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Hyperopia and presbyopia

Hyperopia and presbyopia are two common optical defects, which can be added and penalize the vision of far and near, making it necessary to port a lens correction (glasses, lenses) for all activities of daily living. This page is dedicated to the explanations to understand the commonalities and differences between hypermetropia and presbyopia. and surgical techniques for correcting them.

Light Hyperopia is often ignored until the age of 40, when the presbyopia is settled. While the near vision decreases rapidly, and involves wearing corrective lenses for reading closely, the vision from afar decreases in turn, while it was excellent before. While he was independent with glasses, the hyperopic became longsighted must equip itself with an optical correction not only to see closely, but also from afar...

"Neither close nor far, you will see yesterday," 
"You won't see anything near or far."
(Excerpt from "The Flower of the Age", by Albin de La Simone)

We will begin by addressing the explanations for the visual disturbances of the farsighted presbyopic, and then the surgical solutions used to correct these patients.

Differences between presbyopia and hyperopia

The presbyopia is related to the gradual loss of accommodation resulting from the loss of elasticity of the Crystalline lens whose ability to deform and allow the objects or texts observed to form a sharp image on the retina decreases over time.

The reduction in the flexibility of Crystalline lens is a phenomenon that begins early in life, but since the capacity of accommodation is very important at birth, it takes 4 decades for the residual accommodation to become insufficient to Meet visual needs closely like reading. The range of net vision distance is reduced: from infinity (FAR) to 10 cm in a young subject, from infinity to 20 cm in a pre-longsighted, and when the nearest point where the vision is still sharp is pushed back beyond 30 to 40 cm , the symptoms of presbyopia appear: The longsighted instinctively tends the arms to read, and must increase the illumination of his work.

Presbyopia thus begins at 43 years in patients with no optical defect in distant vision (Emmétropes), and is characterized by a difficulty in reading small characters closely.

THEhyperopia (or hyperopia) st a common optical defect which concerns the distance vision, but can also interfere with near vision: farsightedness is caused by the fact that the eye is "too short" (insufficient axial length, the light received by the eye is focused in a plane located behind the retinal plan: it receives an image blurred because de-focused). One of the peculiarities of hyperopia is that in light of its forms, and in non-presbytes patients, it can be 'auto-corrigée' by the eye  makes a tune-up in accommodating: this accommodation effort is being done to improve vision by far, while this mechanism is normally used to see up close.

To see net off, the Hyperopic therefore accommodates constantly, and to see net closely, it must accommodate even more. The hyperopic is therefore very sensitive to the effects of presbyopia, as the gradual loss of accommodation makes it increasingly difficult to compensate for this optical defect. This is why the close vision can be difficult early in life among the farsighted: all the sooner the hyperopia is important. A 35-year-old patient who feels the need for a correction to read is not an early longsighted, but a hyperopic who can no longer accommodate enough to see net the close, as it already accommodates to see net from afar. Hyperopia and presbyopia combine to alter the vision closely!

As underlined in introduction, moderate and undetected hyperopia is not a visual handicap, at least to quarantine. Previously, it is associated with a TRES good distance vision! Even after the onset of presbyopia, a low farsightedness is a Visual annoyance for intermediate vision or close range (2 to 3 meters), but not for the distances further away (beyond a few tens of meters). Of many hypermetropes become presbyopic arrive to drive without feeling discomfort, because they can see traffic information located at great distance.


Amplitude of accommodation

The range of accommodation is expressed in diopters and is related to the distance between the Punctum point (The furthest seen net point without accommodation) and the Punctum proximum (The nearest net point in accommodating to the maximum). The presbyopia can be defined as a residual accommodation amplitude less than 5 D: the focus cannot be carried out at a distance of less than 1/5 or 20 cm, and it is generally considered that it is necessary to have double the capacity Accommodation required to comfortably read at a given distance (the accommodation required for reading being 2.50 D, an accommodation power of at least 5 D appears as necessary).

amplitude of accommodation (schema)

The course of accommodation is the distance between the punctum point (point seen by the eye effortlessly in vision by far, here located at infinity) and the punctum proximum (point seen by the eye when it accommodates maximum). We use a notation in vergence: If the minimum distance is 40 cm, the amplitude of accommodation is 1/0.4 - 1 / ∞ = 2.5 D.

On average, most adults experience difficulties in reading closely between 35 and 45 years; The age at which the first difficulties in close vision are felt varies in fact not only according to individual factors, but also according to the potential refractive defect for vision from afar. Patients with moderate hyperopia generally feel the effects of nascent presbyopia earlier (just before 40 years) than patients who do not wear eyeglasses from afar and do not compensate for any optical defects (these Patients are the "real" emmétropes).

In other words, patients with suggestive manifestations of presbyopia around 35 or 40 years are often low farsighted: some are unaware of the existence of this optical defect, that they tolerated well so far. In fact, these patients,. that younger often enjoyed excellent vision, are those for which not only the presbyopia reduces the near uncorrected vision, but also the distance vision ! These weak farsighted, with a form of "latent" hyperopia, have to equip themselves with a correction in progressive glasses, which are often all the more poorly tolerated and accepted that the subjects concerned had never worn glasses before. Indeed, in the past, they used their accommodation to perform permanently and "unconsciously" a precise "focus" for vision from afar, while retaining sufficient reserve accommodative to continue this effort in xxx_xxx 51633470 close focus on a close target.


Low or latent hyperopia

The hyperopia is defined as a state where the refractive eye is such that the light rays from a distant source that are refracted by the cornea and the Crystalline lens form the sharpest image behind the plane of the retina (the Rays do Not converge in the plane of the retina but in the back of it).

