LASIK for correction of hyperopia and hyperopia with astigmatism.
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Astigmatism↗
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Excimer laser photorefractive keratectomy for hyperopia.
OBJECTIVE: Excimer laser photorefractive keratectomy (PRK) has been shown to be an effective method in the treatment of refractive errors, especially myopia. We evaluated prospectively the efficacy, predictability, stability, and safety of excimer laser PRK in the treatment of hyperopia. METHODS: Thirty-four hyperopic eyes were treated with an Aesculap-Meditec (MEL 60) excimer laser. The patients were divided into two groups. In the low-moderate hyperopia group, baseline spherical equivalent refraction was between +1.50 and +6.00 diopters (D) (mean, +4.20 +/- 1.30 D) and in the high hyperopia group between +6.25 and +9.75 D (mean, +7.70 +/- 1.30 D). Follow-up visits occurred 1, 3, 6, and 12 months after surgery. RESULTS: One-year results were available for a total 27 eyes (79%): 15 eyes with low to moderate hyperopia and 12 eyes with high hyperopia. One year after PRK in the low-moderate group, six eyes (40%) had a refractive error within +/- 1.00 D of emmetropia, but in the high hyperopia group only two eyes (17%) were within +/- 1.00 D of emmetropia; three eyes (20%) and one eye (8%) were within +/- 0.50 D, respectively. The stability of the refractive change was better in the low to moderate hyperopia group; in the high hyperopia group there was still some regression after 6 months. At 12 months, 10 eyes (67%) in the low-moderate and one eye (8%) in the high hyperopia group had postoperative uncorrected visual acuity of 20/40 or better. One eye in the low-moderate hyperopia group saw 20/20 without correction. Only one eye lost two lines of spectacle-corrected visual acuity. Haze was more intense in the high hyperopia group, but it did not reduce visual acuity. No vision-threatening complications were observed. CONCLUSIONS: When low to moderate hyperopia up to +6.00 D is treated, excimer laser PRK with the Aesculap Meditec MEL60 laser is safe and moderately effective, and refraction stabilizes after 3 months in most eyes. However, PRK is not sufficient to treat high hyperopia in an effective and predictable way.
Adolescent↗
Screening for amblyopia in preverbal children with photoscreening photographs. III. improved grading criteria for hyperopia.
OBJECTIVE: To examine the ability of the Medical Technology and Innovations (MTI), Inc., Photoscreener (Cedar Falls, IA) to detect hyperopia and to improve the photograph grading criteria to screen for amblyopiogenic levels of hyperopia. DESIGN: Cross-sectional study and reanalysis. PARTICIPANTS AND TESTING: In previous work, 392 participants received a complete ophthalmologic examination and were photographed using the MTI Photoscreener. For this study, all 209 participants with normal examination findings (65 children) or hyperopia without anisometropia (144 children) were selected. The data were reanalyzed using modified photograph grading and ophthalmologic examination failure criteria. Potential reasons for why many children with hyperopia passed photoscreening were explored. MAIN OUTCOME MEASURES: We determined whether a study participant would pass or fail screening with a given photograph grading and ophthalmologic examination failure criteria. RESULTS: Most children with hyperopia of +2.00 to +3.50 diopters (D) passed screening with the MTI instrument, in most cases because their photographs lacked bright crescents. When bright crescents in at least two of the four possible meridians were the grading guideline for screening failure and the pediatric ophthalmologists' consensus hyperopia failure criteria (> +3.50 D) were adopted, the sensitivity for hyperopia detection was 100% and the specificity was 88%. Identical results were obtained using the American Academy of Ophthalmology Preferred Practice Pattern hyperopia failure criteria (>/= +4.50 D). CONCLUSIONS: The MTI photograph grading guidelines can be simplified, and the ophthalmologic examination failure criteria for hyperopia can be improved. The presence of a bright crescent in the lower or the left pupillary margin indicate hyperopia in an amblyopiogenic range (> +3.50 D).
