.00 D in 87.7% and 94.7% of eyes, respectively. Refractive stability was demonstrated in 100% of eyes between the intervals of 1 to 3 months and 3 to 6 months and in 97.0% or more to 12 months. A loss of two lines of BSCVA occurred in 1.9% and 0.0% of eyes, respectively, and no eyes lost more than two lines. CONCLUSIONS: The data support safety and effectiveness of the LASIK correction of spherical hyperopia, hyperopic astigmatism, and mixed astigmatism with the LADARVision system.

Adult↗

X-linked congenital stationary night blindness. Review and report of a family with hyperopia.

X-linked congenital stationary night blindness is almost always associated with myopia. We have reviewed all previously reported pedigrees and have found only two with patients without myopia. A recently proposed classification of night blindness includes a complete type associated with myopia and an incomplete type in which both hyperopia and myopia were found. Complete and incomplete types did not occur within the same pedigree. We report on a family in which three of the five affected members had hyperopia and could be classified as the incomplete type and in which a fourth member with myopia was more consistent with the complete type. The lack of myopia in three members of our pedigree can be explained by two hypotheses: crossing over of the night blindness and myopic genes on the X-chromosome, or an autosomal dominant hyperopic gene that masks the myopic gene. The data from our family support the first of these two hypotheses.

Adult↗

Excessive loss of hyperopia. A presenting sign of juvenile aphakic glaucoma.

We present the cases of four patients in whom juvenile aphakic glaucoma developed. An excessive loss of hyperopia was the initial clinical sign that alerted us to the diagnosis of glaucoma. At the time of diagnosis, the mean refractive error of the six glaucomatous eyes in the four patients was +4.75 diopters (D) (range, -0.25 to +6.75 D). The mean change in refraction from time of cataract extraction to diagnosis of juvenile aphakic glaucoma was 17.00 D (range, 9.25 to 21.00 D). All aphakic patients in the private practice of one of us (B.J.K.) with a spherical equivalent of less than +8.00 D in either eye have glaucoma. The only exception are those patients with a coexisting condition predisposing them to myopia. We have found an excessive loss of hyperopia to be a useful sign in alerting the ophthalmologist to the diagnosis of juvenile aphakic glaucoma.

Aphakia, Postcataract↗

Hyperopia correction by noncontact holmium: YAG laser thermal keratoplasty: five-pulse treatments with 1-year follow-up.

BACKGROUND: Previous noncontact holmium (Ho): YAG laser thermal keratoplasty (LTK) studies on correction of low to moderate hyperopia have used treatment algorithms based on ten-pulse, variable-pulse-energy treatment parameters. The purpose of this study was to evaluate the safety, effectiveness, and stability of new five-pulse, constant-pulse-energy treatment parameters for noncontact Ho:YAG LTK. METHODS: Thirty-nine hyperopic patient eyes [up to +4.75 diopters (D) refractive error] were treated using simultaneous noncontact delivery of Ho:YAG laser energy (Sunrise) with two symmetrical octagonal rings of eight spots per ring and radial spot patterns on centerline diameters of 5 and 6 mm (group A), 6 and 7 mm (group B), or 6.5 and 7.5 mm (group C). Each ring of spots received five pulses of laser light at 5 Hz pulse repetition frequency and a fixed pulse energy of 240 mJ. Thirty of the 39 patient eyes (77%) had 1-year follow-up exams. RESULTS: At 1 year, the mean Snellen uncorrected distance visual acuity lines gained was 3.7 +/- 0.5/6.8 +/- 2.7/5.3 +/- 3.3 for groups A, B, and C. The mean changes in subjective manifest refraction (spherical equivalent) were -2.08 +/- 1.13 D, -1.83 +/- 0.88 D, -1.22 +/- 0.88 D for groups A, B, and C respectively. None of the eyes lost two or more lines of spectacle-corrected distance visual acuity. There were no clinically significant complications in any patient. CONCLUSION: This clinical study indicates that five-pulse noncontact LTK treatments of low hyperopia are safe and effective. The stability has to be confirmed with longer follow-up.

Adult↗

Early-onset autosomal dominant retinitis pigmentosa with severe hyperopia.

