Guideline:
Care of the patient with hyperopia
Bibliographic Source(s)
- 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]
Guideline Status
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.
Guideline Category
Diagnosis
Evaluation
Management
Intended Users
Health Plans
Optometrists
Guideline Objective(s)
- 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
Target Population
Patients of all ages with hyperopia
Interventions and Practices Considered
Diagnosis
- Patient history
- Ocular examination
- Visual acuity
- Refraction
- Ocular motility binocular vision and accommodation
- Ocular health assessment and systemic health screening
Treatment
- Optical correction
- Vision therapy
- Medical (pharmaceutical)
- Modification of the patient's habits and environment
- Refractive surgery
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not applicable
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation
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.
Major Recommendations
Diagnosis of Hyperopia:
The evaluation of a patient with hyperopia may include but is not limited to thefollowing areas:
- Patient history
- Nature of presenting problem including chief complaint
- Ocular and general health history
- Developmental and family history
- Use of medications and allergies
- Visual acuity
- Distance visual acuity testing
- Near visual acuity testing
- Refraction
- Retinoscopy
- Static retinoscopy
- Near-point retinoscopy
- Cycloplegic retinoscopy
- Subjective refraction
- Autorefraction
- Retinoscopy
- Ocular motility binocular vision and accommodation
- Versions
- Monocular and alternating cover test
- Near point of convergence
- Accommodative amplitude and facility
- Stereopsis testing
- Ocular health assessment and systemic health screening
- Assessment of pupillary responses
- Visual field screening
- Color vision testing
- Measurement of intraocular pressure
- 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
| Type of Patient | Number of Evaluation Visits | Treatment Options | Frequency of Follow-up Visits | Composition of Follow-Up Evaluations | Management Plan | |||
| VA | REF | A/V | OH | |||||
| Young child with mild to moderate hyperopia an and strabismus or amblyopia | 1 to 2 |
| 3 to 12 mos | Each visit | Each visit | Each visit | p.r.n. | No treatment or provide refractive correction; monitor vision |
| Young child with high hyperopia and no strabismus or amblyopia | 1 to 2 |
| 2 to 6 mos | Each visit | Each visit | Each visit | p.r.n. | Provide refractive correction; treat any accommodative or binocular vision problem; monitor vision |
| Young child with mild to high hyperopia and strabismus or amblyopia | 2 to 3 |
| 2 wk to 3 mos | Each visit | Each visit | Each visit | p.r.n. | Provide refractive correction; treat any amblyopia or strabismus; monitor vision |
| Older child with mild to moderate hyperopia | 1 to 2 |
| 6 to 12 mos | Each visit | Each visit | Each visit | p.r.n. | No treatment or provide refractive correction; monitor vision |
| Older child with high hyperopia | 1 to 2 |
| 6 to 12 mos | Each visit | Each visit | Each visit | p.r.n. | Provide refractive correction; treat any accommodative or binocular vision problem; monitor vision |
| Pre-presbyopic adult | 1 |
| 1 to 2 yr | Each visit | Each visit | Each visit | Each visit | No treatment or provide refractive correction; treat any accommodative or binocular vision problem; monitor vision |
| Presbyopic adult | 1 |
| 1 to 2 yr | Each visit | Each visit | Each visit | Each visit | Provide refractive correction; treat any accommodative or binocular vision problem; monitor vision |
VA = visual acuity testing
REF = refraction
A/V = accommodative/vergence testing
OH = ocular health assessment
p.r.n. = as needed
Clinical Algorithm(s)
An algorithm is provided for Optometric Management of the Patient with Hyperopia.
Type of Evidence supporting the Recommendations
The type of supporting evidence is not specifically stated for each recommendation.
Potential Benefits
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.
Potential Harms
Not stated
Qualifying Statements
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.
Description of Implementation Strategy
An implementation strategy was not provided.
Implementation Tools
Clinical Algorithm
Patient Resources
For information about availability see the "Availability of Companion Documents" and "Patient Resources" fields below.
IOM Care Need
Getting Better
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- 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]
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
Funding was provided by the Vision Service Plan (Rancho Cordova California) and its subsidiary Altair Eyewear (Rancho Cordova California)
Guideline Committee
American Optometric Association Consensus Panel on Care of the Patient with Hyperopia
Composition of Group that Authored the Guideline
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.
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
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.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the American Optometric Association Web site.
Print copies: Available from the American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141-7881
Availability of Companion Documents
None available
Patient Resources
The following is available:
- Answers to your questions about farsightedness. St. Louis MO: American Optometric Association. (Patient information pamphet).
Print copies: Available from the American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141-7881; Web site www.aoanet.org.
Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.
NGC STATUS
This summary was completed by ECRI on December 1 1999. The information was verified by the guideline developer on January 31 2000.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions as follows:
Copyright to the original guideline is owned by the American Optometric Association (AOA). NGC users are free to download a single copy for personal use. Reproduction without permission of the AOA is prohibited. Permissions requests should be directed to Jeffrey L. Weaver O.D. Director Clinical Care Group American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141; (314) 991-4100 ext. 244; fax (314) 991-4101; e-mail JLWeaver@AOA.org.
NGC Disclaimer
The National Guideline Clearinghouse™ (NGC) does not develop produce approve or endorse the guidelines represented on this site.
All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies relevant professional associations public or private organizations other government agencies health care organizations or plans and similar entities.
Guidelines represented on the NGC Web site are submitted by guideline developers and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .
NGC AHRQ and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC AHRQ or its contractor ECRI Institute and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.