Being farsighted: how does a hyperope see?

A farsighted person has an eye that is “too short” or not convergent enough: the sharp image forms behind the retina instead of on it. Near vision demands more effort and quickly becomes tiring, causing eye strain, headaches and reading difficulties. This condition can remain invisible for years thanks to accommodation, then worsen abruptly around the age of forty as the lens ages.

UNDERSTANDING

What is farsightedness?

Farsightedness (hyperopia) is a refractive error, just like nearsightedness or astigmatism. In a normal eye (known as emmetropic), light rays converge exactly on the retina, the light-sensitive membrane at the back of the eye. The image there is sharp. In a farsighted eye, this point of convergence falls behind the retina.

Two mechanisms account for this shift. Most often, the eye is too short from front to back: its axial length is insufficient and the retina sits too close to the cornea and the lens. Less frequently, the eye is of normal length but its optical system is not powerful enough, with a cornea that is too flat or too shallowly curved. In both cases, without correction the image remains blurred as long as the eye does not compensate for this shift itself through accommodation.

Farsightedness is measured in dioptres, with a positive sign (+1.00 D; +3.00 D; +5.00 D, etc.), unlike nearsightedness, which is expressed in negative values. The higher the figure, the greater the error. Many people are slightly farsighted without knowing it, because their eye compensates spontaneously for this small shift from an early age.

VISION

How does a farsighted person see?

Contrary to a widespread belief, a farsighted person does not necessarily see “well far away and poorly up close”. The reality depends on age, on the severity of the error and on the lens’s capacity for accommodation. In a young person, a natural mechanism, accommodation, masks the farsightedness and restores sharp vision, at the cost of a constant and often unconscious effort.

Accommodation that compensates

The lens, the flexible optical element inside the eye, can bulge to increase its optical power. This automatic adjustment is called accommodation. It normally serves to switch from distance vision to near vision. In a young farsighted person, the lens uses it constantly, including at rest, to bring the image back onto the retina. The eye is therefore “working” continuously, even when looking into the distance.

As long as this accommodative reserve is sufficient, vision remains sharp: this is what is known as latent farsightedness, partly invisible to the person concerned. But this sustained effort has a cost: it explains the eye strain and the other symptoms experienced, even when the measured acuity appears perfect.

Distance vision and near vision

Near vision is the most demanding, because it requires adding extra accommodation to that already mobilised to compensate for the underlying error. It is therefore while reading, on screen or when sewing that the discomfort first appears. When the error is high (+3.00 D and above), or when the accommodative reserve declines with age, distance vision eventually blurs as well.

SYMPTOMS

What are the symptoms of farsightedness?

The signs of farsightedness nearly all stem from the constant effort of accommodation. They are often more pronounced at the end of the day, after prolonged work on screen or on documents, or during periods of general fatigue. Here are the most common manifestations:

• Eye strain (asthenopia): heavy eyes, stinging, a sensation of ocular tension after reading or screen use.
• Headaches: often frontal or above the eyes, arising at the end of the day or after a prolonged effort of visual concentration.
• Blurred near vision: difficulty focusing on text, a need to move the book or phone further away to read comfortably.
• Needing to “refocus”: vision becomes sharp again after a blink or a brief effort, a sign of accommodation adjusting itself.
• Difficulties in low light: accommodation is less effective when light is lacking, which worsens the discomfort in the evening.
• In children: reading difficulties, poor concentration, tiredness at school, and sometimes a convergent squint triggered by the excess of accommodative effort.

These symptoms are not specific to farsightedness. Many people attribute them to stress or general fatigue. This is why a complete eye examination by an ophthalmologist remains essential to establish the diagnosis. In children in particular, early screening prevents repercussions at school and reduces the risk of amblyopia.

AGE

Farsightedness and age: the role of presbyopia

Many farsighted people live for decades without noticeable discomfort, then see their symptoms appear or worsen around the age of forty. It is not the farsightedness that increases: it is the accommodative reserve that naturally declines with age, as it does for everyone.

This phenomenon is called presbyopia. The lens gradually loses its flexibility and its ability to bulge. In an emmetropic person, this translates into near-vision discomfort from around 42 to 45 years of age. In a farsighted person, presbyopia arrives earlier and shows up in a more pronounced way, because the lens was already using part of its reserve to compensate for the underlying error.

This is how a farsightedness that was long “latent” becomes “manifest”: the lens can no longer mask the shift. Near vision blurs first, then, over time, distance vision can deteriorate as well. Many patients discover at this stage that they had been farsighted all along. The combination of farsightedness and presbyopia is one of the cases most frequently referred to a refractive surgery consultation after the age of 45. The available solutions are described on the presbyopia page.

CHILDREN

Farsightedness in children and the risk of amblyopia

All newborns are farsighted at birth. The eye grows during the first years of life and the error disappears naturally in most cases. When farsightedness is significant or asymmetric between the two eyes, however, it can lead to serious complications if it is not detected and corrected in time.

Accommodative squint

In a farsighted child, the significant effort of accommodation is neurologically linked to ocular convergence. If the error is too strong, this effort triggers an inward deviation of the eyes: this is convergent accommodative squint, typically diagnosed between 2 and 4 years of age. Full optical correction (glasses with suitable convex lenses) is often enough to correct or significantly reduce this squint by restoring a normal accommodation-convergence balance.