We studied a four-generation family with early-onset autosomal dominant retinitis pigmentosa, severe hyperopia, and axial eye lengths of less than 20 mm. The affected members had decreased vision, night blindness, typical peripheral retinal pigmentary changes, and electroretinographic abnormalities characteristic of retinitis pigmentosa. This pedigree suggests there is another variant of retinitis pigmentosa associated with hyperopia besides Leber's congenital amaurosis and preserved para-arteriole retinal pigment epithelium.

Adolescent↗

Flicker parameters are different for suppression of myopia and hyperopia.

Axial eye growth rates in the chicken are controlled by local retinal image-processing circuits. These circuits quantify the loss of contrast for different spatial frequencies and promote axial eye growth rates in correlation with the amount of retinal image degradation ("deprivation myopia"). They also distinguish whether the plane of focus lies in front of or behind the retina. How the sign of defocus is detected still remains unclear. Cues from chromatic aberration are not important. In an attempt to isolate retinal circuits controlling the development of myopia or hyperopia, young chickens were raised in flickering light of different frequencies (12 and 6 Hz) and duty cycles (4-75%) produced by rotating chopper disks. The effects of flickering light on refractive errors and change in axial growth rates induced by translucent occluders or defocusing lenses were measured by infrared retinoscopy and A-scan ultrasound, respectively. Retinal electrical activity was evaluated by flicker ERG after matching flicker parameters and stimulation brightness at retinal surface. Changes in retinal and vitreal dopamine content caused by flicker in occluded and normal eyes were determined by HPLC-ECD. Strikingly, suppression of myopia occurred for similar flicker parameters, whether induced by translucent occluders ("deprivation") or negative lenses ("defocus"). The degree to which myopia was suppressed was correlated with the duration of flicker dark phase and with the ERG amplitude. In contrast, suppression of hyperopia did not correlate with these parameters. We conclude that two different retinal circuits with different temporal characteristics are involved in the processing of hyperopic defocus/deprivation and of myopic defocus, the first one dependent on flicker ERG amplitude. However, we did not find any correlation between the rate of dopamine release and the degree of inhibition of deprivation myopia in flickering light.

Animals↗

Refractive lensectomy for hyperopia.

PURPOSE: The purpose of this study was to evaluate refractive lensectomy as a surgical procedure for the treatment of hyperopia. DESIGN: A retrospective noncomparative case series. PARTICIPANTS: Twenty-nine patients were included in the study. Fifty eyes underwent extraction of the crystalline lens and intraocular lens implantation. METHODS: Operations were performed by the same surgeon with the patient under general anesthetic. All lenses were removed by phacoemulsification with insertion of lens implants singly or as piggyback lenses. The Holladay2 formula was used to calculate lens powers. Results are compared with other methods of treating hyperopia. MAIN OUTCOME MEASURES: The main parameters assessed were safety, efficacy, predictability, stability, and complications. RESULTS: Eyes were divided into group A (n = 26), with an average preoperative spherical equivalent (SE) of +2.26 +/- 0.94, and group B (n = 24), with an average preoperative SE of +6.32 +/- 1.32. In group A, after refractive lensectomy, 80.7% had no change in best-corrected visual acuity (BCVA) or gained a line, whereas 11.5% lost one line; 88.5% had an uncorrected visual acuity (UCVA) of 20/40 or better, and 88.5% were within 1 diopter (D) of intended postoperative SE. In group B, 70.9% of eyes had no change or gained a line in BCVA, whereas 29.2% lost a line of BCVA; 62.5% had UCVA of 20/40 or better postoperatively, and 58.3% were within 1 D of the intended SE. In one eye the posterior capsule was breached intraoperatively. One eye had a symptomatic episode of cystoid macula edema that settled spontaneously. To date, seven eyes have required secondary refractive procedures, and three eyes have required yttrium-aluminum-garnet capsulotomy. CONCLUSIONS: In the presbyopic age group refractive lensectomy may be a realistic alternative to photorefractive keratectomy or laser in situ keratomileusis, with certain potential advantages.

Female↗

Intraocular pressure after LASIK for hyperopia.

