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Hyperopia surgery

The operation to correct hyperopia

Surgery of thehyperopia is used in refractive surgery to rid the farsighted patients of their glasses and lenses.

Hyperopia is a frequent, sometimes unknown (up to 40) and mainly caused by a too "short" look, or a cornea whose power is insufficient for converging enough incident light to the retina (this lack of power of the cornea is related to a defect of Camber: the cornea is too "flat").

The hyperopic eye has a lack of optical power: from light rays from a distant source converge at the back of the retina: the image formed on the retina is thus extended, which explains the feeling blur. The operation to correct hyperopia is therefore increase the optical power of the eye. This can be achieved by various methods which the choice is based on many parameters (age, degree of farsightedness, thickness of the cornea, presence of a cataract, etc.):

Increase in optical power of the cornea

The excimer laser sculpts the front of the cornea in order to increase the curvature (ex:) technique of LASIK hupermetropique(, the PKR)-see profile of ablation for the correction of hyperopia. This technique is particularly suitable for the correction of hypermetropies of less than 6 diopters, in patients including the lens is transparent (absence of cataract). It is performed on an outpatient basis under local anesthesia by drops.

principles of surgery on the cornea laser hyperopia

Correction of hyperopia by photoablation laser on the cornea. The hyperopic eye has insufficient length to the power of the cornea and the lens focus. The image formed on the retina is blurred because de-focused backwards: the image of a distant source is a disk, instead of forming "a point". Corneal refractive surgery for hyperopia using the laser to reshape the surface of the cornea. In the case to the hyperopia, we must add the power of the cornea focus: this is done by increasing its arch by a sculpture laser (LASIK in the vast majority of the case). The increase in the curvature of the cornea is calculated based on the degree of farsightedness and the size of the optical zone scheduled. The following image shows the hypermetropique an eye before and after LASIK corneal profile. A superposition of the profiles allows to view the profile of ablation for Arch the paracentrale region of the cornea.

Hypermetropique before and after LASIK corneal profile

After hypermetropique LASIK, postoperative corneal profile within the optical area is more arched. The overlap between profiles pre and postoperative allows to visualize the change profile. Note the progressive coupling with the periphery untreated.

Replacement of the lens by a artificial lens implant

This technique is proposed to strongly farsighted patients, at or above 40, and the achieved hypermetropes of cataract.

The lens is removed (classic cataract operation in) phacoemulsification) and the power of the implant put in replacement of the lens is calculated so that the operated eye is more farsighted)Biometry). In case associate of origin corneal astigmatism, toric implant can be placed. To increase independence to the correction in glasses by correcting distance vision and near vision pose a multifocal implant may also be considered.

surgery for hyperopia correction with implant principles

To correct hyperopia strong or beginner cataract patients, we can increase the focal power of the couple "crystalline corneal" by replacing the lens with an implant, whose optical power is calculated to correct farsightedness of the operated eye. This calculation is called 'biometrics': it logically depends on the length of the eye (called axial length) and power (curvature) corneal, who is not changed by this surgery. Patients who wish to benefit from a correction from far and near, the implant may be multifocal (or even "presbyopia surgery").

The correction of hyperopia by replacement of the lens occurs preferentially in case cataract beginner or proven, or from the sixties.  In case of high hyperopia (not operable by LASIK: ex: + 8 D), we can consider the surgery with implant in a patient having reached midlife.

We can also correct hyperopia by adding a positive power implant in the anterior chamber or the posterior Chamber without removing the lens, but these techniques rarely used for the correction of hyperopia. The hyperopic eye is a generally shorter look so small, the volume of the compartments likely to receive an implant (without removal of the lens) is generally incompatible with the addition of a foreign element.

31 responses to "Hyperopia Surgery"

  1. Dr. Damien Gatinel says:

    Is the treatment of hyperopia possible with the Relex Smile technique?