Amblyopia: the lazy eye

Amblyopia refers to a reduction in the visual acuity of one eye that cannot be corrected by glasses alone, in the absence of any organic lesion. It occurs when the eye has not received enough sharp visual stimulation during the critical developmental period (roughly 0 to 7 years). Strong farsightedness, especially if it is more pronounced on one side (anisometropic farsightedness), is one of the major causes of amblyopia in children.

Treatment relies on early optical correction, sometimes combined with occlusion of the dominant eye to force the lazy eye to work. The earlier the management, the higher the chances of recovery. After the age of 7 to 8, cerebral plasticity declines sharply and recovery becomes difficult. This is why ophthalmological screening is recommended from the age of 9 months, repeated at 3 years and at 5 to 6 years.

DIFFERENCES

Farsighted, nearsighted, astigmatic: what are the differences?

These three refractive errors are often confused. Their common feature: the image does not form exactly on the retina. What changes is where and how it forms. The combined visual errors page details the frequent associations.

• Farsightedness: the eye is too short (or not convergent enough), the image forms behind the retina. Corrected with positive dioptres. Near vision is the most taxed; eye strain predominates.
• Nearsightedness: the eye is too long (or too convergent), the image forms in front of the retina. Corrected with negative dioptres. Distance vision is blurred; it is the optical opposite of farsightedness.
• Astigmatism: the cornea is not perfectly spherical, the image is distorted or doubled at all distances. Corrected with a cylinder. It is often associated with farsightedness or nearsightedness.

To understand in detail how astigmatism reads on a prescription, see the being astigmatic page. A single person may combine several errors, farsightedness and astigmatism for example, which calls for a precise spherocylindrical correction. Only a complete refraction examination can measure each component.

CORRECTION

How is farsightedness corrected?

Correcting farsightedness means providing the eye with the converging power it lacks, in order to bring the image exactly onto the retina. This correction relieves the effort of accommodation and makes the eye strain disappear. Several solutions exist, from the simplest to the most durable.

• Glasses: convex (converging) lenses, of positive value, remain the most common and most flexible solution, particularly in children and adolescents. Progressive lenses can correct farsightedness and presbyopia at the same time.
• Contact lenses: they offer a wider field of vision and suit many farsighted adults, provided there is regular ophthalmological follow-up and good wearing hygiene.
• Refractive surgery: in adults whose error has been stable for at least two years, several techniques can durably reduce or eliminate dependence on glasses, following a complete preoperative assessment.

SURGERY

Refractive surgery and farsightedness: what are the options?

Refractive surgery aims to modify the optical geometry of the eye in order to correct the error in dioptres and reduce dependence on glasses. The indication, the technique and the expected result depend on the severity of the farsightedness, on the thickness and shape of the cornea, on the patient’s age and on the absence of contraindications. These criteria are assessed during a complete preoperative assessment.

LASIK and PRK for mild to moderate farsightedness

LASIK and PRK (surface photoablation / Trans-PRK) use an excimer laser to reshape the cornea and increase its curvature, thereby compensating for the lack of power in the farsighted eye. These techniques commonly treat farsightedness up to around +4 to +5 dioptres, sometimes more depending on the available corneal thickness. The accessible range is not defined by dioptres alone: corneal topography and pachymetry, measured during the assessment, are decisive.

SMILE: mainly for nearsightedness

SMILE (small-incision intrastromal lenticule extraction) is essentially indicated for nearsightedness and nearsighted astigmatism. Its use for correcting farsightedness is more limited and not yet widespread; it remains to be discussed on a case-by-case basis.

The phakic implant (ICL) for strong farsightedness

When farsightedness is strong (beyond around +5 D), when the cornea is too thin for safe laser ablation, or when the topography shows irregularities, the phakic implant (ICL/IPCL) is often considered. This implantable lens is placed inside the eye, in front of the natural lens, without removing any corneal tissue. It can correct farsightedness up to around +10 dioptres, with good precision even on strong errors. The phakic implant for farsightedness is a less frequent procedure than for strong nearsightedness: eligibility depends on the size of the anterior chamber and on other anatomical criteria.

Farsightedness after 45: lens surgery

In a farsighted patient over 45 to 50 years of age, whose natural lens is already losing its flexibility, replacing the lens with a multifocal or EDOF implant (refractive lens exchange) can treat farsightedness and presbyopia at the same time. This option is technically close to cataract surgery: it is discussed during the assessment when laser techniques are no longer optimal. To learn more about these implants, see the page dedicated to farsightedness surgery.

FREQUENTLY ASKED QUESTIONS

Frequently asked questions about farsightedness

Sources

• French Society of Ophthalmology (SFO) — Refraction and refractive errors: farsightedness, accommodation, amblyopia.
• College of University Ophthalmologists of France (COUF) — “Ametropias” item: farsightedness, nearsightedness, astigmatism, presbyopia and their corrections.
• French National Authority for Health (HAS) — Recommendations on screening for visual disorders in children and on laser refractive surgery.
• Ameli.fr — French public health insurance service: vision disorders and coverage of optical care.

This article is for information purposes and does not replace a medical consultation. Only a complete ophthalmological examination can assess your farsightedness, establish a personalised diagnosis and discuss the correction solutions best suited to your situation.