Hyperopia is related to insufficient axial length towards the optical power)vergence) combined the cornea and the crystalline lens: the hyperopic eye is usually shorter than the Emmetropic eye, and of course the myopic eye. We correct hyperopia by convex glasses glasses, whose optical power (vergence) is a positive convention. The degree of hyperopia is expressed as the power of the corrector glass required to correct: a farsightedness from + 1.50 D can be corrected by a convex glass the vergence is + 1.50 diopters. As we have reported before, the weak hypermetropia can "auto correct" their farsightedness by increasing the power of their crystalline, IE in accommodating (short-sighted do not have this possibility: instead, accommodating, they improve the blur of the retinal image). The Visual acuity of a farsighted patient who adapted to "correct" this defect can reach or exceed 10/10! The focus of the image on the retina is "modulated" by accommodation, and can in fact be performed fine. The hypermetropic is 'latent', because she can to slip if it paralyzes the accommodation - some techniques of measure for refraction, as well as some eye drops, let make a latent, hyperopia becomes manifest.

Accommodation and latent hyperopia

It is important to specify that the hyperopia is defined for an eye is "at rest", i.e. an eye that does not accommodate. Indeed, the accommodation of the Crystalline lens consists of an increase of the power of the Crystalline lens via the bombing of it. The accommodation allows a emmetropic eye to see net closely, but can also be solicited to further the vision by far from a hyperopic eye.

A light hyperopia (e.g. + 1 D to + 2 D) can be compensated by an accommodation, whose power is expressed in diopters, equal to that of the hyperopia.

latent hyperopia offset before presbyopia

Latent hyperopia and distance vision: latent hyperopia is characterized by a more or less permanent accommodation of the lens, which the power increases, which allows the image of a distant point source to be seen net - as long as the amplitude of accommodation is sufficient.

A low hyperopia can be compensated by a slight accommodative effort, enough to keep from light rays from a distant source converge in terms of the retina, through the increase of the optical power of the lens. This mechanism is "unconsciously": it provides a very good vision, because it allows to adjust the accommodation so that the development in the plan of the retina is optimally. At the age of 25, a low hypermetropic boasts an excellent distance vision, his uncorrected Visual acuity can reach 12 or even 16 tenths. However, her near vision (example: reading) requires extra accommodative effort. Without correction. the hypermetropic must accommodate twice : for long distance, then to see up close. This poses no problem as long as the amplitude of accommodation exceeds the maximum accommodative effort.


Accommodation and eyestrain

Accommodation can increase the optical lens power, so that the rays emitted by nearby objects are focused in terms of the retina. If the lens (young) was not stretched permanently by ligaments (which forms what is called the zonule), its form was that of a very convex lens, and its maximum optical power. The lens in one eye at rest is in tension, and his front and his back are less curved than the released State. Accommodation requires the game to a complex mechanism, which associated a muscular contraction (ciliary muscle), a relaxation of the ligaments of the zonule, causing a bulge of the lens... as long as it retains its elastic properties, which unfortunately wither over time, which in return causes a decrease in the amplitude of accommodation over time (the crystalline bomb less and less).

To be comfortable and allow a vision extended nearly effortless, estimated as pointed out above that all of the accommodation set game to correct hyperopia and allow to see net close must not exceed half of the total amplitude of accommodation of the patient (approximately). This amplitude is high at birth, but steadily declining then, because the lens of the eye loses its flexibility during the existence. On average, she is 8 dioptres at age 30, but is more than 4 dioptres at age 40. If Visual needs (far and near) require a maximum accommodation of 2.50 to 3 diopters in farsighted patients presbyopia pre including the amplitude of accommodation is more than + 4 diopters, eyestrain symptoms may appear: blurred vision by intermittent, headaches, red eyes, etc.

For example, a + 2 D (latent) light farsighted. This farsighted may request its accommodation to see net by far: it accommodates so close + 2 D. To read 40 cm (0.4 meter), must make an extra effort of 1/0.4 = 2.5 diopters. Altogether, necessary to see accommodation is close to 4.5 diopters for this farsighted (she would only 2.5 diopters at an Emmetropic that does not need to accommodate for net long distance).

latent hyperopia and presbyopia-

Latent hyperopia and vision closely in a far-sighted meadow: accommodation allows always the image of a remote source to be seen net. Accommodate yet to see a source close net. If the total accommodation (one needed to compensate for hyperopia and see net from afar, added to that needed to see up close) exceeds the amplitude of residual accommodation, near vision becomes blurred.


Asymptomatic so far, a farsighted + 2 diopters exceeding 30 may feel a fatigue increased in near vision ; However, it isn't yet farsighted, because its amplitude of accommodation is far greater than + 5 diopters.

However, at midlife, when the amplitude of residual accommodation becomes lower than 4 diopters, the accommodative effort needed to see net by far (+ 2 D) exceeds half of the amplitude of residual accommodation: by far the vision blurs late in the day, and near vision becomes very difficult if not impossible without correction in glasses.

hyperopia Decompensated by presbyopia

When presbyopia sets in, the amplitude of accommodation no longer allows to correct farsightedness, that of latent becomes clear: by far the vision is blurred, as well as the near vision.

A prescription of glasses far then progressive (far and near) should be performed. This patient, who saw from far and near without effort or eyestrain to the 30 or 40 quickly became Depending on the optical correction. If he can dispense with distance vision glasses, near his poor vision forced him to put on glasses for Visual tasks close to everyday life. Reading, DIY, viewing screen of tablets and smartphones, labels, maps, restaurant menus... are impossible without glasses.

