PRESBYOPIA vs HYPEROPIA – what is the difference?

Farsightedness

What is important to know?

Farsightedness (hypermetropia) is a common congenital vision condition. It represents a refractive error of the eye – light focuses not directly on the retina but slightly behind it.

To see clearly, the eye is forced to strain and compensate for this imbalance. The closer the object we are looking at, the more effort is needed.

In children and young people, the eyes usually manage to compensate for farsightedness without noticeable complaints. However, with age, this compensatory mechanism weakens, and around the age of 35–40, the first symptoms of eye strain appear, especially during prolonged work:

• headache
• pain and heaviness around the eyes
• tearing and burning

To neutralize the eye’s refractive error, glasses (or contact lenses) with a ‘plus’ diopter are prescribed. They focus light precisely on the retina and relieve discomfort by reducing eye strain. Therefore, it is necessary to wear them constantly.

Prescribing glasses for farsightedness often requires conducting cycloplegia – a prolonged examination involving multiple applications of eye drops. After the examination, near vision is blurred for several hours or a day.

More sensitive patients sometimes find it somewhat difficult to adapt to the new diopters, even though they have been precisely determined. This is normal, as prolonged (over years) eye strain causes spasm and rigidity of the fine eye tissues. Gradually, patients adapt, and the complaints subside.

However, constant wearing of glasses is quite tedious. Fortunately, modern refractive surgery also offers a solution for farsighted patients, who do not tolerate glasses. At PENTAGRAM Eye Hospital for this purpose, we use the FemtoLASIK method. This is one of the most innovative methods for correcting nearsightedness, farsightedness, and astigmatism, during which vision correction is performed using two state-of-the-art lasers of the latest generation. The entire procedure lasts about 15-20 minutes. The patient is under local anesthesia and feels nothing. Half an hour after the procedure, they are free to go home, and as early as the next day, they can ‘get rid of their glasses.’

In children, high farsightedness is dangerous because, if not corrected in time, it can cause lazy eye (amblyopia).

Presbyopia (age-related farsightedness)

Presbyopia, also known as ‘age-related farsightedness,’ is a natural process that gradually occurs as we age. The cause is the weakening of the tissues in the eye, leading to the loss of the ability to focus on nearby objects (located less than 5 meters away).

When does it appear?

In people without other vision issues (with ‘zero diopter’), presbyopia usually begins at around 40–45 years of age.

In patients with farsightedness (with a positive diopter), this condition occurs earlier, while in those with nearsightedness (with a negative diopter), it occurs later.

How does it feel?

The most typical complaint is that ‘arms are getting shorter’ – i.e., when reading or doing close-up work (30–50 cm), objects appear blurry and need to be moved further away to be seen clearly. When attempting to focus up close, the eye becomes strained, leading to:

• headache
• tearing
• burning and stinging

How is it corrected?

With so-called ‘reading glasses’ – glasses with a positive diopter that assist the weakened visual system in focusing up close. They relieve symptoms and restore visual comfort.

Over time, the eye gradually loses its ability to focus up close completely. Therefore, glasses need to be adjusted every 1–2 years, with the diopter increasing as required. This is a normal process that cannot be stopped or slowed down.

Myths and misconceptions:

• ‘If I don’t wear glasses, I will train my eyes.’ – False. Avoiding glasses does not improve vision; it only causes more fatigue and discomfort.
• ‘Glasses spoil the eyes.’ – Also false. The reason for presbyopia is the age-related weakening of tissues, not the wearing of glasses.
• “My eyes have deteriorated from working on a computer or under artificial lighting.” – That is also not true. Presbyopia is a natural age-related change and is not linked to lifestyle.

What should you do?

The best solution is to consult an ophthalmologist at the first signs of visual fatigue. The specialist will perform an examination and prescribe suitable reading glasses. These are used whenever you need to look at objects less than 1 meter away. Keep in mind that these glasses are intended only for close vision – when looking into the distance, the image will be blurry.

In selected cases refractive surgery – laser or with intraocular lens implantation – can be offered to patients who cannot adapt to reading glasses. Whether this option is suitable for you can be determined by scheduling a consultation with our specialists.

Author: Dr. Ina Antonova,
resident at Pentagram Eye Hospital