Expert Articles

Hyperopia & Astigmatism

Author: Vanessa Thai
Developmental and Behavioural Optometrist
Central Health Southside – Child Development Team


What Is It?

Hyperopia, also known as longsightedness or farsightedness, is a refractive error where distant objects are seen more clearly than near ones. Hyperopia occurs when there is an imbalance between the length of the eye and the refractive power of the cornea, causing light to focus behind the retina, rather than on it, leading to blurred images.

Risk Factors

Family History

Hyperopia can have a hereditary component. If there is a family history of significant hyperopia, the child may have an increased risk of having higher degrees of hyperopia or experiencing a progression of the condition over time.


Premature birth or low birth weight may increase a child’s risk of developing hyperopia.

Accommodation or Focusing Ability

Accommodation is the ability of the eye to adjust its focusing power to see objects at different distances. In some cases, the focusing system may not function optimally, leading to difficulties in compensating for hyperopia. This can result in the perception of blurred vision or eye strain despite efforts to accommodate.

Signs and Symptoms

Most children have slight hyperopia, which is usually compensated for by their ability to adjust the lens shape for refocusing, or accommodating. However, significant hyperopia can lead to blurred distance and near vision. While some children may not show any noticeable signs, others may display behaviours that indicate visual challenges with:


Children with hyperopia may squeeze their eyelids together in an attempt to improve focus and clarity. This temporarily alters the way light enters the eye and potentially reduces the impact of hyperopia.

Eye rubbing

Excessive eye rubbing can be a sign of eye strain or discomfort related to an uncorrected prescription. Children may rub their eyes to alleviate any blurred vision or eye fatigue caused by their hyperopic refractive error.

Frequent headaches

Hyperopia can cause eye strain, which may lead to headaches, especially after prolonged near visual tasks such as reading or drawing. These headaches can occur regularly and may be more pronounced in the afternoon or evening.

Avoidance of close-up tasks

Children with hyperopia may show reluctance or avoidance when engaging in activities that require near vision, such as reading, colouring, or drawing. They may express frustration or fatigue when attempting these tasks.

Short attention span

Hyperopia can make it challenging for young children to sustain focus on close-up objects or tasks for an extended period. They may appear easily distracted or have difficulty maintaining attention during activities that require near vision.

Eye fatigue

Hyperopia may lead to eye fatigue, especially after prolonged near work. Children may appear tired or report achy eyes, particularly towards the end of the day or after engaging in activities that demand visual concentration.

Poor eye-hand coordination

Hyperopia can affect depth perception and visual-motor integration, making it more challenging for children to coordinate their eye movements with their hand movements. This can impact activities such as catching a ball, stacking blocks, drawing, or in some cases, delayed motor development.


Cases of moderate to high hyperopia can contribute to strabismus (eye misalignment).

Misalignment can occur as the eye muscles struggle to compensate for the refractive error.

It is important to note that these symptoms are not exclusive to hyperopia and can be indicative of other visual conditions or issues. An optometry evaluation is crucial to accurately diagnose hyperopia and determine the appropriate management and intervention.

Treatment Options

In many cases, mild to moderate hyperopia is a normal part of a child’s visual development and tends to improve naturally as they grow older. This is because the eyeball elongates and the focusing system of the eye becomes more mature, a process called emmetropisation.

However, it’s important to note that not all children will experience a spontaneous improvement in hyperopia. In some cases, hyperopia can persist or even worsen over time. This can occur due to several factors, including genetic predisposition, environmental influences, or other underlying eye conditions. Regular eye examinations, even in the absence of symptoms, are recommended to monitor visual development and detect any potential issues early on.

In cases where hyperopia causes visual discomfort and difficulty with visual tasks, prescription spectacle glasses or contact lenses may be prescribed to help the child see more clearly and support their visual development. Vision therapy or other interventions may also be recommended if additional visual skills, such as eye coordination or focusing abilities, need to be addressed.

It is important to understand that the course of hyperopia can vary among individuals, and each child’s visual development is unique. Close collaboration with an optometrist will help ensure an appropriate course of action is implemented to support optimal visual function.


What Is It?

Astigmatism is a common refractive error in which both near and distant objects are blurred or distorted. Individuals who are hyperopic or myopic (shortsighted) often also have astigmatism, or astigmatism can occur by itself. Uncorrected astigmatism can cause eyestrain, headaches, and tired eyes at the end of the day.

Causes of Astigmatism

Astigmatism occurs due to the cornea or lens having an irregular shape, causing light to be focused unevenly. This leads to blurred or distorted vision.

Signs and Symptoms

While some children with astigmatism may not exhibit noticeable signs and symptoms, others may experience symptoms similar to those of hyperopia, with eye strain and headaches being the most prominent indicators when their visual performance is affected. An optometrist will be able to assess if your child’s astigmatism requires treatment.

Treatment Options

In cases of mild astigmatism, your child may be prescribed glasses for part-time use. This correction aims to improve your child’s vision and provide visual comfort, especially during visually demanding activities that require focus and concentration. For moderate to severe astigmatism, full-time correction is recommended to ensure visual clarity and avoid potential amblyopia. In some instances, contact lenses may be an option.

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Hyperopia & Astigmatism