Do all Hyperopes with Presbyopia, end up in glasses full time?

It depends on how bad the hyperopia is and your particular vision needs.

We see many Delta pilots at the clinic -almost all of them are hyperopic! But they rarely know it and almost never have even heard of hyperopia. Hyperopes have usually never worn glasses or contact lenses, and usually only start to need reading glasses around age 40-50, same as most all people. But unlike most non-hyperopic people, it is usually not too long after they notice a problem developing at distance that, curiously enough, the reading glasses seem to help!

Hyperopic people usually have really excellent distance vision for most of the first half of their lives, often seeing considerably better than 20/20. [That is where the "hyper" comes from.] So it is very common to see so many hyperopic people become pilots and professional athletes.

But their hyperopia doesn't usually become apparent until a year or two after they become dependent on reading glasses. This is because hyperopes have been accommodating their whole life: using the eye's internal muscles to squeeze the eye's natural lens into a shape better suited for near. This accommodation neutralizes what would otherwise be blurred distance vision. Nearsighted people cannot do that!

But hyperopes' accommodation has had to do "double work" their entire lives: accommodation just to keep distance vision focused and then on top of that, accommodation for its real purpose -to read up close. So as everybody's accommodative ability slowly but progressively declines with age, eventually there is no longer enough extra accommodative ability to even keep the distance in focus.

People who have had "super" visual acuity most of their lives are often very unhappy to now need bifocals! These tend to be the best patients for IOL surgery (with or without cataract) because presbyopia-correcting IOLs can treat both hyperopia and presbyopia at the same time. LASIK is not so good an option: it can only reduce hyperopia (and tends to wear off) but not the presbyopia.

J. Trevor Woodhams, M.D. - Chief of Surgery, Woodhams Eye Clinic