Thus, latent hyperopia is a State where the distinction between Beginner presbyopia and hyperopia with a pre-presbyte is sometimes difficult. When we measure the refraction of a low hypermetropic, is needed to use so-called "interference" techniques that are designed to minimize the accommodation.

Can also be used for so-called "cycloplegics" eyedrops to paralyze the accommodation (cycloplegia). Besides using these drops in children, which accommodates very easily and sometimes in very important... which can conceal strong hypermetropies.

Effects of glasses

One can show that for a same correction absolute value (ex: + 3 D vs - 3 D) hypermetropia corrected vision at a distance by convex lenses have to equal residual accommodation amplitude, an accommodative effort to see closely compared to short-sighted corrected vision at a distance by concave lenses. This factor explains that the young presbyopic hypermetropes need a slightly stronger than the young myopic presbyopic correction for vision (adding) closely.

Thus, after a period or the view was often excellent,  the weak hypermetropes need a distance vision correction between 35 and 40 years, then a correction close to correct presbyopia in midlife.


Surgical correction of hyperopia, presbyopia

The Hypermetropique LASIK is the most suitable surgical technique for the correction of low to moderate hyperopia (up to + 3.50 D) in Young longsighted (40-55 years). Not only is LASIK effective on vision from afar, But this technique promotes the recovery of a near uncorrected visual acuity because it naturally induces a certain degree of multifocal corneal. This multifocal can be modulated using some of the so-called "aspherical" laser ablation profiles.

Thus,. the presbyopic hypermetropia, whose farsightedness is between + 1.50 D and 3 D are good potential candidates for LASIK refractive surgery, because the synergistic effect of the vision by far on the near vision correction allows maximize their independence to the corrective lenses in post operative.  This effect can be potentialized by some adjustments during surgery: for example, the size of the optical zone programmed can be modulated to accentuate the multifocal effect of the correction, and a little more on the non-dominant eye correction allows to increase vision closely on this side.

Thus, the depth of field of the hyperopic eye surgery LASIK increases significantly in the postoperative period.  Adjustments to increase the natural multifocalite corrections in hyperopia LASIK-induced are sometimes combined and presented as a technique of "presbyLASIK. The contours of this term are rather vague, as the correction of hyperopia (far vision) is a source of multifocalite, and there are sometimes subtle differences between multifocalite and monovision: a certain degree of "over-correction" is always done on the side of the eye non-dominant with these techniques... "PresbyLASIK' as the Supracor techniques are mainly proposed and issued at farsighted presbyopes. The Supracor is an algorithm providing a profile of aspheric ablation to induce a multifocalite at the presbyopic farsighted.

Some laser platforms (ex: Alcon/Wavelight) allow to aim a particularly negative Asphericity for postoperative corneal profile, by an adjustment of the corneal Asphericity factor (commonly referred to as 'Q factor'). A nomogram (check) of treatment can be developed from this feature the Alcon/Wavelight company called "custom q", for the correction of presbyopia and hyperopia. The author of this site has developed a non-empirical technique that allows a multifocal aspheric correction for the eye no dominant presbyopic hypermetropia (here in English).  Other laser platforms (Zeiss / "Laser blended vision" renamed "Presbyond") also offer some modalities of treatment for presbyopia correction, and are more particularly suited to the presbyopic hypermetropia, but the mechanisms involved are not revealed.

In the vast majority of the case, to remember that the multifocalite induced by hypermetropique LASIK is mainly related to an increase in the rate of negative spherical aberration, itself is secondary to the induction of a profile hyper-prolate aspherical after surgery.

The installation of a corneal implant KAMRA is also a particularly interesting technique in weakly farsighted presbyopes: it allows to increase the depth of field of the eye where the implant is placed (non-dominant eye).

Some farsighted patients have been sighted in the past, and made radial keratotomy, which was a technique for correction of myopia based on corneal incisions. A common complication of this technique is the appearance of a progressive over-correction (over-correction of a correction for myopia, inducing a farsightedness). Today, these patients, operated during the late 1980s and early 1990s, have reached or passed the age of presbyopia. They may be subject a correction by PKRwhich is effective to reduce their dependence on glasses in far and near vision.

In conclusion, hyperopia is presbyopia potentiate their negative effects on the vision from far and close to midlife. However, when it is feasible, surgical correction in LASIK induced a synergistic beneficial to restore independence to the optical correction in these patients.





63 responses to "hyperopia and presbyopia"

  1. Ford Samikos says:

    Good evening
    I am 57 years old and I am Hypermetrope + 6.50 D Det + 7.00 D and of course seen my age I'm longsighted.
    I would like to know what are the possibilities to rectify these vision flaws to have maximum comfort, and what would be their costs.
    Thank you for answering me.
    Kind regards.

  2. Dr. Damien Gatinel says:

    Given the degree of farsightedness and the fact that you have a total presbyopia, the crystalline lens surgery seems than laser correction. Multifocal implant is a good option if you no longer wear glasses from far or near, and or intermediary (with trifocals implants). The cost of the surgery (variable according to the centers, surgeons, and which in theory should be your dependent if indeed you have no cataract), addition of multifocal implants.

  3. CORDIER says:


    I have a recent farsightedness corrected from my childhood (latent) and a presbyopia which make me two years to wear progressive lenses since my eyes are too dry so that I could wear contacts. These glasses I bother in General.
    My corrections are:
    – Right eye + 1.25 (+ 0.25) Add + 2.25
    – Left eye + 1 (+ 0.25) Add + 2.25

    Is it possible a laser treatment to eliminate these defects? If yes what is the price range for this treatment? I need surgery?