Amblyopia↗
A clinical review of hyperopia in young children. The Hyperopic Infants' Study Group, THIS Group.
BACKGROUND: Hyperopia is the most common refractive error of children. Children with mild (or even moderate) levels of hyperopia usually do not experience visual problems resulting from this hyperopia. However, children with moderate-to-high degrees of hyperopia are at significantly increased risk for the development of amblyopia and strabismus. It is this association with these visually threatening disorders that makes hyperopia in children an important public health problem. In addition, even lesser degrees of hyperopia may affect the child's ability to perform well in near-related tasks, such as reading. The effect hyperopia has on an individual child is dependent on a variety of factors, including the magnitude of hyperopia, the age of the individual, the status of the accommodative and convergence system, and the demands placed on the visual system. Early detection and treatment of hyperopia may help prevention of potential complications from adversely impacting the child's vision. Although much is known about childhood hyperopia and its effects on vision, there is also much that is not known. The natural history, ocular biometry, relationship to accommodative function, the indications for treatment, and the most effective treatment modalities are among the underlying issues and clinical considerations awaiting more complete understanding.
Accommodation, Ocular↗
Photorefractive keratectomy for hyperopia and aphakia with a scanning spot excimer laser.
OBJECTIVE: To study the safety, efficacy, predictability, and stability of photorefractive keratectomy (PRK) for hyperopia and aphakia. METHODS: Fifteen eyes of 15 patients (mean age, 33 +/- 5.95 yrs) were enrolled in the study and divided into three groups. The first group was comprised of six eyes that had hyperopia ranging from +1.75 to +4.75 D; the second group had seven hyperopic eyes ranging from +5.00 to +9.75 D; the third group included two eyes of two aphakic patients. All eyes had PRK with a 193 nm argon fluoride excimer laser (Chiron-Technolas, Keracor 116) with a 10 Hz repetition rate and a fluence of 120 mJ/cm2. The total follow-up time in all eyes was 12 months. RESULTS: In the lower hyperopia group, 0% eyes were within +/- 0.50 D and 66% (N = 4) of eyes were within +/- 1.00 D of emmetropia with the other two eyes between +1.00 and +2.00 D at 1 year after PRK. In the higher hyperopia group, all eyes had at least +3.00 D of hyperopia at 1 year. In the aphakic group, both eyes achieved less than 50% of the target correction of +10.00 D at 1 year. Final uncorrected visual acuity ranged from 20/20 to 20/30 in the lower hyperopia group, 20/30 to 20/50 in the higher hyperopia group, and count fingers in the aphakic group. CONCLUSIONS: PRK is a relatively safe, stable, and effective procedure with reasonably good predictability for eyes with less than +5.00 D of baseline hyperopia, and poor predictability for eyes with more than +5.00 D of baseline hyperopia. PRK is ineffective in the correction of aphakia.
Adult↗
Screening for abnormal levels of hyperopia in children: a non-cycloplegic method with a hand held refractor.
AIMS: High hyperopia constitutes the majority of refractive errors in large scale visual screening at preschool ages. The authors aimed to assess the validity of the Retinomax hand held refractor to detect high hyperopia in a refractive screening performed without cycloplegia and carried out on children aged 9-36 months. They considered +1.5 D of manifest hyperopia to be the threshold value and abnormal absolute hyperopia to be above +3.5 D. METHODS: Of the 897 children screened without cycloplegia, 220 were refracted with cycloplegia. The validity of several thresholds of manifest hyperopia was estimated by receiver operating characteristic (ROC) curves using cycloplegic measures as a reference. The reproducibility of Retinomax measurements was assessed. Normal and quick mode measurements were compared using the Wilcoxon test. RESULTS: The manifest threshold of +1.5 D offered the best combination of sensitivity (70.2%), specificity (94.6%), positive predictive value (78.6%), and negative predictive value (91.9%) to disclose abnormal absolute hyperopia. A good agreement was obtained between the various measurements using Retinomax on the same subject. In the results of this survey, there is no evidence that accommodation is minimised in the normal mode of measurement compared with the quick mode. CONCLUSION: The Retinomax hand held infrared autorefractor is a suitable instrument to diagnose abnormal hyperopia (manifest hyperopia > +1.5 D) in noncycloplegic refractive screening at preschool ages. It is suggested as the quick mode of measurement as it is more feasible in children (success rate 98.5%).
