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## Complete Summary

#### GUIDELINE TITLE

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.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Hyperopia

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Management

#### CLINICAL SPECIALTY

Optometry

#### 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*

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

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### 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.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

*Diagnosis of Hyperopia*:

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

A.  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

B.  Visual acuity

    1.  Distance visual acuity testing

    2.  Near visual acuity testing

C.  Refraction

    1.  Retinoscopy

        a.  Static retinoscopy

        b.  Near-point retinoscopy

        c.  Cycloplegic retinoscopy

    2.  Subjective refraction

    3.  Autorefraction

D.  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

E.  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**

+-------+-------+-----------------+-------+---+---+---+---+----------+
|       |       |                 |       |   |   |   |   |          |
+-------+-------+-----------------+-------+---+---+---+---+----------+
| *     | **N   | **Treatment     | *     | * |   |   |   | **Ma     |
| *Type | umber | Options**       | *Freq | * |   |   |   | nagement |
| of    | of    |                 | uency | C |   |   |   | Plan**   |
| Pati  | Evalu |                 | of    | o |   |   |   |          |
| ent** | ation |                 | Foll  | m |   |   |   |          |
|       | Vis   |                 | ow-up | p |   |   |   |          |
|       | its** |                 | Vis   | o |   |   |   |          |
|       |       |                 | its** | s |   |   |   |          |
|       |       |                 |       | i |   |   |   |          |
|       |       |                 |       | t |   |   |   |          |
|       |       |                 |       | i |   |   |   |          |
|       |       |                 |       | o |   |   |   |          |
|       |       |                 |       | n |   |   |   |          |
|       |       |                 |       | o |   |   |   |          |
|       |       |                 |       | f |   |   |   |          |
|       |       |                 |       | F |   |   |   |          |
|       |       |                 |       | o |   |   |   |          |
|       |       |                 |       | l |   |   |   |          |
|       |       |                 |       | l |   |   |   |          |
|       |       |                 |       | o |   |   |   |          |
|       |       |                 |       | w |   |   |   |          |
|       |       |                 |       | - |   |   |   |          |
|       |       |                 |       | U |   |   |   |          |
|       |       |                 |       | p |   |   |   |          |
|       |       |                 |       | E |   |   |   |          |
|       |       |                 |       | v |   |   |   |          |
|       |       |                 |       | a |   |   |   |          |
|       |       |                 |       | l |   |   |   |          |
|       |       |                 |       | u |   |   |   |          |
|       |       |                 |       | a |   |   |   |          |
|       |       |                 |       | t |   |   |   |          |
|       |       |                 |       | i |   |   |   |          |
|       |       |                 |       | o |   |   |   |          |
|       |       |                 |       | n |   |   |   |          |
|       |       |                 |       | s |   |   |   |          |
|       |       |                 |       | * |   |   |   |          |
|       |       |                 |       | * |   |   |   |          |
+-------+-------+-----------------+-------+---+---+---+---+----------+
|       |       |                 |       | * | * | * | * |          |
|       |       |                 |       | * | * | * | * |          |
|       |       |                 |       | V | R | A | O |          |
|       |       |                 |       | A | E | / | H |          |
|       |       |                 |       | * | F | V | * |          |
|       |       |                 |       | * | * | * | * |          |
|       |       |                 |       |   | * | * |   |          |
+-------+-------+-----------------+-------+---+---+---+---+----------+
|       |       |                 |       |   |   |   |   |          |
+-------+-------+-----------------+-------+---+---+---+---+----------+
| Young | 1 to  | -   Optical     | 3 to  | E | E | E | p | No       |
| child | 2     |     correction  | 12    | a | a | a | . | t        |
| with  |       |                 | mos   | c | c | c | r | reatment |
| mild  |       | -   Modify      |       | h | h | h | . | or       |
| to    |       |     habits and  |       | v | v | v | n | provide  |
| mod   |       |     environment |       | i | i | i | . | re       |
| erate |       |                 |       | s | s | s |   | fractive |
| hype  |       |                 |       | i | i | i |   | cor      |
| ropia |       |                 |       | t | t | t |   | rection; |
| an    |       |                 |       |   |   |   |   | monitor  |
| and   |       |                 |       |   |   |   |   | vision   |
| strab |       |                 |       |   |   |   |   |          |
| ismus |       |                 |       |   |   |   |   |          |
| or    |       |                 |       |   |   |   |   |          |
| ambl  |       |                 |       |   |   |   |   |          |
| yopia |       |                 |       |   |   |   |   |          |
+-------+-------+-----------------+-------+---+---+---+---+----------+
| Young | 1 to  | -   Optical     | 2 to  | E | E | E | p | Provide  |
| child | 2     |     correction  | 6 mos | a | a | a | . | re       |
| with  |       |                 |       | c | c | c | r | fractive |
| high  |       | -   Vision      |       | h | h | h | . | cor      |
| hype  |       |     therapy     |       | v | v | v | n | rection; |
| ropia |       |                 |       | i | i | i | . | treat    |
| and   |       | -   Modify      |       | s | s | s |   | any      |
| no    |       |     habits and  |       | i | i | i |   | accom    |
| strab |       |     environment |       | t | t | t |   | modative |
| ismus |       |                 |       |   |   |   |   | or       |
| or    |       |                 |       |   |   |   |   | b        |
| ambl  |       |                 |       |   |   |   |   | inocular |