    Thank you in advance for your answers.

  4. Dr. Damien Gatinel says:

    The correction of hyperopia and presbyopia in laser surgery is possible and has some advantages, such as the synergistic effect on vision close to the correction of hyperopia (far Visual defect). This page presents the pirncipes.
    In your case, this hyperopia is weak and does not really penalise the vision of "very" far (20 meters and more). But it hinders the closer vision (intermediate and closely, because of the presbyopia that reduces the ability of the eye to "force" to see better). Correcting your vision by far will bring a gain in intermediate vision, and also a little in close vision, but the wearing of corrective lenses will remain necessary for the reading of small print. It may be interesting to test a monovision correction in contact lenses (toggle), where the non-dominant eye will be overcorrected to better see closely (but less well seen from afar). Finally, the dryness of the eye must be evaluated objectively during the examination. If it is not complicated by keratitis or other lesions of the corneal surface, you will be able to benefit from the intervention (which will not fail to accentuate at least transiently this drought). If you have a dry keratitis or signs of severity, it may be preferable to reconsider the interest of a presbyopia hyperopia surgery. The cost of surgery varies according to the centres and the practitioners, it usually varies between 2500 and 4000 euros for both eyes in the well-equipped centres where the laser platforms are recent and have the technological options allowing To optimise the result of this type of surgery (personalized centring, control of the asphéricité corneal, taking into account the dynamics Pupillary, etc.)

  5. Dufour says:

    Is it possible to hyperopia a non-conceivable operation due to too fine corneal thickness with implants?

  6. Dr. Damien Gatinel says:

    If you are referring to the so-called implants "phakes", room before or after their use is possible but potentially discouraged in hyperopia, or eye volume is limited ('short' eye) and are increased risk of excessive contact with the eye tissue. On the other hand, beginner cataract case or proven, or "big lens" after midlife, it may be wise to proceed with surgery the lens and replace it with an implant nickname phakic. The completed technique is in all respects identical to that of the cataract surgery.

  7. Hoe says:

    My prescription may 2016 is the following OD/+ 1.25 Add 1.75
    OG + 1.75 (+ 0.50 to 140 °) add 1.75
    I am 47 years old, when I remove the glasses and watch television for example, I do not see the eyes of the presenter, it is blurry. is that normal. A year ago I did not have this problem, I got it after changing glasses.

  8. Claude says:

    Hello doctor, I have 53 years in 3 weeks, here's my current situation:
    OD SPH + 2.00 CYL + 0.50 Axis 170 Near Add + 2.25
    OS SPH + 2.25 Near ADD + 2.25

    I would like to know what would be my options (Laser (Lasik or Lasek), implant... or stay with my progressive glasses) and the approximate price of an intervention. I live in the Paris region and I would like to know how many vacation days I should expect.
    Thank you in advance for your help.

  9. Dr. Damien Gatinel says:

    The first option to consider is that of LASIK, which can correct hyperopia and using some adjustments allow also to improve near vision without glasses (correction of presbyopia). The cost of this type of surgery for both eyes is usually between 1300 and 1700 euros per eye. If an early cataract was present, it might be possible to consider surgery, with multifocal implant.

  10. Dr. Damien Gatinel says:

    It is possible that the blur is far related to decompensation of a slight latent hyperopia, frequent event during installation of presbyopia. In these circumstances, the vision of (very) far (ex: road signs) is preserved, but for which closer distances (3 to 4 meters), hyperopia actually hurts the perception of fine details. Previously, this slight farsightedness was offset by a slight effort of accommodation, which is not enough today.

  11. mouhica dominique says:

    Hyperopic has always been added today a slight presbyopia begins. I'm 42 years old.
    My correction to date:
    Right eye: (165 °-0.75) + 5.50, Addition + 0.75
    Left eye (0 °-0.50) + 5.50, Addition + 0.75
    Is it really necessary to use progressive lenses at this stage of presbyopia?
    Using progressive lenses now will it not accelerate the evolution of the presbyopia?

    Thanks for your reply.

  12. Dr. Damien Gatinel says:

    The effects of beginner presbyopia are more marked at the hypermetropia, for various reasons, including the fact that the correction by far (+ 5.50D) causes an apparent reconciliation of the reading plan and requires more converging. If you are weary to read without the addition of + 0.75, it is best to use it, this will speed up not the evolution of presbyopia which is a rather passive mechanism (gradual reduction of the flexibility of the lens).

  13. Létourneau says:

    Hello doctor,

    I wear progressive lenses for:
    Right eye: Sphere + 2.75 – Cylinder:-0.75 – Axle: 10

    left eye: + 2.75 Sphere - cylinder: 0.75 - axis: 155

    What surgery I depend on?
    And what does the axis mean? Why it is not the same as the other eye?
    Am I a moderate or accentuated hyperopic?

    Thank you

  14. Dr. Damien Gatinel says:

    Your farsightedness is moderate. The axis of astigmatism can be different between both eyes although there is often an aspect in "mirror". The lighthouse for your farsightedness correction is LASIK.

  15. Mali says:

    Hello doctor

    We my prescription glasses far OD sphere + 3.50 + 3.50 + 2.50 D and G Add sphere OG
    I wanted to know if I could take the reading glasses that we sell in the big stores. Thank you

  16. Dr. Damien Gatinel says:

    For playback, the necessary correction for reading in your situation is the sum of the powers closely and by far, is + 3.50 + 2.50 D D = + 6.00 D.A my knowledge, corrections disponivles for glasses sold in supermarkets do not exceed + 3.50 D or + 4.00 D, which may be insufficient... unless you put for example on two pairs of + 3.00 D ... which could be a troubleshooting solution.

