Which types of corrective eye surgery are best suited for farsightedness (hyperopia)?

What we call "farsightedness" is one or both of two conditions: Presbyopia and/or Hyperopia. Generally speaking both of these mean your distance vision is better than your up-close vision.

Hyperopia is where your eye is "too short." But unless severe, hyperopia is usually completely compensated for through the "accommodation" of the natural lens in the eye -at least while we are young and we have sufficient accommodation to do so. This accommodative neutralization of hyperopia is so effective that most hyperopic people do not even discover they have a vision problem until they reach middle age! "Accommodation" is the ability of our natural lens to be squeezed into a shape suitable to bring our focus from distance to near. With a young, healthy natural lens in our eye, accommodation is so instantaneous and effortless we don't even know we are doing it. In fact, young hyperopes (people with hyperopia) generally have vision better than 20/20 thanks to this accommodation. Hence the "hyper-" part of the word. [Most airline pilots, snipers, and professional athletes are hyperopic.]

Since low to moderate hyperopia is not apparent to us while we are young, these people do not even look into eye surgery to correct it! However, with age, we slowly lose the ability to accommodate. This gradually affects everybody's near vision, hyperopic or not (Presbyopia). Eventually, as accommodation inevitably decreases, a hyperope ends up not having enough to keep either distance or near vision in focus.

LASIK reshapes the cornea, not the lens of the eye. These laser corneal procedures can usually help distance vision problems, but are not ideally suited to helping near vision. So if your Hyperopia is causing blurred distance vision -and if you are under 45 or so, they may help. But if you are older than that, you undoubtedly have some Presbyopia, too (on top of the hyperopia problems) which means you should probably investigate a lens replacement procedure (IOL) that can help both of these two types of farsightedness at the same time.

_Written by J. Trevor Woodhams, M.D. - Chief of Surgery, Woodhams Eye Clinic