• Description: Distance vision blur due to light focusing in front of the retina secondary to either an elongated eye (most common) or a steep cornea; commonly referred to as "nearsightedness" and develops during childhood. 

• Prescribing Considerations: When prescribing glasses or contact lenses for myopia, generally the full correction is given. Depending on the extent of myopia, some patients prefer to wear glasses for distance only and read without their glasses. 

• Patient Education: Discuss importance of distance correction (at school, when driving/meeting legal requirements to drive); discuss increased risk of retinal complications; discuss genetic nature of myopia; discuss reducing progression via limiting near work and spending time outdoors. 

Notes + Additional Treatment Options

Myopia Management

• Myopia typically progresses at a rate of 0.50D per year in children. If you diagnose myopia young or notice a patient progressing faster, consider myopia management.

• Options that can be discussed with the patient and their guardians include glasses, standard contact lenses, multifocal glasses, multifocal contact lenses, atropine therapy, and/or orthokeratology. 

General Refractive Surgery Considerations

• LASIK: up to -12.00D of myopia, 6.00D of astigmatism.

• PRK: up to -12.00D of myopia, 6.00D of astigmatism.

• Implantable Collamer Lenses: between -3.00 to -20.00D of myopia, up to 6.00D of astigmatism.

• Cataract Surgery: patients undergoing cataract surgery can have their myopia corrected by an IOL.

• Description: An underpowered eye in which light focuses behind the retina. In mild-moderate cases, non-presbyopic patients are able to accommodate to place the image on the retina to clear a distant image, but may struggle at near, giving the condition it's common name of "farsightedness". 

• Prescribing Considerations:  Depending on the severity of the hyperopia, prescribing for hyperopes can be tricky! Factors such as accommodative esotropia (see binocularity review section) amblyogenic factors (see binocularity review section), and patient comfort must be considered.
  
  Mild to moderate hyperopes may have difficulty accepting full plus; in these cases, consider trial framing and/or prescribing glasses that reflect the manifest refraction (a.k.a. what the patient is telling you their max plus acceptance is.
  
  Mild hyperopes may see well and be comfortable during adolescence and young adulthood, but may prefer a pair of glasses for near/computer work. These patients often start to become more symptomatic for distance during the onset of presbyopia and you can consider increasing their plus over time. 
  

• Patient Education: Discuss correction options with patients, discuss possibility of increasing prescription over time. 

Notes + Additional Treatment Options

General Refractive Surgery Considerations

• LASIK: up to 6.00D of hyeropia, 6.00D of astigmatism.

• PRK: up to 6.00D of hyperopia, up to 5.00D of astigmatism. 

• Conductive Keratoplasty: +0.75 to +3.00D 

• Cataract Surgery: patients undergoing cataract surgery can have their hyperopia corrected by an IOL. 

• Description: Refractive error secondary to the cornea not being perfectly round; may be regular or irregular (irregular due to ectasia, corneal scarring, etc.) 

• Prescribing Considerations: Typically prescribed in full unless severe and patient is unable to tolerate full cylinder correction. Trial frame patients with high or unequal cylinder between the eyes. 

Notes:

Remember to consider corneal ectasias like keratoconus when a patient has a lot of astigmatism.