• American Optometric Association. Care of the patient with hyperopia. St. Louis (MO): American Optometric Association; 1997. 56 p. (Optometric clinical practice guideline; no. 16). [124 references]

This is the current release of the guideline.

According to the guideline developer, this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.

Hyperopia

Diagnosis
Evaluation
Management

Optometry

Health Plans
Optometrists

• To accurately diagnose hyperopia
• To document the patient care treatment options for patients with hyperopia
• To identify patients at risk for the adverse effects of hyperopia
• To minimize the adverse effects of hyperopia
• To preserve the gains obtained through the treatment
• To inform and educate parents, patients, and other health care practitioners about the visual complications of hyperopia and the availability of treatment

Patients of all ages with hyperopia

Diagnosis

1. Patient history
2. Ocular examination
   • Visual acuity
   • Refraction
   • Ocular motility, binocular vision and accommodation
   • Ocular health assessment and systemic health screening

Treatment

1. Optical correction
2. Vision therapy
3. Medical (pharmaceutical)
4. Modification of the patient's habits and environment
5. Refractive surgery

Not stated

Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases

The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.

Not stated

Expert Consensus (Committee)

Not applicable

Review

Not applicable

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

The Reference Guide for Clinicians was reviewed by the American Optometric Association (AOA) Clinical Guidelines Coordinating Committee and approved by the AOA Board of Trustees.

Diagnosis of Hyperopia:

The evaluation of a patient with hyperopia may include, but is not limited to, thefollowing areas:

1. Patient history
   1. Nature of presenting problem, including chief complaint
   2. Ocular and general health history
   3. Developmental and family history
   4. Use of medications and allergies
2. Visual acuity
   1. Distance visual acuity testing
   2. Near visual acuity testing
3. Refraction
   1. Retinoscopy
      1. Static retinoscopy
      2. Near-point retinoscopy
      3. Cycloplegic retinoscopy
   2. Subjective refraction
   3. Autorefraction
4. Ocular motility, binocular vision, and accommodation
   1. Versions
   2. Monocular and alternating cover test
   3. Near point of convergence
   4. Accommodative amplitude and facility
   5. Stereopsis testing
5. Ocular health assessment and systemic health screening
   1. Assessment of pupillary responses
   2. Visual field screening
   3. Color vision testing
   4. Measurement of intraocular pressure
   5. Evaluation of anterior and posterior segments of eye and adnexa

Management of Hyperopia:

The specific elements of treatment should be tailored to individual patient needs. Among the factors to consider when planning treatment and management strategies are the magnitude of the hyperopia, the presence of astigmatism or anisometropia, the patient's age, the status of accommodation and convergence, the demands placed on the visual system, and the patient's symptoms.

Among several available treatments for hyperopia-related symptoms, optical correction of the refractive error with spectacles and contact lenses is the most commonly used modality. It is the optometrist's responsibility to advise and counsel the patient regarding the options and to guide the patient's selection of the appropriate spectacles or contact lenses. Vision therapy and modification of the patient's habits and environment can be important in achieving definitive long-term remediation of symptoms. The use of pharmaceutical agents or refractive surgery may also be used in treating some patients.

The frequency and composition of evaluation and management visits of patients with hyperopia are summarized in the table, below.

Frequency and Composition of Evaluation and Management Visits of Hyperopia

VA = visual acuity testing
REF = refraction
A/V = accommodative/vergence testing
OH = ocular health assessment
p.r.n. = as needed

An algorithm is provided for Optometric Management of the Patient with Hyperopia.

The type of supporting evidence is not specifically stated for each recommendation.

The early diagnosis and treatment of significant hyperopia and its consequences can prevent a significant amount of visual disability in the general population. Because hyperopia is usually not readily apparent, preventive examination of all young children is essential. Periodic eye and vision examinations are needed thereafter to help ensure the provision of treatment appropriate to the changing visual needs of the hyperopic patient.

Not stated

Clinicians should not rely on this Clinical Guideline alone for patient care and management. Please refer to the references and other sources listed in the original guideline for a more detailed analysis and discussion of research and patient care information.

An implementation strategy was not provided.

Getting Better

Effectiveness
Patient-centeredness

• American Optometric Association. Care of the patient with hyperopia. St. Louis (MO): American Optometric Association; 1997. 56 p. (Optometric clinical practice guideline; no. 16). [124 references]

Not applicable: The guideline was not adapted from another source.

1997 (reviewed 2006)

American Optometric Association - Professional Association

Funding was provided by the Vision Service Plan (Rancho Cordova, California) and its subsidiary Altair Eyewear (Rancho Cordova, California)

American Optometric Association Consensus Panel on Care of the Patient with Hyperopia

Members: Bruce D. Moore, O.D. (Principal Author); Arol R. Augsburger, O.D., M.S.; Elise B. Ciner, O.D.; David A. Cockrell, O.D.; Karen D. Fern, O.D.

AOA Clinical Guidelines Coordinating Committee Members: John F. Amos, O.D., M.S. (Chair); Kerry L. Beebe, O.D.; Jerry Cavallerano, O.D., Ph.D.; John Lahr, O.D.; Richard L. Wallingford, Jr., O.D.

Not stated

This is the current release of the guideline.

According to the guideline developer, this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.

None available

This summary was completed by ECRI on December 1, 1999. The information was verified by the guideline developer on January 31, 2000.