PURPOSE: To determine whether hyperopic laser in situ keratomileusis (H-LASIK) affects Goldmann applanation tonometry measurements. DESIGN: Retrospective, comparative, self-controlled case series. PARTICIPANTS: One hundred eight eyes of 58 patients were enrolled in the study. METHODS: Baseline intraocular pressure (IOP) was measured by Goldmann applanation tonometry. These readings were compared with readings obtained at least 6 months after surgery. RESULTS: After H-LASIK, a decrease was observed in the measured IOP of treated eyes that could not be related to the degree of hyperopia treated or to the treatment zone diameter. A significant difference was observed between the IOP before and after surgery (P < 0.00001). CONCLUSIONS: The applanation tonometer underestimates the true IOP after LASIK for hyperopia.

Adult↗

Photorefractive keratectomy for hyperopia: long-term nonlinear and vector analysis of refractive outcome.

PURPOSE: To characterize the refractive changes after excimer laser photorefractive keratectomy for the correction of hyperopia over a follow-up up to 3 years and to assess refractive stability and changes in astigmatism. DESIGN: Noncomparative, nonrandomized, retrospective, interventional case series. PARTICIPANTS: Thirty-eight hyperopic eyes of 28 patients (age range, 33-62 years) with refraction in the range +1.00 to +8.00 diopters (D). Mean attempted correction was +3.33+/-0.98 D (range, +1.00 to +4.00 D). Data were compared to those from 216 eyes treated for myopia in the range -1.00 to -12.70 D. INTERVENTION: The hyperopic correction was made using an erodible mask inserted in the laser optical pathway to produce a circular ablation measuring 6.5 mm in diameter. An axicon was then used to create a blend transition zone from 6.5 mm up to 9.4 mm in diameter. Eyes were evaluated 3 to 11 times (5.5+/-2.4) over a 3- to 34-month follow-up (16.8+/-8.4 months). MAIN OUTCOME MEASURES: Vector analysis of refractive error, applying a nonlinear statistical model fitting the spherical equivalent, and the sphere component data. The fit parameters were the long-term error at stabilization (epsilon(infinity)), the amount of regression (epsilon0), being the difference of refractive errors immediately after surgery and at stabilization, and the time constant (T1/2) giving the temporal scale length by which the overcorrection halves (regression half-life). Cylinder was analyzed by a linear regression. RESULTS: The initial overcorrection was much larger after hyperopic treatments than myopic ones (epsilon0 = -3.26+/-0.35 D vs. +1.43+/-0.35 D), and it takes typically four times longer to regress (T1/2 = 3.30+/-0.91 months). Refractive stabilization is reached after more than 1 year, with a satisfactory refractive result. The hyperopic treatment induces a mean astigmatism of 1.00 D, which remains constant throughout the follow-up, and tends to be aligned along the with-the-rule meridian. CONCLUSIONS: The advantages of a reasonably well-designed algorithm to correct hyperopia (epsilon(infinity) = +0.20+/-0.23 D) are counterbalanced by the long time to refractive stabilization and by the induced astigmatism.

Adult↗

Correction of hyperopia with intracorneal implants.

PURPOSE: To evaluate the safety and efficacy of intracorneal lenses as a surgical alternative for the correction of hyperopia. SETTING: Al-Azhar University, Cairo, Egypt, and Louisiana State University Eye Center, New Orleans, Louisiana, USA. METHODS: PermaVision lenses (Anamed Inc.) were implanted in the left eye of 20 albino rabbits that were followed for 6 months by confocal microscopy. The lenses are made of a highly permeable hydrogel with 70% water content and a refractive index close to that of corneal tissue (1.376). The Carriazo-Barraquer microkeratome (Moria) was used to create a 150 microm corneal flap with a diameter of 8.5 mm or larger. The intracorneal lens was placed under the flap after minimal interface irrigation. RESULTS: At 3 days, confocal microscopy showed interface edema that resolved after 1 week. No flap melting or excursion of the lens was noted. In 1 eye, a deep lamellar keratitis was seen. At 6 months, the edge of the lens showed excellent compatibility, with no keratocytic activity or intrastromal fibrosis. CONCLUSIONS: Intracorneal hydrogel lenses were well tolerated by stromal tissue in rabbits. They are potentially safe and can be considered as an alternative for the correction of hyperopia. Further clinical studies are required to confirm their safety in humans.

Animals↗