| yopia |       |                 |       |   |   |   |   | vision   |
|       |       |                 |       |   |   |   |   | problem; |
|       |       |                 |       |   |   |   |   | monitor  |
|       |       |                 |       |   |   |   |   | vision   |
+-------+-------+-----------------+-------+---+---+---+---+----------+
| Young | 2 to  | -   Optical     | 2 wk  | E | E | E | p | Provide  |
| child | 3     |     correction  | to 3  | a | a | a | . | re       |
| with  |       |                 | mos   | c | c | c | r | fractive |
| mild  |       | -   Strabismus  |       | h | h | h | . | cor      |
| to    |       |     and         |       | v | v | v | n | rection; |
| high  |       |     amblyopia   |       | i | i | i | . | treat    |
| hype  |       |     therapy     |       | s | s | s |   | any      |
| ropia |       |                 |       | i | i | i |   | a        |
| and   |       | -   Modify      |       | t | t | t |   | mblyopia |
| strab |       |     habits and  |       |   |   |   |   | or       |
| ismus |       |     environment |       |   |   |   |   | str      |
| or    |       |                 |       |   |   |   |   | abismus; |
| ambl  |       | -               |       |   |   |   |   | monitor  |
| yopia |       | Pharmaceuticals |       |   |   |   |   | vision   |
+-------+-------+-----------------+-------+---+---+---+---+----------+
| Older | 1 to  | -   Optical     | 6 to  | E | E | E | p | No       |
| child | 2     |     correction  | 12    | a | a | a | . | t        |
| with  |       |                 | mos   | c | c | c | r | reatment |
| mild  |       | -   Vision      |       | h | h | h | . | or       |
| to    |       |     therapy     |       | v | v | v | n | provide  |
| mod   |       |                 |       | i | i | i | . | re       |
| erate |       | -   Modify      |       | s | s | s |   | fractive |
| hype  |       |     habits and  |       | i | i | i |   | cor      |
| ropia |       |     environment |       | t | t | t |   | rection; |
|       |       |                 |       |   |   |   |   | monitor  |
|       |       |                 |       |   |   |   |   | vision   |
+-------+-------+-----------------+-------+---+---+---+---+----------+
| Older | 1 to  | -   Optical     | 6 to  | E | E | E | p | Provide  |
| child | 2     |     correction  | 12    | a | a | a | . | re       |
| with  |       |                 | mos   | c | c | c | r | fractive |
| high  |       | -   Vision      |       | h | h | h | . | cor      |
| hype  |       |     therapy     |       | v | v | v | n | rection; |
| ropia |       |                 |       | i | i | i | . | treat    |
|       |       | -   Modify      |       | s | s | s |   | any      |
|       |       |     habits and  |       | i | i | i |   | accom    |
|       |       |     environment |       | t | t | t |   | modative |
|       |       |                 |       |   |   |   |   | or       |
|       |       |                 |       |   |   |   |   | b        |
|       |       |                 |       |   |   |   |   | inocular |
|       |       |                 |       |   |   |   |   | vision   |
|       |       |                 |       |   |   |   |   | problem; |
|       |       |                 |       |   |   |   |   | monitor  |
|       |       |                 |       |   |   |   |   | vision   |
+-------+-------+-----------------+-------+---+---+---+---+----------+
| Pre-  | 1     | -   Optical     | 1 to  | E | E | E | E | No       |
| presb |       |     correction  | 2 yr  | a | a | a | a | t        |
| yopic |       |                 |       | c | c | c | c | reatment |
| adult |       | -   Vision      |       | h | h | h | h | or       |
|       |       |     therapy     |       | v | v | v | v | provide  |
|       |       |                 |       | i | i | i | i | re       |
|       |       | -   Modify      |       | s | s | s | s | fractive |
|       |       |     habits and  |       | i | i | i | i | cor      |
|       |       |     environment |       | t | t | t | t | rection; |
|       |       |                 |       |   |   |   |   | treat    |
|       |       |                 |       |   |   |   |   | any      |
|       |       |                 |       |   |   |   |   | accom    |
|       |       |                 |       |   |   |   |   | modative |
|       |       |                 |       |   |   |   |   | or       |
|       |       |                 |       |   |   |   |   | b        |
|       |       |                 |       |   |   |   |   | inocular |
|       |       |                 |       |   |   |   |   | vision   |
|       |       |                 |       |   |   |   |   | problem; |
|       |       |                 |       |   |   |   |   | monitor  |
|       |       |                 |       |   |   |   |   | vision   |
+-------+-------+-----------------+-------+---+---+---+---+----------+
| Presb | 1     | -   Optical     | 1 to  | E | E | E | E | Provide  |
| yopic |       |     correction  | 2 yr  | a | a | a | a | re       |
| adult |       |                 |       | c | c | c | c | fractive |
|       |       | -   Vision      |       | h | h | h | h | cor      |
|       |       |     therapy     |       | v | v | v | v | rection; |
|       |       |                 |       | i | i | i | i | treat    |
|       |       | -   Modify      |       | s | s | s | s | any      |
|       |       |     habits and  |       | i | i | i | i | accom    |
|       |       |     environment |       | t | t | t | t | modative |
|       |       |                 |       |   |   |   |   | or       |
|       |       |                 |       |   |   |   |   | b        |
|       |       |                 |       |   |   |   |   | inocular |
|       |       |                 |       |   |   |   |   | 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.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

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

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### 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

#### 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.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Clinical Algorithm\
Patient Resources

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### 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.

#### DATE RELEASED

1997 (reviewed 2006)

#### GUIDELINE DEVELOPER(S)

American Optometric Association - Professional Association

#### 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](http://www.aoa.org/documents/CPG-16.pdf).

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](http://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>.

### DISCLAIMER

#### NGC DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/10/2008