Age Distribution↗
Diode laser thermal keratoplasty to correct hyperopia.
PURPOSE: We investigated long-term efficacy, predictability, stability, and safety of diode laser thermal keratoplasty (DTK) to correct hyperopia. METHODS: DTK was performed on 24 eyes (18 patients). Eight eyes with high hyperopia (mean +4.75 +/- 0.63 D; range +3.50 to +5.50 D) received 12 pairs of coagulation spots at 6-mm and 7-mm treatment zone diameters; eight eyes with low hyperopia (mean +2.25 +/- 0.40 D; range +1.50 to +2.75 D) received eight coagulation spots at 8 mm, and eight eyes with low hyperopia (mean +1.50 +/- 0.46 D; range +1.25 to +2.25 D) were treated to induce mild myopia (-1.50 D) in the non-dominant eye for monovision using eight pairs of spots at 7 and 8-mm diameters. Minimum follow-up was 18 months. RESULTS: Mean decrease in cycloplegic refraction at 18 months was 5.00 +/- 0.38 D in the high hyperopia group, 1.75 +/- 0.19 D in the low hyperopia group, and 3.25 +/- 0.27 D in the presbyopia group. Mean increase in uncorrected visual acuity (UCVA) at 18 months was 8.125 +/- 2.1 Snellen lines in the high hyperopia group, 6.625 +/- 0.744 lines for low hyperopia; decrease of 1.00 +/- 1.85 line occurred in the presbyopia group. Near UCVA in the presbyopia group improved by 3.875 +/- 0.83 Jaeger lines. Best spectacle-corrected visual acuity (BSCVA) was restored by 3 months in all eyes. CONCLUSION: DTK was an effective and fairly safe procedure, with reasonable predictability and stability. Nomograms for laser energy level, treatment zone diameter, and number of spots need improvement.
Adult↗
Six-month results of hyperopic and astigmatic LASIK in eyes with primary and secondary hyperopia.
PURPOSE: To assess the safety and efficacy of laser in situ keratomileusis (LASIK) for hyperopia and hyperopic astigmatism and develop a LASIK nomogram for primary hyperopia or hyperopia secondary to myopic refractive surgery using the VISX STAR S2. METHODS: Prospective evaluation of LASIK in 46 primary eyes and 29 secondary eyes with fogged manifest sphere from +0.5 diopters (D) to +6.0 D and cylinder from 0 to +5.0 D. RESULTS: Mean manifest spherical equivalent (SE) in patients with primary hyperopia was +2.50 D +/- 0.93 preoperatively and +0.70 D +/- 1.19 at 6 months. At 6 months, 79% of primary hyperopes had uncorrected visual acuity (UCVA) of 20/40 or better; 63% were within +/- 1 D of emmetropia. One primary hyperope lost 2 lines of best spectacle-corrected vision (BCVA) at 1 month. Complications included transient epithelial defect (6.5%), epithelial cells in the interface (4.3%), diffuse lamellar keratitis (4.3%), haze (2.2%), and mild irregular astigmatism (2.2%). In those with secondary hyperopia, mean manifest SE was +1.70 D +/- 0.82 preoperatively and -0.27 D +/- 0.95 at 6 months. At 6 months, 83% of secondary hyperopes had UCVA of 20/40 or better; 74% were within +/- 1 D of emmetropia. No secondary hyperope lost > or = 2 lines of BCVA. Complications included intraoperative bleeding (3.4%), intraoperative epithelial defect (3.4%), transient interface debris (3.4%), significant dry eye (3.4%), blood in interface (3.4%), irregular astigmatism (6.9%), slight decentration (6.9%), trace haze (6.9%), mild epithelial ingrowth not requiring removal (3.4%), or corneal irregularity (3.4%). CONCLUSION: These early data suggest that LASIK for hyperopia from +0.5 to +6 D and astigmatism from 0 to +5 D using the VISX STAR S2 benefits from a nomogram adjusted for preoperative refraction, age, and prior refractive surgery and is safe and effective. Patients with secondary hyperopia achieved more correction than those with primary hyperopia, although the accuracy and predictability of LASIK in both groups has improved with the nomogram adjustments.
