The surgical correction of moderate hypermetropia: the management controversy.

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.