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Controversies in ophthalmology
The surgical correction of moderate hypermetropia: the management controversy
  1. C N McGhee1,
  2. S Ormonde1,
  3. T Kohnen2,
  4. M Lawless3,
  5. A Brahma4,
  6. I Comaish3
  1. 1Discipline of Ophthalmology, University of Auckland, New Zealand
  2. 2University of Frankfurt, Germany
  3. 3The Eye Institute, Sydney, Australia
  4. 4Royal Manchester Eye Hospital, Manchester, UK
  1. Correspondence to: C N McGhee, Discipline of Ophthalmology, University of Auckland, New Zealand

https://doi.org/10.1136/bjo.86.7.815

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    Considerable debate still surrounds the best management of hypermetropia and to explore the options in this communication a hypothetical patient is considered at two different ages with identical refraction. Four experienced ophthalmic surgeons (CMcG, TK, ML, and AB) who have undertaken cornea and refractive surgery fellowships and have a combined experience of more than 10 000 refractive surgical procedures were asked to consider the best options for this hypothetical subject, aided by contributions from two fellows (SO, IC).

    The hypothetical patient is a 25 year old woman with moderate hypermetropia and astigmatism: right eye +3.00D/+1.25D × 85 and left eye +5.00/+1.00 × 90. She is currently corrected by spectacles and increasingly intolerant of her rigid gas permeable (RGP) contact lenses, which she has not worn for 6 months. She is keen to seek a solution to her refractive error and self refers for assessment. Members of our expert panel were asked to consider and discuss appropriate options for the patient at age 25, and also for the same individual with an identical refractive error at age 45 years. For the older age, members of the panel were asked to consider complaints of increasing presbyopia in reaching a management plan.

    INTRODUCTION

    The treatment of myopia and myopic astigmatism has evolved significantly since the introduction of radial keratotomy (RK) in the 1970s and the exponential development of photoablative techniques using the 193 nm excimer laser: photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).1 In contrast, the refractive surgical correction of hypermetropia has lagged far behind the advances that have been achieved in treating myopia.1–3 To a far greater degree than encountered in myopia, refractive regression and unpredictability have been reported.2 In general, the hypermetropic eye, compared to the myopic eye, shows important anatomical variations that have to be …

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    Footnotes

    • Series editors: Susan Lightman & Peter McCluskey