Adult↗
Early results of hyperopic and astigmatic laser in situ keratomileusis in eyes with secondary hyperopia.
PURPOSE: To assess the safety and efficacy of laser in situ keratomileusis (LASIK) for secondary hyperopia and hyperopic astigmatism and to develop a VISX STAR S2 LASIK nomogram (VISX Inc., Santa Clara, CA) for consecutive hyperopia after prior myopic refractive surgery. DESIGN: Prospective, nonrandomized, self-controlled interventional study. PARTICIPANTS: Thirty patients with consecutive hyperopia or hyperopia and astigmatism after LASIK, photorefractive keratectomy, automated lamellar keratoplasty, or radial keratotomy. INTERVENTION/METHODS: Prospective evaluation of LASIK in 30 secondary eyes with fogged manifest sphere from +0.5 to +6.0 diopters (D) and cylinder from 0 to +5.0 D. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalent (SE). RESULTS: Mean manifest SE was +1.73 +/- 0.79 D before surgery, -0.13 +/- 1.00 D at 6 months after surgery, and -0.18 +/- 1.08 D at 1 year after surgery. At 6 months, 84% of patients with secondary hyperopia had UCVA of 20/40 or better; 76% were within +/-1 D of emmetropia. At 1 year, 85% had UCVA of 20/40 or better and 85% were within +/-1 D of emmetropia. No patients with secondary hyperopia lost 2 or more lines of BCVA at 1 year. Complications included intraoperative bleeding (3.3%), intraoperative epithelial defect (3.3%), transient interface debris (3.3%), significant dry eye (3.3%), blood in interface (3.3%), irregular astigmatism (6.7%), slight decentration (6.7%), trace haze (6.7%), or mild epithelial ingrowth not requiring removal (3.3%). CONCLUSIONS: These early data suggest that LASIK for consecutive hyperopia from +0.5 to +5.50 D and astigmatism from 0 to +2.75 D using the VISX STAR S2 benefits from a nomogram adjusted for preoperative refraction, age, and prior refractive surgery, and is safe and effective.
Adult↗
Laser in situ keratomileusis for hyperopia and hyperopic astigmatism using the Meditec MEL 70 spot scanner.
PURPOSE: To evaluate safety, predictability, efficacy, and stability of laser in situ keratomileusis (LASIK) for spherical hyperopia and hyperopia with astigmatism. METHODS: In this retrospective study we analyzed the results of 23 eyes of 23 patients who had LASIK for spherical hyperopia (preoperative cylinder < or = 0.75 D) and 44 eyes of 44 patients who had LASIK for hyperopia with astigmatism; (Bausch & Lomb Hansatome microkeratome with a 180-microm plate and a suction ring for a 9.5-mm flap diameter; Asclepion-Meditec MEL 70 G-scan flying spot laser with a 1.8-mm Gaussian beam). RESULTS: In Group 1 (spherical hyperopia), mean preoperative spherical equivalent refraction was +4.88 +/- 2.13 D (range +2.13 to +9.63 D); in Group 2 (hyperopic astigmatism), +4.33 +/- 2.15 D (range +0.50 to +9.50 D). One year after LASIK, mean spherical equivalent refraction was +0.30 +/- 0.90 D (range -0.75 to +2.50 D) in Group 1 and +0.29 +/- 1.27 D (range -3.25 to +3.25 D) in Group 2. In Group 1, 78%, and in Group 2, 42% were within +/- 0.50 D. In Group 1, no eyes lost two or more lines, and one eye (6%) lost one line of best spectacle-corrected visual acuity at 1 year. In Group 2, one eye (4%) lost one line and one eye (4%) lost more than two lines at 1 year. Uncorrected visual acuity of 20/40 or better was achieved in 83% (Group 1) vs. 62% (Group 2) at 1 year; these values improved to 100% vs. 71% for corrections up to +6.00 D. CONCLUSIONS: LASIK with the Meditec MEL 70 G-Scan flying spot laser seemed to be safe and effective for hyperopia and hyperopia with astigmatism for corrections up to +6.00 D. Large flap diameters are necessary to avoid epithelial ingrowth.