  17. Mali says:

    Hello doctor
    Thanks for the answer but is it possible that I use a + 3.50 for by far and A + 2.50 for pres?

  18. Eric PETRONIN says:


    Would it possible to tell me what type of LASIK option would take me it for a fixed total or partial of my view with the following indication:

    Order of 06/09/2016 eyeglasses
    A pair of glasses with progressive mount
    Right Eye: + 4.00 (-2.75) 175 °
    Left Eye: + 4.25 (-2.50) 20 °
    Addition: + 1.50

    Take into account that my job is truck driver ais as the view by far is crucial for this job.

    Please pass me the address of the Center who can made this intervention as well as the approximate time for such intervention.

    Kind regards
    Mr. Eric PETRONIN

  19. Didier says:

    Hello doctor,

    I'm 42 and I put progressive glasses for a year. Reading your article, I find myself in the definition of presbyopic farsighted.
    OD: SF + 1.0 CIL-0.5 ADD: + 1.25
    OG: SF + 1.0 CIL-0.75 ADD: + 1.25

    Because I can't take the progressive glasses (comfort more or less well depending on how I put them on the nose), I evaluate the possibility to operate.
    Is it feasible for this type of defect, with what technology and with what potential results?

    Thank you very much.

  20. Dr. Damien Gatinel says:

    LASIK surgery is possible, where your vision by far is deteriorating, by "unmasking" of a farsightedness which was well tolerated up to the onset of presbyopia. Details of the precise correction depends on Visual more special wishes (to encourage the recovery of good vision from afar, rather than close, or vice versa). It is all case possible to improve your vision and reduce your dependence on glasses, because the correction of hyperopia is synergistic with presbyopia. A pre-surgery remains necessary to confirm your pertinent and the interest of a correction.

  21. Dr. Damien Gatinel says:

    The vision correction by far should considerably reduce your dependence on glasses and simplify your correction. Several strategies are possible, but your profession requires an optimal result in far priori vision. It is also important to limit unwanted Visual effects (ex: halos) in the postoperative period. A precise preoperative assessment is necessary to ensure the feasibility of a lens correction, in the best conditions. A residual correction for vision closely (reading) will probably be necessary in posteoperatoire.

  22. AKO says:


    I'm farsighted birth. I wear glasses or lenses in + 24.50 + 16.50 (7.40 radius - diameter 13.20).
    I had a divergent strabismus and convergent child, which corrected without surgery, I am amblyopic of the left eye and I have a congenital nystagmus and a microphthalmia of length on both eyes.

    Since last year we try to equip myself in rigid, except that all tests ended in failure. It is not clear why, weight or shape of the eye but it shifts temporal downstairs. After the 20th I have abandoned.

    I don't normally wear soft lenses but it is at the moment my only viable alternative.

    I was also told to implant that I refuse. I have "only a look" more or less valid and I find the operation too risky in view of my age (30 years).

    I know that the laser is normally reserved to the hyperopia low but if I win + 6 or + 2 for example, my daily glasses would be much more portable than currently. Is this an option? I understand that it could not last in time, but it would always be something gained.

    They also told me that normally the farsighted cornea was fairly flat, off mine is rather curved. Is it perhaps a factor penalising?

    Thanking you :)

  23. Dr. Damien Gatinel says:

    Unfortunately laser correction would not significantly improve vision in your case. A cataract surgery later, can greatly reduce this farsightedness, but for now he must wait and try to find a solution in lenses. The fact that the cornea is convex in fact translated the "smallness" of your eye (low total length, and small radius of curvature of the cornea).

  24. cinnamon says:


    I'm 43 and I am farsighted. I'm corrected OD: + 2.75 and OG: + 2.25. Since a few weeks I felt a big eye strain with a permanent muscle below my left eyelid blink. When I close my right eye with my glasses, my near vision is troubled similarly for the left eye him strongly disturbed and the afternoon I see very evil of 20-40 cm. I went to the optician that went me to an eye test and he my advised of the progressive: right eye: + 2.50 (+ 0.50) 180 ° + 1.00 Add and the eye left + 2.25 (+ 0.50) 180 ° Add + 1.00. I don't understand this new fix, can you enlighten me? Why told you he declined my correction? On the other hand, I was wondering if laser surgery might be beneficial to me and allow me to no longer wear glasses. Thanks a lot for your answer

  25. Dr. Damien Gatinel says:

    Your Visual symptoms reflect the installation of presbyopia, which is characterized by a reduction in the accommodative power that no longer allows to see net, even forcing, to a decent reading distance (30-40 cm). Presbyopia is accentuated by your farsightedness. The correction that you have precrite is not less strong, but it has a moderate bilateral astigmatism correction (+ 0.50 x 180 °), as well as beginner presbyopia (Addition + 1.00). The laser, especially in alternative LASIK surgery, is potentially indicated in the farsighted become presbyopic. The vision correction far relieves some of the efforts made for near vision. It is also possible to discuss a monovision technique and/or multifocalite associated, that allows to promote the vision of close an eye, to anticipate the evolution of presbyopia.

  26. cinnamon says:

    Thanks for your reply. So you think that my new progressive eyeglass prescription will allow me to no longer look at troubled? If I wanted to know what you think of l Orthokeratology and whether it would be possible for my case. Thank you.

  27. Dr. Damien Gatinel says:

    There are no reasons that a well-executed glasses equipment will allow you to see well up close and far away. The indications of the Orthokeratology for presbyopia are not very well codified, you can always try this solution, but it won't only give you a priori the same visual comfort as the correction in glasses.