  2. Dr. Damien Gatinel says:

    There are currently protocols under clinical evaluation for the correction of hyperopia with SMILE technique; However, this option is not available (yet?). The shape of the lenticule of corneal extract (little or no thickness at the Center to induce the corneal curvature) raises certainly some technical problems.

  3. Juliette thomas says:

    Hello
    I have a very strong hyperopia, + 10, with each eye, this embellished well on presbyopia, I have 52 years and I am also astigmatism.
    This is for the painting, wearing excessively expensive corrective lenses to be the finest possible, change every two years on average despite all the very heavy glasses and a huge RAS the bowl.
    I am considering an intervention if it is feasible without major risks.
    What can be the possible treatment? What's the result? What risks? I am talking about all the risks.
    Thank you if you take a little of your precious time to answer me.
    Kind regards
    Juliette

  4. Dr. Damien Gatinel says:

    Given the degree of farsightedness you present, a correction by LASIK is to exclude (it is effective up to 6 diopters about). At midlife, it may be quite possible to achieve a 'cataract surgery', in everyway technically similar to the cataract surgery. The replacement of the lens by an implant allows (by choosing a power through biometric examination) to correct hyperopia. This surgery can also prevent some complications of high hyperopia (acute angle closure glaucoma). No surgery is without risk, so it is important to weigh this indication by the yardstick of the discomfort you are experiencing currently.

  5. Teat says:

    Hello
    I am reaching a very strong hyperopia greater than 30 D. + 28 Right eye and + 30 left eye and a fctle amblyopia since my childhood. I am 41 years old and I would like to know if he has a way to definitively correct the defect I have.
    I am a wearer of rigid lenses and resting glasses.
    Thank you.

  6. Dr. Damien Gatinel says:

    This is the most extreme hyperopia I have ever met! It would be instructive to document it, to understand the importance of it. A priori, clear crystalline surgery and its replacement with a suitable power implant would be the most appropriate technique. But a priori, there is no implant powerful enough to correct your optical defect, the importance of which leaves me perplexed ...

  7. Anna Lea says:

    Hello Dr. Gatinel,
    I have the hyperopia and astigmatism I have 20 years I want to have surgery at you here is my vision:
    OD:-3.25 + 5.75 269 °
    OG:-2.50 + 6.75 269 °
    Am I operable? Thank you for answering

  8. Dr. Damien Gatinel says:

    Your Ametropia (optical defect) corresponds to mixed astigmatism (it is a kind of mixture of myopia and hyperopia, depending on the direction of the planes where the light rays are located). In any case, it is possible to correct this refraction defect by performing a LASIK procedure (provided that the preoperative balance sheet does not reveal any particular anomalies). Some methods for correction, such as irisne recognition, and the realization of personalized flaps, should be used. Note that the expression of the axis of astigmatism is between 0 ° and 180 °, there is certainly an error in the wording you used here.

  9. Chris Paul says:

    Hello
    My ophthalmologist offers refractive surgery with implants.
    I'm almost 59 years old and his diagnosis is as follows:
    Right eye:-0.50; Addition + 2.25
    Left eye:-0.75; Addition + 2.25
    Do you think it is wise to choose this operation?
    Is the success rate really 100%? A question left on your site by one of your colleagues, who has not been operated by you and to whom you respond, because one of his implants is problematic, with the key a reduction of his vision, suggests to me that this is not the case.
    Subsidiary Question, could you receive me and the case I need to operate?
    Thank you for answering me.
    Well yours,
    Chris Paul

  10. Dr. Damien Gatinel says:

    Implant installation is usually done in the course of a "Crystalline lens" surgery, which can still be "clear" at home, or with cataracts. This is not quite the same thing. Experience proves that the results of this type of surgery are judged more positively in patients with cataracts. The results cannot really be expressed as a percentage, it does not mean much. Surgery by implants is never innocuous, even if the techniques used today are safe and lapped. You have to agree on the objectives of the surgery, the visual issues and the expected results, etc. The installation of Trifocal implants is a possibility that gives the patient the possibility of not wearing glasses, but it can cause some visual effects, and it is important to discuss it with your surgeon.