Adult↗
Hyperopia is predominantly axial in nature.
PURPOSE: Myopia has been found to be predominantly axial in nature, i.e. myopic eyes have longer than normal axial lengths, with corneal radius variations having only a small influence on the magnitude of the refractive error. In this study we assess whether a similar relationship exists for hyperopia. METHODS: Biometric data were collected on 57 subjects with either emmetropic or hyperopic refractive errors ranging in magnitude from -0.37 D to +17.25 D. Our main analysis concentrated on subjects with less than +10 D of hyperopia (group 1, n = 53), as subjects with +10 D of hyperopia or more (group 2, n = 4) exhibited marked differences in their biometric characteristics. RESULTS: Analysis of group 1 data revealed a significant relationship (r2 = 0.611, p = 0.0001) between the degree of hyperopia and the measured axial lengths. A weak but statistically significant relationship (r2 = 0.128, p = 0.009) was also found between mean corneal radius measures and mean spherical refractive errors, with the mean corneal radius flattening with increasing hyperopia. In group 2, three of the four subjects exhibited much steeper corneal characteristics than predicted from the group 1 data. CONCLUSIONS: Our results suggest that hyperopia, like myopia, is predominantly axial in nature, although the corneal radius also plays a role in determining refractive error magnitude. These results have implications for refractive surgery and visual performance in hyperopic eyes.
Adolescent↗
Photorefractive keratectomy using the meditec MEL 70 G-scan laser for hyperopia and hyperopic astigmatism.
PURPOSE: To evaluate the results of photorefractive keratectomy (PRK) using Gaussian flying spot technology in the treatment of hyperopia and hyperopic astigmatism. METHODS: Two hundred eyes were evaluated with 12-month follow-up. An Asclepion-Meditec MEL 70 G-scan flying spot ArF excimer laser with a Gaussian scanner was used (6.0-mm treatment zone and 9.0-mm transition zone). Eyes were divided into four groups: Group 1 (spherical hyperopia up to +3.50 D and astigmatism less than 1.00 D, n=62); Group 2 (hyperopia up to +3.50 D and astigmatism of 1.00 D or more, n=44); Group 3 (hyperopia greater than +3.50 D and astigmatism less than 1.00 D, n=56); and Group 4 (hyperopia greater than +3.50 D and astigmatism of 1.00 D or more, n=38). RESULTS: In Group 1, 82.2% (51/62 eyes) were within +/-0.50 D of target refraction; 88.7% (55/62 eyes) had 20/20 or better uncorrected visual acuity; 1.6% (1/62 eye) lost two or more lines, 3.2% (2/62 eyes) gained two or more lines of spectacle-corrected visual acuity. In Group 2, 68.1% (30/44 eyes) were within +/-0.50 D; 77.2% (34/44 eyes) had 20/20 or better uncorrected visual acuity; 9.1% (4/44 eyes) lost two or more lines of spectacle-corrected visual acuity. In Group 3, 76.8% (43/56 eyes) were within +/-0.50 D; 78.6% (44/56 eyes) had 20/20 or better uncorrected visual acuity; 5.4% (3/56 eyes) lost two or more lines of spectacle-corrected visual acuity. In Group 4, 42% (16/38 eyes) were within +/-0.50 D; 60.5% (23/38 eyes) had 20/20 or better uncorrected visual acuity; 15.8% (6/38 eyes) lost two or more Snellen lines. CONCLUSION: PRK with the flying spot Meditec MEL 70 G-scan was most safe and effective for low hyperopia.
