CASE REPORT

HYPEROPIA & PRESBYOPIA ODS

Zakiyuddin Abd. Azam
H1A015069

FACULTY OF MEDICINE
UNIVERSITAS OF MATARAM
2019
Introduction
• Hyperopia (hypermetropia, farsightedness)  non accommodating eye focuses
the shadow behind the retina. Can be caused by reduced axial length, decrease in
the index of refraction (refractive hyperopia), or a lack of corneal curvature or the
lens so that the shadow is focused behind the retina (hypermetropy curvature).
• total prevalence in US  around 10% (14 million), with a prevalence of around
9.9% in people aged 40 years and over.
• A study reports that hyperopia is most commonly found in Hispanic populations,
followed by the American, African-American and Pacific Islands populations, and
most rarely in Asian and Caucasian populations. Gender differences are not
known to be related to the prevalence of hyperopia.
• Family history, mothers who smoke during pregnancy, prematurity, and low birth
weight are associated with the incidence of hyperopia. Living in rural areas is also
associated with a higher prevalence of hyperopia than urban areas. In addition,
diabetes mellitus can also be associated with hyperopia.
Con’t
• People with hyperopia usually experience accommodative asthenopia
(fatigue eye, dizziness, headache, glare, watery, burning sensation, blurred
vision, and so on). In addition, esotropia can also occur in patients with
hyperopia. People with hyperopia tend to experience presbyopia more
quickly, namely the condition of the irreversible loss of accommodative
power (of the lens) due to the aging process.
• diagnosis of hyperopia is done by a visual examination, assessment of
refraction and physical examination of the eye
• A correction lens can help shadows fall right on the retina. In addition, it
can also be corrected by surgery under certain conditions. If the patient
has experienced presbyopia, a plus lens for close reading can also be given
according to the reading distance and age of the patient.
Case Report
Patient Identity
• Name : Drs. H. Supriyadi
• Age : 62 years old
• Jenis Kelamin : Male
• occupation : retired employe
• Religion : Islam
• rate : Sasak
• Adress : Kel. Tanjung Karang, Sekarbela, Mataram.
• Date of examination : 17 July 2019
Anamnesis
• Main Complaint: Blurred vision for far and near objects
• Current Medical History: The patient came to the Eye Clinic of the RSUP NTB
because the vision was increasingly blurred. Blurred vision began to be felt
around 15 years ago, especially when reading at close range. Since then, patients
have begun to use glasses with the right and left sizes of +0.50 each which are
purchased from overhang eyeglass traders. Since then, patient routinely use the
same glasses. When patient has health insurance, he begins to check his eyes to
the ophthalmologyst and routinely change his glasses every 2 years, but patients
do not remember the size. The last glasses the patient uses are S-1.50 and
S+3.00, same for the right and left eye. Currently, patient complains that his
glasses are no longer suitable for reading near or looking far away, so the patient
feels his eyes get tired easily, headache and a blurred vision. Therefore, patient
comes to change his glasses size. The patient dienies eye pain, red eyes, glare and
foggy vision.
Past medical History
• eye disease: the patient experiences impaired vision since the age of
around 48 years and routinely uses glasses, especially when reading.
The size of the glasses is also routinely changed every 2 years.
• other diseases: Patients deny hypertension, diabetes mellitus,
cholesterol, heart and kidney disease. A history of trauma to the eye
and the use of certain drugs are also denied by the patient.
History of Family diseases:-
Allergy History: -
Treatment history: using glasses since around 15 years ago
Social History
• The patient is a retired civil servant since around 2.5 years ago. The
patient is a smoker, but the patient denies having experienced
respiratory illness or other metabolic diseases. The patient also said
that he used to consume enough water every day from childhood.
• The habit of patients since school that they never left behind was like
being in front of a computer.
Physical Examinations
General stats
• General condition : good
• GCS : Compos mentis/E4V5M6
Vital signs
• BP : 120/80 mmHg
• HR : 84 x/m
• RR : 16 x/m
•T : 36.6OC
 Eye Physical Examination
No Examination Right eye Left eye
1. Visus 6/9 6/6 F2
2. Pinhole 6/6 6/6
S+1,00  6/6 S+1,00  6/6
correction
(confort) (confort)
Add S+3,00 Add S+3,00
3. Eyeball position Ortophoria Ortophoria
4. Eyeball movement Normal, all direction, Smooth Normal, all direction, Smooth
movement, full range, pain (-), movement, full range, pain (-),
nystagmus (-) nystagmus (-)

5. Upper eyelid Edema (-) (-)

Hyperemia (-) (-)
Pseudoptosis (-) (-)
Entropion (-) (-)
Ectropion (-) (-)
Trichiasis (-) (-)
Scar (-) (-)
tenderness (-) (-)
No Examination Right eye Left eye
6. Lower eyelid Edema (-) (-)
Hyperemia (-) (-)
Pseudoptosis (-) (-)
Entropion (-) (-)
Ectropion (-) (-)
Trichiasis (-) (-)
Scar (-) (-)
7. Palpebraic fissura + 10 mm + 10 mm
8. Upper and lower palpebraic Hyperemia (-) (-)
conjunctive
Follicle (-) (-)

Papil (-) (-)

Scar (-) (-)

Anemia (-) (-)

chemosis (-) (-)