  11. Céline says:

    Hello doctor,
    I had surgery of the left eye 4 days ago of a strong hypermetropie with Astigmasie: Correction OG + 8 and OD + 7.50 in lenses.
    I underwent a surgery by ablation of the Crystalline lens and the installation of a multifocal O-symphony Lens.
    To date I have a blur, normal to so little time of surgery. My view is very good from afar but I can not see closely and especially I see extremely annoying hâlos at night. My surgeon told me about an adaptation that brain will do but not a disappearance of these hâlos... That worries me a lot and starts to make me regret the surgery. Note that I am 37 years old, no cataracts and that I had surgery because my left eye no longer tolerated the contact lenses I wore for nearly 20 years (always respecting the hygiene and life of the glasses)..
    I am supposed to have surgery right eye in 2 days... Do you think I should wait? At the moment I compensate by wearing a contact glass on the right side...
    Thank you for your reply...

  12. Dr. Damien Gatinel says:

    If you feel halos after you implant the Symfony lens, you should determine the cause. The blurred vision is normal, this implant is designed to provide a clear range of vision between the distance and the intermediate (approx. 70 cm) but not the near (30-50 cm). Nocturnal halos can occur with this type of implant (called "EDOF" for Extended Depth of Focus), since it distortss light into several foci, so as to extend the range of sharpness. The halos correspond to the defocused light for the home or households close to the intermediate distance. Halos are often more troublesome in patients who did not have cataracts before surgery (cataracts degrade vision more than what multifocal implants impose as a compromise vis-à-vis the light sharing in several Households). At 36 years old, you had no cataracts, so you are more sensitive to the perception of these halos. They may actually fade a bit (adaptation), but if you are embarrassed, you may need to reconsider the choice of implant for the second eye. A monofocal implant is possible, will not give (or little) halos a priori, but the net vision distance will in principle be lower. That said, if you can not read without glasses with the eye already operated, but that you can work on computer, it should be possible to consider a monofocal implant, to avoid the occurrence of halos?

  13. Gwen says:

    Hello to you, my 8 year old son is very hypermetrope, OD: + 6 + 2.5 and OG + 6 + 1.5 (These are the values that are listed on lordonnance of his glasses), my question is simple, is it operable?? is refractive surgery possible at her age?? His daily life is rather complicated because of his vision problems... but this is just a question..
    Thank you, Mr.

  14. Dr. Damien Gatinel says:

    The surgery of the hyperopia, except case very peculiar, is reserved for the adult. It will be necessary to re-exmaminer your son in about ten years to make a precise assessment and to appreciate the operational possibilities and their justification.

  15. Valérie says:

    Hello Dr,
    My 17 year old son is very hyperopic and astigmatism:
    OD (95 ° + 2.25) + 6.00 and OG (80 ° + 2.50) + 7.25
    Even though I know that he is too young for surgery I wanted to know if you are dealing with these corrections and especially if an operation is possible when we cumulate hyperopia and astigmatism?
    Thank you very much in advance for your answer.

  16. Dr. Damien Gatinel says:

    In some case, an intervention can be considered, but your son is a case limit, and the hyperopia often increases a little after the twenties... The correction by Contact lens is advisable, and in case of future intolerance the possibility to carry out an intervention must be re-evaluated.