Adult↗
[Implantation of the Starr Surgical intraocular posterior chamber lenses for phakic eyes in medium and higher levels of myopia and hyperopia].
Implantation of an Intraocular Posterior-chamber Lens for a Phacik Eye from STAAR Surgical Co. in Medium and Higher Grades of Myopia and Hyperopia Implantation of an intraocular Collamer lens for a phacic eye produced by STAAR Surgical (ICL) co. is a modern method of correction of medium and high-grade refractive defects--myopia and hyperopia. The authors evaluate the results of implantation of ICL Staar Surgical in 20 eyes of 13 patients (1 man and 12 women). Their mean age was 31.36 +/- 9.21 years and the follow-up period 1-54 months (mean 28.8 months +/- 12.42). The group was divided into two sub-groups--hyperopia (8 eyes) and myopia (12 eyes). The mean value of refraction before surgery was 28 D +/- 2.03 and +0.25 Dcyl manifest (in cycloplegia +7.6 +/- 2.28 D) (from 3.75 D to 10.0 D) in the group of hyperopia and -14.25 D +/- 5.68 and -1.81 Dcyl (from -5.5 D to -25.0 D) in the myopic group. The required postoperative refraction was in 17 eyes emmetropia and in 3 eyes residual myopia up to -3.0 D with regard to incipient presbyopia. The authors evaluate the resultant best corrected visual acuity (BCVA), the resultant postoperative refraction, the incidence of postoperative complications and changed density of endothelial cells in the centre of the cornea in the course of time. In the group of hyperopia improvement of the BCVA as compared with the preoperative value occurred by one line in two eyes (25%), in 5 eyes (62.5%) BCVA remained unchanged. In one instance deterioration by one line occurred due to a diminution of endothelial cells in the centre of the cornea after surgery. In the group of myopia in 7 eyes (58.3%) improvement by 1 line occurred, in 2 eyes (16.7%) by 2 lines and in 3 cases (25%) BCVA remained unchanged. The mean value of postoperative refraction in the myopic group in required emmetropia (9 eyes) was -0.77 +/- 1.62 D and in required residual myopia (3 eyes) -1.5 +/- 1.32 D. The mean value of postoperative refraction in the group of hyperopia was +0.57 +/- 0.5 D for far sight and +1.28 +/- 0.58 D for near sight. The most frequent early postoperative complications included keratitis striata in 5, epithelopathy in 3 and residues of viscoelastic material behind the ICL in 3 eyes. As to late postoperative complications, in 2 eyes a change in endothelial cell density was involved, in 12 eyes the syndrome of pigment dispersal and in one eye late decentration of ICL occurred with subsequent anterior subcapsular cataract. The change in density of endothelial cells was most markedly expressed 3 months after surgery in the hyperopic group. The advantage of ICL implantation is rapid postoperative visual rehabilitation, reversibility of the operation, preserved accommodation and satisfactory stability of the postoperative refraction.
Adult↗
Conductive keratoplasty for the correction of low to moderate hyperopia: U.S. clinical trial 1-year results on 355 eyes.