9. Bulbic conjunctive Conjunctival injection (-) (-)

Cilliary injection (-) (-)

(-) (-)
Subconjunctival bleeding

Pterygium (-) (-)

Pinguecula (-) (-)

No Examination Right eye Left eye
10. cornea shape Convex Convex
Clarity Clear clear
surface Slippery impression Slippery impression
scar (-) (-)
Foreign object (-) (-)
11. COA depth Deep impression Deep impression
Hyphema (-) (-)
Hypopion (-) (-)
12. Iris Color brown brown
shape round and regular round and regular
13. Pupil shape Round round
DLR (+) (+)
ILR (+) (+)
14. Lens clarity Clear clear
Iris Shadow (-) (-)
Subluxation (-) (-)
dislocation (-) (-)
15. IOP Palpation normal normal
Visual field
Diagnosis
• Hyperopic Presbyopia ODS
Treatment
• Correction lens S+1.00 Add +3.00 for the right and left eye
Presbyopia
• Quo ad vitam : ad bonam
• Quo ad sanam : dubia ad malam
• Quo ad cosmeticam : ad bonam
• Quo ad functionam : dubia ad bonam
Education
• Explain to patients and families of patients that the patient has
hypermetropic and presbyopic eye abnormalities that cause the
patient's vision to blur, especially at close range.
• Explain to patients and their families that the therapy for
abnormalities of nearsightedness is to use glasses that are in
accordance with the correction.
• Explain to patients and their families so that patients routinely carry
out a sharp examination of vision every 1 year.
Discussion
• The diagnosis of this patient is ODS Presbyopic Hypermetropy based on the results of the
history and physical examination performed. Tie the results of the history found that the
patient complained of blurred eye vision, especially when reading at close and clearer
distances if slightly distanced. However, objects that are too far away are also sometimes
seen blurred by the patient. Complaints have been felt for about 15 years and patients
have routinely changed the size of their glasses every 2 years. Red eye complaints, glare,
dirt on the eyes, and foggy views denied by the patient.
• In patients with hyperopia, the most common complaint is a blurred view when looking
at a short distance and improves when viewing long distances, especially when the
patient is reading. This is because the shadow of objects located far away is focused
behind the retina by the eyes that do not accommodate and the beam cannot be
focused on one point sharply. feel blurred at a distance, so the ability to see near
diminishes. This is found in patients with presbyopia.6 As a result of the eyes that
continue to try to accommodate to see objects near, the eye will experience
accommodative asthenopia.4 In these patients, the symptoms of accommodating
asthenopia such as the eyes are tired and dizzy.
Discussion
• Examination of ophthalmological status was not found in the presence of turbidity of
refractive media and obtained initial visualization of OD 6/9 and OS 6/6 with reading
errors of 2 letters. After visualization of both eyes with an S + 1.00 D lens with Add S +
3.00, visualization of both eyes became 6/6. In these patients, glasses therapy is
provided with the lens according to the results of the correction. Hypermetropy patients
are given a lens correction plus so that the shadow that had fallen behind the retina can
be focused so that it falls right on the retina. Usually the size of the lens provided is the
strongest and according to patient comfort. Whereas presbyopia is also needed for the
provision of a lens plus additional reading distance. Usually given according to the age of
the patient taking into account their comfort. For example, a 40-year-old patient will be
given an add + 1.00D supplemental lens, or at the age of 60 as in this patient, given an
add + 3.00D lens.
• Giving glasses therapy according to correction is done to improve the patient's vision. A
visual examination every 1 year is recommended to monitor the progression of refractive
abnormalities suffered by the patient. The education provided to patients aims to
prevent rapid progression and maintain the best possible state of vision.
Conclusion
• A male patient aged 62 years has been reported with a diagnosis of
hypermetropy with ODS presbyopia. The diagnosis is based on the results
of the history because the patient complains of blurred vision both at close
reading distance and viewing distant objects. There is also a history of
using glasses plus additional reading lenses for patients since about 15
years ago. From subjective physical examination, there was a decrease in
vision and a decrease in reading power, so a correction glasses of S + 1.00
were given with add +3.00 in the right and left eyes.
• Hypermetropy and presbyopia cases are often found, especially in older
patients. Therefore, enforcement of the diagnosis and the provision of
appropriate therapy is expected to increase patient productivity in carrying
out work and daily activities.
References
• Riordan-Eva, P & Whitcer, JP. 2009. Vaughan & Asbury: Oftalmologi
umum, edisi 17. Jakarta: EGC.
• Ilyas, S et al. 2002. Ilmu Penyakit Mata Untuk Dokter Umum dan
Mahasiswa Kedokteran. Edisi ke-2. Jakarta : Sagung Seto.
• Carpenter, N & Grigorian AP. 2015. Hyperopia. American Academy of
Opthalmology. [online] Available at: <https://eyewiki.aao.org/Hyperopia>.
• Lang, GK et al. 2000. Ophthalmology: a short textbook. New York: Thieme.
• Dentone P & Afshari N. 2015. Presbyopia. American Academy of
Opthalmology. [online] Available at: <https://eyewiki.aao.org/Presbyopia>.
• Snell, RS. 2012. Anatomi Klinik Untuk Mahasiswa Kedokteran. Edisi 6.
Jakarta: Penerbit Buku Kedokteran EGC.
Thank You