  28. Donat thierry says:

    Hello doctor, I am 54 years old and am farsighted light and now long-sighted, my distance, proximity and close is vision trouble, progressive glasses (correction: OD + 0175 add225, OG + 0125 add225) which allows me to see properly and that I can hold, however, for convenience in my workplace, I work under water, I'd like to know if refractive laser surgery would be interesting for me. After surgery, how long should it stay without being able to scuba diving.
    In advance thank you.

  29. Helen Marie touchet says:

    Hello, following the last visit to my eye doctor (13/12/2016), I had very bad when I move my eyes and headaches, she found me a dry eye (I have a PR since end of 2011). I wear progressive lenses (eye d. sphere + 2.50, cyl-0,50, axis 80 °, add 2.75 and eye g. only the axis is different 90 °) but I wanted to stop glasses and surgery. She told me that this was not possible with my pathology. Big, big disappointment! Laser, implants? Isn't it really no alternative than wearing glasses? Thank you for your kind reply.

  30. Dr. Damien Gatinel says:

    To give you a more precise answer, it is necessary to examine you. If rheumatoid arthritis causes symptomatic drought and dry keratitis, then it is indeed likely that the refractive laser surgery is not the best solution; Surgery of the lens might be more appropriate. A more detailed assessment will quantify the presence (or exclude) a light spreading of the lens (cataract beginner), and of course take stock of dry eye.

  31. Dr. Damien Gatinel says:

    A laser correction could actually be an interesting option for your current correction. Scuba diving is possible after refractive surgery (one month after LASIK).

  32. Bodin says:

    For my right eye it is rated + 5.25 (-1.75) 100 °
    For my left eye it is rated + 5.25 (-2.50) 97 °
    Addition: + 2.25
    I am 64 years old and my question is: can I have an operation to avoid glasses?
    Thank you

    Alain Bodin

  33. Dr. Damien Gatinel says:

    Correction laser intervention is possible to correct distance vision, but it is may be preferable to opt for surgery the lens, if you are a beginner cataract in particular, it is necessary to carry out a consultation with an ophthalmologist specializing in deciding.

  34. Cathleg says:

    I am 62 years old and here is my last correction, which is not yet made:
    OD: + 0.75 (-0.25 à145 °) + 2.75
    OG: + 0.50 (-0.25 to 20 °) + 2.75
    I'm very migraine. I was at + 1.5 and + 1.75 by far in 2014.
    A orthoptist friend tells me that I spasm too much, that these hyperopia values do not correspond to my age, that surely it is much higher (+ 2 to + 3, perhaps more)?
    Under Skiacol, no real differences in values. A little more...
    As to reduce the correction of hyperopia goes into the "wrong" sense! That the muscles should be released? How?
    Is there a relationship between age and hyperopia that applies to presbyopic people? Is it normal that it seems to improve? It is true that by far I see almost well...
    In short can we have a view from far almost good, without forcing at 62 years?
    In advance thank you.

  35. Dr. Damien Gatinel says:

    The first cause of reduction of hyperopia in your 60s is the occurrence of a nuclear cataract. In this situation, the nucleus of the lens becomes more dense. Its refractive index (and therefore its optical power) increases. This increase in the optical power of the lens corrects a part of hyperopia. In the beginner forms, there is not always of Visual symptoms, but nuclear cataract will eventually provide a feeling of sailing, and the need to shed more light on hard to see up close. A detailed ophthalmological examination will be able to confirm this hypothesis.

  36. BRANDAO says:

    Here is my correction
    Right eye sphere + 3.00 Cylinder + 0.50 Axis 25 Add. 1.25
    Left eye sphere + 4.50 Cylinder + 1.00 Axis 130 Addis Ababa. 1.25.
    My question is what an operation could bring me the best and then I wear lenses occasionally?
    Thanks for your reply.

  37. Dr. Damien Gatinel says:

    You are farsighted, slightly astigmatism and presbyopia. These defects are self-correcting in glasses, lens, and surgery (LASIK). The interest of the correction of hyperopia is synergistic with presbyopia. Distance vision and near vision are improved, which allows to significantly reduce (sometimes completely, depending on the activities), the dependence on glasses.

  38. LaSala says:

    Here is my fix: OD + 0125 (+ 025) 040 ADD 250
    OG-0150 (+ 375) 090 ADD 250
    is an eye surgery and what surgery would allow me to see from afar and close without wearing glasses.
    Thanks in advance for your reply

  39. Dr. Damien Gatinel says:

    The technique of LASIK is likely to provide you with an overall improvement, but to see net from close and far, a differentiated correction between the two eyes must be performed. A correction of the only vision from afar can make an improvement in intermediate vision (and also a little close), and this can give you partial independence to the correction in glasses. A preoperative assessment is necessary to verify your operability and to review the objectives of the intervention.

  40. Andre Lamb says:


    Doctor here below my correction:

    Sphere + 0.00
    Axis 120 °
    Addition 2.50

    Sphere + 0.25
    Axis 120 °
    Addition 2.50

    Am I operable and if so, would I no longer need correction.
    Thank you for your reply

  41. Dr. Damien Gatinel says:

    You are far-sighted, without any real optical defect in vision by far (minimal correction). With laser, it is possible to program a monovision (myopia of the non-dominant eye) but it is necessary to test the comfort of this type of strategy in contact lens. If you suffer a day of cataracts, the installation of trifocal implants could be indicated to provide you with the independence of the goggles you ask for.