OBJECTIVE: To document the 1-year safety, efficacy, and stability results of 355 eyes treated in the multicenter study of conductive keratoplasty (CK) used to correct low to moderate hyperopia. DESIGN: Nonrandomized comparative (self-controlled) trial. PARTICIPANTS: Twenty surgeons at 13 centers performed CK on the eyes of all patients enrolled in a multicenter, 2-year, U.S. phase III clinical trial. Treated eyes had +0.75 to +3.00 diopters (D) of hyperopia and < or =0.75 D of cylinder. Patients were 40 years of age or older. INTERVENTION: Low-energy, high-frequency current was applied directly into the peripheral corneal stroma through a delivery tip inserted at 8 to 32 treatment spots. The number of treatment spots was increased for increasing levels of hyperopia, but the amount of radiofrequency energy remained constant. Emmetropia was intended. All eyes were treated once (there were no retreatments). MAIN OUTCOME MEASURES: Data from 355 eyes with 1 year of follow-up were analyzed for safety and stability, and data from 318 eyes were analyzed for efficacy and predictability, as well as stability and safety. All patients reported on satisfaction and quality of vision after surgery. RESULTS: At 1 year, uncorrected visual acuity was < or =20/20 in 56%, < or =20/25 in 75%, and < or =20/40 in 92% of eyes. The manifest refractive spherical equivalent refraction was within 0.50 D in 63%, within +/-1.00 D in 89%, and within +/-2.00 D in 99%. Seven of 355 eyes lost 2 lines of best spectacle-corrected visual acuity at 1 year, but no eye lost >2 lines. One eye of 355 had induced cylinder of >2.00 D. The cycloplegic refractive spherical equivalent changed a mean of 0.25 +/- 0.50 D between months 3 and 6, 0.11 +/- 0.41 D between months 6 and 9, and 0.11 +/- 0.35 D between months 9 and 12. Refractive stability seemed to be attained by 6 months and remained stable through 12 months. Histology and confocal microscopy showed deep penetration of the treatment into the stroma. Endothelial cell counts were not changed by the treatment. CONCLUSIONS: CK seems to be safe, effective, and stable for correcting low to moderate spherical hyperopia in patients 40 years old or older. Treatment penetration is deep and cylindrical in shape, and it does not damage the corneal endothelium. Uncorrected visual acuity, predictability, and stability are as good as or better than those obtained with other techniques used to correct hyperopia.
Adult↗
Treatment of simple hyperopia: comparison of laser in situ keratomileusis and laser thermal keratoplasty.
PURPOSE: To evaluate and compare the efficacy, stability, and safety of laser in situ keratomileusis (LASIK) and laser thermal keratoplasty (LTK) for the treatment of simple hyperopia. SETTING: John Hill Eye and Laser Centre, Cape Town, South Africa. METHODS: This retrospective study comprised consecutive patients having primary treatment of simple hyperopia of up to 3.0 diopters (D) with astigmatism of 0.5 D or less. Treatment methods were as follows: Group 1 (81 eyes), LASIK with the Nidek EC-5000 excimer laser; Group 2 (69 eyes), LASIK with the LaserSight LSX excimer laser; and Group 3 (84 eyes), LTK with the Sunrise holmium:YAG laser. RESULTS: The hyperopia decreased in all 3 groups. Both LASIK groups were stable by 1 month; there was continued regression in the LTK group for up to 18 months. The percentage of eyes achieving uncorrected visual acuities of 20/20 and 20/40 at 3 months were Nidek, 41% and 92%, respectively; LaserSight, 50% and 90%, respectively; and LTK, 21% and 89%, respectively. No eye lost more than 2 lines of best spectacle-corrected visual acuity. Surgically induced astigmatism (SIA) was evident in all 3 groups; it was highest in the LTK group. The mean posttreatment astigmatism was -0.47 D +/- 0.40 (SD) (range 0 to -1.50 D) in the Nidek group, -0.45 +/- 0.40 D (range 0 to -1.25 D) in the LaserSight group, and -0.81 +/- 0.51 D (range 0 to -2.25 D) in the LTK group. The enhancement rates were 16.75%, 22.57%, and 38.30%, respectively. Because of the SIA, 61% of the LTK enhancements were corrected with LASIK. CONCLUSIONS: All 3 treatment methods corrected hyperopia, but stability was achieved early in both LASIK groups, allowing early enhancement when necessary. Because LTK cannot currently correct astigmatism, many of the LTK repeat treatments required LASIK procedures. For these reasons, LASIK remains my preferred method to treat simple hyperopia up to +3.0 D.
