Farsightedness (Hyperopia): Surgery

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Surgery

Several types of surgery are available to treat farsightedness (hyperopia). Surgery is done to reshape the cornea so that light is refocused directly on the retina.

The goal of surgery is to allow people who are farsighted to see clearly without corrective lenses or to be less dependent on them. Most doctors consider 20/40 vision or better after surgery a satisfactory result. People with 20/40 vision or better are allowed to drive a car without corrective lenses.

Laser surgery for farsightedness is not as common as surgery to correct nearsightedness (myopia). This is because the cornea must be reshaped and steepened to correct farsightedness, which is more difficult than it is to flatten it, as is done to correct nearsightedness. Therefore, LASIK is done for lower degrees of farsightedness. Other options are also available, such as conductive keratoplasty and thermal keratoplasty.

Other procedures used to treat farsightedness include phakic intraocular lenses and clear lens extraction with intraocular lens implant. These options can correct high degrees of farsightedness. Both of these procedures involve implanting an intraocular lens (IOL) into the eye. As clear lens extraction leads to the loss of the ability to accommodate, this may be the best option for older people with severe farsightedness who have already naturally lost this ability.²

Surgery Choices

There are several types of surgery used to treat farsightedness.

• Hyperopic laser in-situ keratomileusis (H-LASIK), which uses a laser to steepen the central cornea, is becoming the most commonly used surgery to treat farsightedness. H-LASIK is about as effective as H-PRK, but H-LASIK is associated with less postoperative pain and quicker stabilization of vision. H-LASIK corrects mild to moderate hyperopia more predictably than more severe cases.
• Excimer laser photorefractive keratectomy for hyperopia (H-PRK) is a procedure that also uses a laser to change the shape of the central cornea, making it steeper. This changes the refractive power of the lens and focuses light entering the eye on the retina. H-PRK requires no cutting or flap, but the procedure is painful and heals more slowly than H-LASIK. H-PRK can correct mild to moderate hyperopia more predictably than more severe cases.
• Thermal keratoplasty is a technique that uses heat to change the shape of the cornea by shrinking the collagen fibers in the cornea. There are two types of thermal keratoplasty: noncontact (laser thermokeratoplasty, or LTK) and contact (conductive keratoplasty). A risk involved in either type is the possibility of inducing astigmatism.
• Clear lens extraction with an intraocular lens (IOL) implantation, in which the clear lens is removed from the eye and an IOL is implanted in its place, has been used to correct severe farsightedness. The surgery provides predictable results and rehabilitation is quick, but an eye that receives this treatment loses the ability to accommodate, and there is a risk of retinal detachment. Phakic intraocular lenses, in which an IOL is placed in the eye with the natural lens left in place, have been used with good results in early trials and have been approved by the United States Food and Drug Administration (FDA).

What To Think About

Most farsighted people do not require treatment for the condition. Of those who do, most get satisfactory results from using eyeglasses and contact lenses. Surgery to treat farsightedness, now more common with the increasing availability of LASIK, is best for low degrees of farsightedness.

For some people who find glasses or contact lenses inconvenient, surgery to correct farsightedness may be appropriate. However, farsightedness is not a disease, and a farsighted eye is otherwise normal and healthy. Some eye specialists question whether these procedures are appropriate for anyone, because most people can have good vision with eyeglasses or contacts.

Weigh your desire to have clear vision without glasses or contacts against the risks of surgery. Ask your eye doctor any questions about surgery that you have (for example, what are the risks, benefits, possible outcomes, and alternatives to surgery) so you have a balanced understanding and can make the best decision.

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Last updated:	December 19, 2005
Author:	Kathe Gallagher, MSW
Reviewed By:	Martin Gabica, MD - Family Medicine, Carol L. Karp, MD - Ophthalmology
Editors:	Kathleen M. Ariss, MS, Tracy Landauer