  17. Frederique says:

    Hello doctor,
    I am a woman of 54 years hyperopic astigmatism since my childhood and longsighted recently.
    Following 3 interventions in 2014 as well as radiotherapy 25 sessions.
    Acute bronchitis of more than 3 months and big fatigue my view to exceedingly lowered
    Close right Eye: (155 °-1.00) + 10.75
    From near left Eye:
    (20 °-0.75) + 10.25
    By far right eye:
    (155 °-1.00) + 8.50
    By far left eye:
    (20 °-0.75) + 8.00
    This correction is not enough because I do not see well closely as by far I miss about + 3 or more and I see trouble. Impossible to do more, my correction is maximum.
    Regarding my contact lenses I have a lens of + 9.75 right eye and left eye with a pair of glasses to see close to + 2
    But I miss much more because with the lenses I do not see as well as with my glasses. I'll need four more, but I won't see anything from afar.
    In addition, I have to practice rehabilitation sessions orthoptic
    I remain waiting for your answer, thank you in advance.

  18. Dr. Damien Gatinel says:

    In this context, I think that the surgery of the clear Crystalline lens could be indicated (it is in any technical point identical to that of cataract). Removing the Crystalline lens and replacing it with an implant can correct the entire hyperopia. Depending on your ocular state and the measurement in biometrics, it is also possible to envisage the installation of multifocal implants to correct both the strong hyperopia and give a vision of close and intermediate without correction (trifocal implants).

  19. Frédérique says:

    Hello doctor,
    Thank you for spending your time to answer my last request.
    Being very hyperopic,
    If I have a clear Crystalline lens, what exams do I need to be sure I am operable?
    Why do we always have to wait for a cataract to replace the Crystalline lens in general?
    If my eye is too short and too flat, what will my correction be by far and intermediate after the operation?
    Will it be 5 tenths and should I wear glasses to see from afar and is it possible?
    Can my general condition interfere with my long-term view after the operation, as I suffer from a cervicarthrose C5 C6 and degenerative L5 L4, headache, dizziness, vision disorder and fatigue.
    Currently:
    Without glasses 1/10th
    With glasses 5/10th but blurry.
    My keratometry:
    Right eye: 7.94; 175/7.62; 85
    Left eye: 7.85;  15/7.65; 105
    Closely right eye:
    (155 °-1.00) + 10.75
    From near left Eye:
    (20 °-0.75) + 10.25
    By far right eye:
    (155 °-1.00) + 8.50
    By far left eye:
    (20 °-0.75) + 8.00
    Waiting for your answer.
    Frédérique. 

  20. Frédérique says:

    Hello doctor,
    Some new things about me.
    Following the incident I had had in October.
    I did a scan of the eyes after I put some drops,
    It's by claiming the images.
    The photos clearly show a flat and distorted a creu on each side, two waves, rather than making a rounding.
    I don't know if this deformation on both eyes was there before my accident last October.
    But since my eyesight has fallen enormously and I see rather cloudy, I can no longer bear the light as well as the halos around the lights, and a phobia of the eyes that the orthoptist uncovered, I can not converge and does not support progressive glasses.
    The optician does not understand why my correction is limited, I can not correct more than 5 tenths.
    So many questions that leave me less hope and enthusiasm for the operation of the clear Crystalline lens.
    Maybe you had this case one day and an operation is still possible.
    I remain waiting for your reply and thanking you in advance.

  21. Sybille says:

    Dear Doctor
    I would like to better understand why the implants are proposed only from quarantine. Do we know the lifetime of the implants? Are they deteriorating after a certain number of years? Is it possible to replace them?
    I ask the question for a strong hyperopia (prescription glasses: Right eye + 4.50 (+ 2.50) 90 ° left eye + 4.50 (+ 2.25) 90 °) at my 21-year-old son who is struggling with such a correction (eye-magnifying glasses despite tip top lenses) and Hard to support his lenses. Thank you very much.

  22. Dr. Damien Gatinel says:

    It is not a problem of the lifetime of the implant, but rather of the tolerance of the implant in the ocular media. On the other hand, in Hyperopic, intraocular volumes are rather restricted (short-eyed), and the placement of an implant exposes certain complications such as increased intraocular pressure, cataract, etc. After the quarantine, it is generally preferable to perform a surgery where the Crystalline lens is replaced by an implant. This surgery is technically comparable to that of cataract, except that the implant replaces a Crystalline lens still clear and not clouded. Regarding your son, are visual defect is potentially correctable in LASIK, provided that there are recent equipment and that the pre-operative balance is satisfactory.