Adult↗
Laser in situ keratomileusis for hyperopia.
PURPOSE: To evaluate the results of laser in situ keratomileusis (LASIK) to treat hyperopia. SETTING: Instituto de la Vision, Buenos Aires, Argentina. METHODS: This nonrandomized study comprised 679 eyes of 321 patients having LASIK. Patients were divided into three groups based on preoperative spherical equivalent: Group A (low hyperopia, 2.00 diopters [D] or less); Group B (moderate hyperopia, between 2.00 and 3.00 D); Group C (high hyperopia, more than 3.00 D). The following were measured postoperatively: uncorrected visual acuity (UCVA); best spectacle-corrected visual acuity (BSCVA); refraction (evolution and distribution); lines of visual acuity gained and lost. Follow-up was 1 month in 79.4% of cases, 3 months in 75.5%, 6 months in 68.5% and 1 year in 38.3%. RESULTS: Six months after LASIK. 100% of cases in Group A, 95.3% in Group B, and 71.4% in Group C were within +/- 1.00 D of emmetropia; UCVA was 20/40 or better in 94.1, 100, and 87.8%, respectively. The percentage losing or gaining 0 +/- 1 line of BSCVA was 100, 97.6, and 100, respectively. CONCLUSIONS: Laser in situ keratomileusis was predictable and safe in the treatment of low and moderate hyperopia.
Adult↗
Study of gene-environment effects on development of hyperopia: a study of 191 adult twin pairs from the Finnish Twin Cohort Study.
The Finnish Twin Cohort material was used to estimate genetic and environmental effects in the etiology of hyperopia (farsightedness). All twin pairs in the cohort born before year 1927 (age 60 years and over at the time of the study), with both members alive, were sent a questionnaire. The questionnaire included questions of past and present eye diseases, visits to ophthalmologists, use of glasses and other vision-related questions. The hyperopia was assessed by asking the patients to send their last prescription for glasses to the authors. Twins with any eye disease affecting refraction (cataract, corneal damage), operation or trauma to their eyes were discarded from the present study. In 191 pairs (80 monozygotic and 111 dizygotic pairs) one or both members of the pair had a hyperopic refractive error. The correlations of refraction between right and left eyes of both MZ and DZ pairs were high (Spearman Rank Correlations of 0.86-0.89). The intrapair correlations among MZ pairs were higher (0.44 for right and 0.45 for left eyes) than intrapair correlations among DZ pairs (0.24 for right and 0.15 for left eyes). The variances were not significantly different among MZ and DZ pairs. The classical analysis of heritability gave an estimate of 0.75 for hyperopia. The result suggests that genetic factors are important in hyperopia and especially in hyperopia of higher degree.
Adult↗
Visual acuity outcome in isometropic hyperopia.
Refractive amblyopia may occur as a unilateral or bilateral condition. Although bilateral refractive amblyopia may account for 1 to 2% of all refractive amblyopia, there is little consistent information in the literature regarding isoametropic amblyopia resulting from bilateral hyperopia. Hence, this retrospective study investigated the prevalence of reduced aided acuity in patients aged 10 years and younger (mean age 3.97 years) with 5 D or more of isometropic hyperopia and considered the following factors that may influence visual acuity: (1) age at first correction; (2) magnitude of hyperopia; and (3) duration of refractive correction of the hyperopia. The results indicate that the majority of patients (87%) have aided acuity poorer than 6/6 at initial correction of refractive error. However, if the full hyperopic correction was worn for 1 year or longer, only 43% of these patients demonstrated acuity poorer than 6/6 and none showed acuity poorer than 6/12. The magnitude of the hyperopia appeared to have the greatest influence on the visual acuity outcome both at initial correction of refractive error and 1 year or longer after correction. Duration of correction also influenced the visual acuity outcome, but to a lesser extent than the magnitude of refractive error. In contrast, the age of first correction showed little correlation with visual acuity either at the time of first refractive correction or after a minimum of 1 year of correction.
Age Factors↗