  42. Christian barriers says:

    Hello doctor,
    I'm 60 years old and my ophthalmology diagnoses an enlarged and a presbyopia.
    I also have eyes that cry all the time.
    The brightness of day and night m intolerable.
    Wearing glasses far and near make me even more weeping eyes.
    Diagnosis: OD + 0175 (+ 025) 165 Add250
    OD + 0125. Add250
    A friend advises me to have surgery and to make me change the Crystalline lens by trifocal implants.
    This friend made it to 60 years and it is six years that he is delighted.
    I need to know if this operation is valid for me and if the eyes won't cry anymore?
    Kind regards

  43. Dr. Damien Gatinel says:

    Crystalline lens surgery with trifocal implant replacement is an interesting option for the correction of Hyperopia and presbyopia. However, cataract surgery (or clear Crystalline lens – a more relevant designation if there is no cataract, but surgery is identical to that of cataracts) does not solve the problems of tearing, and photophobia (discomfort to brightness). You need to consult an ophthalmologist to clarify the origin of these symptoms that are not a priori related to your wearing glasses.

  44. John Bihl says:

    Hello doctor
    J, I am 62 years old, J, would have liked to know if by surgery and if my case so ready I could do without glasses
    – Right eye + 1.25 + 0.00 A 2.25
    -Left eye + 1.50 + 0.50 25 ° A 2.25

    Thank you

  45. Dr. Damien Gatinel says:

    In your situation, depending on the pre-operative balance sheet, the realization of a multifocal LASIK technique (Crystalline lens clear, no contraindication corneal) or surgery of Crystalline lens (onset of cataract) with the installation of a multifocal implant (ex : trifocal) can be considered.

  46. Fiona says:

    I have 59 years Progressive gate Correction: Right eye: + 1.75 (-0.25) 125 °
    Left Eye: + 1.50
    Addition: + 2.50
    After consultation I am offered a bilateral LASIK (but wearing a bezel for close vision)
    Also possible multifocal IMPLANT PRESBYSMART (BFGA004) (Finished glasses)
    My ophthalmologist immediately offers me the laser and the implant in 3 to 4 years.
    Is it better to proceed directly to the implant?
    According to you, what is the most appropriate procedure?
    Kind regards

  47. Dr. Damien Gatinel says:

    It all depends on the degree of opalescence of your Crystalline lens, and the regularity of your cornea... In general, LASIK is preferred when Crystalline lens is clear, as this technique is less invasive than removing a clear Crystalline lens and replacing it with a multifocal implant.

  48. Greg says:

    Hello doctor,

    I'm 40 years old. I have been hyperopic since childhood, and have been presbyopia for a few years.
    My vision from afar does not pose me really problem but the close one becomes annoying on a daily basis: difficulty reading, eye fatigue, need for brightness
    I would like to know if my correction is compatible with an operation? PresbyLASIK?
    And what would be the expected effects in close vision?

    ODG + 1.50
    ADD + 0.75

    Thank you.

  49. Ben says:

    Hello doctor,
    All my old prescriptions for vision lenses from afar start with the negative like
    OD – 0.50 – 0.50 100 and OG – 0.50 – 0.75 75..... for a myopia I think.
    The very last d a week ago begins with positive as
    OD + 0.50 – 0.75 95 and OG + 0.75 – 1.5 75...... for a hypermetropie I think.
    Is it possible that a myopia will turn into Hypermetropie in 3 years?

    Thank you, Doctor.

  50. Dr. Damien Gatinel says:

    It is sometimes possible that the eye accommodates during initial measurements (it is common in astigmatism), and that a "false" myopia is measured and its correction prescribed. Check that the port of the new prescribed glasses is comfortable, and if this is the case, then you can consider yourself purely astigmatism (or astigmatism and slightly hyperopic).

  51. USED says:

    My friend has the following values:
    OD: + 2.25 (+ 0.75) 0 º
    OG: + 2.00 (+ 1.00) 0 º
    He tells me that he is only embarrassed by close vision, yet it seems to me that he also has difficulties for vision from afar. Can you tell me what correction he needs?
    With my thanks.

  52. Dr. Damien Gatinel says:

    The correction reported is that of a hyperopia. If the person concerned is not yet longsighted, it is likely that the vision from afar is indeed, judged to be appropriate (subjectively). Weak farsighted rarely feel the need to wear a correction from afar – except in visual fatigue case, or after 50. On the other hand, the oversight of accommodation for the near vision is responsible for increased discomfort and towards the quarantine, the need for corrective lenses for reading becomes necessary. It is rather towards the fifties that the vision from afar is perceived as degraded and then compels to wear glasses constantly.

  53. John Sanders says:

    Hello Mr. Ganeshan, I do not understand my problem! And I can't make myself understood by my ophthalmologist...
    I have 42 years and hyperopic corrected since the age of 35 years. Today for 2 eyes: + 2.25 (-0.25 to 130 °)
    I wear my correction permanently otherwise I see blurry from afar and very blurry closely
    By forcing, I can see without correction by far impossible close.
    With my correction, I see FAR and near (even very small characters), yet I have a permanent visual discomfort. When I'm released muscularly or at rest, I see blurry. By "forcing" or "rconcentrant" my view become precise...
    I have just done 12 sessions of orthoptics for a lack of convergence. The values have evolved positively following the balance sheet, but my problem remains...
    I am upset because I often have headaches because of this – it's worse when I'm tired. If you could put me on the right track, I would be very grateful to you because it ruins my life...
    Thank you.
    Very cordially.