  23. Sybille says:

    Thank you very much for taking the time to answer me. I didn't want to give him false hope, but he's going to consult.

  24. Camille says:

    Hello doctor,
    I'm a 53-year-old woman.
    I am very hyperopic and longsighted
    Also certainly astigmatism!
    My Prescription:
    Right eye:
    (+ 155 °-1.50) + 9.00 (4/10) Low
    Addition over 2.25.
    Left eye:(+ 15 °-1.00) + 8.50 (7/10)
    Addition over 2.25.
    Poor view quality.
    Glare to light and visual fatigue.
    The correction of the right eye hyperopia and the left eye as well as the presbyopia are very insufficient.
    + 3 for each would be much better.
    But the correction of the hyperopia is already too strong, I see very murky by far and very small.
    Some exams lately:
    To the Slit lamp:
    White eye, clear cornea, ac calm, RPM +/+
    I have a small NCC in both eyes.
    Bottom of the enlarged eye:
    Papilla a bit excavated with C/d = 0.4 *-0.5.
    Normal Macula, Periph RAS.
    Keratometry
    OD K1 = 8.06 K2 = 7.64 k avg = 7.85
    0G K1 = 7.95 K2 = 7.55 k avg = 7.75.
    Other exams awaiting the optic nerve, Feb...
    And I was told that I had a beginner cataract plus a amblyopia.
    Is this limiting and lowering my eyesight for a while?
    I've been hyperopic since I was a kid.
    My view in correction keeps dropping.
    I see no veil.
    I've had a lot of rays treatments over a long time.
    It is unlivable every day I see very badly and I would like to know if this is operable?
    Is it possible to find a correct view even wearing glasses?
    Waiting for your answer doctor.
    Thank you

  25. Dr. Damien Gatinel says:

    Glare is a sign of early cataract. It is necessary to check the presence of this cataract, which can be done by carrying out additional tests such as the OQAS (or HD-analyzer) for example;

  26. Cresci says:

    Hello doctor,

    I met you for a pre-operative checkup but I did remove my rigid lenses only 3 days before this checkup. When making an appointment for the intervention, in the brochure that was given to me, it is indicated that it is not necessary to wear its lenses 8 days before. Are the exams likely to be distorted?
    Do I have to remake them eventually because the intervention will take place in January and I am concerned.

    I thank you for the answer you would like to give me to reassure myself.

  27. Dr. Damien Gatinel says:

    It is possible that the measurement of refraction (correction) may have been altered. If you want to neutralise this possibility, you should substitute flexible lenses for your rigid (to do with your treating ophthalmologist), and redo a measurement of the correction on the day of the intervention (come for this a little in advance).

  28. Gaëlle Penin says:

    Hello doctor,
    I have recently discovered the possibility of laser surgery for hyperopia and astigmatism. I would like to know if this is possible in my case :
    OD: + 5.50 (+ 1.75 to 75 degrees)
    OG: 5.00 (+ 1.75 to 100 degrees)
    I'm 23 years old.
    Thanks in advance

  29. Dr. Damien Gatinel says:

    You have a pronounced form of hyperopia, which can be corrected in LASIK if you use a recent laser platform. A partial regression of the correction could however occur in the years to come (you are 23 years old, the hyperopia tends to increase/decompensate over time). A precise and detailed pre-operative assessment is required to verify your operability.

  30. Bathsabee says:

    Hello doctor, I am 23 years old and I have hyperopia at +8 plus strabismus. I would like to have the operation, but I understand that there is no solution at the moment. What do you think of that?

  31. Dr. Damien Gatinel says:

    Unfortunately, the options are more than limited for this type of hyperopia. A partial reduction may sometimes be proposed in order to meet certain professional recruitment standards (e.g. having less than 3 diopters of hyperopia).

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