The Dynamics of Hyperopia Explained

It is another beautiful day today and all too soon our weekend is here, I am pretty excited about it and I am certain you are too. Weekends are for relaxation as we take a break from the hustle and bustle of the week, have time with the family, and do that binge-watching, etc.

But even as we begin an exciting period I do hope that you are doing well and have been taking good care of your general and ocular health. Well, once I am at your door-steps again then I am sure that most of my readers know I am going to say something about our eyes and you are right, we going to look at some dynamics of one of the components of refractive error and I do hope you enjoy the read as always.

Today I had a 7-year-old child whose mother brought her in because although she started wearing glasses about a year ago due to complaints of not being able to see what's going on in class or what's written on the board, she currently has serious complaints of headaches and pains in the eyes even with the glasses and thus has become a headache and for them for quite a and so they would want to know what can be done to make things better.

After work, I was quite exhausted and so I took a nap only to wake up quite later than I expected, then I saw @lemouth's comment about him not remembering when he started wearing Anti-reflective coated lenses because he has been wearing glasses for as long as he could remember since he was quite young. This reminded me of the child I saw today, so I decided to talk about it.

I hope that providing the answers to the child's problems as was found today would also help others out there who may be long- or short-term wearers with similar issues. And so the questions are why am I still getting headaches and pains when my doctor said me wearing the glasses would make them go away, and what do I need to do now?

Let's begin with the diagnosis the child had, the diagnosis was Simple High Hyperopia hyperopia is a type of refractive error condition where one has difficulties seeing objects nearby clearly however it gets better when they are further away, 6 meters and beyond. The condition is also known as far-sightedness, I am sure this one you may have heard before?

What happens in hyperopia is that the eyeball of the individual tends to be either too short or the refractive ability of the eye which is mainly done by the cornea with support from the crystallin lens tends to be too weak to focus light directly on the retina as it ought to be. When this happens the focus is somewhere further than the retinal point and so blurred images result.

In an attempt to get the images back on track, the eye's system known as accommodation which is normally used for near vision is activated. And so the lens changes its shape and puts in extra effort to generate more refractive power to bring the image onto the retina. When we are young we have a lot of accommodative power and so even if the power required to bring the image to the retina is high our eyes can do this to enable us to see.

But there is so much the eyes can do already and then there's the fact that this system was not meant to be used when viewing objects far off but for near work thus reading, threading a needle, use of the phone or laptop, etc, and so when this system is been used to view objects far off and we need to also do something up close, the system gets overloaded, the work demand overwhelms it and things spiral out of control.

The end result is an inability to sustain near work for long, especially for high hyperopes, the vision becomes blurred after reading for a while, and this is followed by pains in the eye as well as headaches which could be quite severe and may come about so often you could easily be misdiagnosed as a migraine patient. Now if your hyperopia is high enough like in the case of my patient today whose power was almost 10 diopters then you may not need to do near work to experience all this discomfort.

And so what I did for her was something we call wet refraction, where the eyes' accommodative system is paralyzed using cycloplegic eye drops, this was after I used the auto refractor to find out the refractive error within the eyes. What I realized was that whiles her current lenses enabled her to see 6/5 it was about 3 diopters away from the measured power.

Now, these 3 diopters may not seem like much but it is a whole lot for one to be accommodating daily, and because she is a child she had enough power within the eye to be doing this which inevitably has resulted in her asthenopia. Wet refraction revealed that she could actually still see 6/5 with all the powers given for her refractive status however latent hyperopia would have to be catered for.

So given the fact that I needed to let the cycloplegic wear off and increased her power to take care of her headaches and pain I asked them to go home after taking note of everything, she is to come back for review within the following week since the weekend is here already and then the lens would be changed, the powers increased and accommodation relaxed accordingly, she may not be given the entire measured power however she should get better real fast with the increase in power.

Such is the dynamics of hyperopia, it doesn't only happen to kids though and so if you are a lens wearer, unsure of what your diagnosis is but used to experience headaches and pains quite often and was given lenses to help with this and it seems to have come back, then just maybe you may be having a similar case like my patient and may need to go in for another check.

And so do not hesitate to go back to your optometrists if things are still not working quite well for you, it is the reason why reviews are so important and we ought not to skip them. I hope someone has learned something that could help not just themselves but their wards, families, and friends.

_{by @nattygo}

It is always a pleasure to serve you and to share these fun lights with you. As always let me end by reminding us to be particular about our health generally, avoiding counter medication without proper care could save your life as well as sight, if you do not grasp the intensity of this issue check out @apineda's post on heart failure, learn to recognize and you will see the possible damage you put yourself in with that habit. I wish you a wonderful weekend and thanks once again for your time.