  54. Dr. Damien Gatinel says:

    At 42 years old, you are a "pre longsighted". Your accommodative function is no longer as effective, and the fact of wearing correction lenses from afar can induce an apparent "rapprochement" of the image (in close view especially), which on solicits your accommodation, and induces this feeling of discomfort. You may need to equip yourself in progressive glasses with a minimal addition of close; In all case, this would be an interesting test.

  55. Mohammed Leila says:

    Hello doctor,
    First of all, I would like to point out that the questions you are asked and the answers you have made are extremely informative. Thank you.

    For my case, I saw the "mourning" of a vision without glasses. Aged 48 years, my eyesight was brutally degraded (in 1 to 2 months): I began to experience difficulty reading on my computer screens and cell phone (blurred vision). So I started, to make my reading easier, to use so-called "reading Glasses" (1 to 1.5). In continuity, it is my view from afar that has been extremely diminished (blurred vision). I consulted urgently and diagnosed a hyperopia associated with a presbyopia three days ago. Progressive glasses were prescribed to me. Besides the effect of the advertisement, I hardly saw the sensation (dizzy, impressions of vertigo, etc.).

    I immediately thought about the Lasik surgery.
    Do you think I can ask for it now without having to wait a while after getting used to the corrective lenses? I do not know the degree of my hyperopia also.
    Here is the information on my prescription:
    O.D. Sphere + 1.75 Cylinder-0.50 Axis 30 ADD + 1.50
    O.S. Sphere + 1.50 cylinder-0.50 Axis 140 Add + 1.50

    Thank you so much for your lighting.

    Kind regards

  56. Dr. Damien Gatinel says:

    Your clinical history is quite characteristic of what happens in low farsighted become presbyopic. The presbyopia, which is the result of a gradual reduction in accommodation, also disturbs the vision from afar, as it was previously corrected by a partial accommodation, less efficient and disturbed also by the wearing of reading glasses. LASIK is a technique quite adapted to the situation. The correction of the hyperopia is often beneficial not only to the vision from afar, but also to the intermediate vision and vision of close (to a lesser extent). It is not always appropriate to perform a technique of overcorrection or multifocal, if your objective is to find comfort in vision from afar, and an improved intermediate vision. You will however have to wear simple correcting glasses closely for prolonged reading;

  57. Alasin Ousman says:

    Hello, Dr. Ganeshan,

    Let me ask you my question, which is part of what I read here.
    On this subject, Bravo for your enlightened comments, and the quality of your information:-)

    After a consultation with an ophthalmologist, it seems that an intervention is not indicated in my home, because of the density of my Crystalline lens, if I understood correctly.
    I am 55 years old, and I have been testing for two months progressive lenses for my presbyopia, and my weak hyperopia.
    At the moment I have tested two brands Alccon and Cooper vision, but I have very bad results for distant vision, from 5 meters, blurred to possible.
    I don't have this problem with progressive goggles, but on the other hand they give me a headache quickly, as well as nausea.
    Can I hope to find progressive lenses that are OK for close vision, and who, failing to improve vision from afar, who hardly needs it does not aggravate it to the point of making the vision very uncomfortable beyond 5 meters?
    Thank you for your lighting, I keep hope...
    Very cordially.

  58. Dr. Damien Gatinel says:

    In patients who see well from afar without correction, it is difficult to provide a good vision closely without inducing a degradation of vision from afar. In some case, the "rocking" technique can give, at least subjectively, the impression of a preservation of visual acuity from afar (in Monovision, the dominant eye is corrected for the distance, and the non-dominant eye for the Close: Some patients neutralize well the blurred image perceived in vision by far by the non-dominant eye, others not...). A lens test can be conducted with various correction strategies. If these tests fail, it is better to give up surgery, whether it is based on multifocal and/or monovision.

  59. Dr. Damien Gatinel says:

    It is indeed difficult to correct the hyperopia and the presbyopia, without the correction not spouting a little on the vision from far away. You could try other lenses or correction modes. If a cataract appears, surgery could correct all or part of your optical problem (Hyperopia and presbyopia), using for example multifocal implants.

  60. Mpoyenda says:

    Hello my 19 year old daughter is hypermetrope + 8.00 and astigmatism 2
    She wears lentils since the age of 13 and would like to be operated
    At LASIK I think it improves this correction but will certainly still wear glasses
    What correction can we hope for after the intervention? Will she be able to do without a spare scope for recreation?

    Kind regards

  61. Dr. Damien Gatinel says:

    If the astigmatism you report is a negative sign in the formulation of the correction, a quasi-total correction is possible, provided that the local conditions (condition of the cornea) are met. Over time, the effect of a correction of this importance in a young woman can be reduced, and the wearing of a residual correction for activities that require a perfect vision will be necessary. Neanmminus, as far as everyday life is concerned, it should be possible to do without glasses. A detailed pre-operative balance sheet is required to confirm operability.

  62. David candy says:

    Hello doctor GATINEL,
    I am considering refractive surgery to no longer wear glasses, I am 54 years old and I wear glasses since my 40 years.
    Here are my latest corrections in progressive lenses:
    OD: + 2.75 (-0.25 to 30 °) add: 2.00
    OG: + 2.25 (– 0.50 to 150 °) add: 2.00
    Do you think this surgery is possible: laser or implants?
    With all my thanks,
    Well cordially

  63. Dr. Damien Gatinel says:

    If the ophthalmologic examination is normal outside of the hyperopia and presbyopia, a laser correction (LASIK/presbyLASIK) is particularly indicated. A pre-operative assessment including corneal topgoraphy and an objective analysis of ocular transparency are particularly recommended.

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