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Hyperopia or hypermetropia “farsightedness” is a refractive error which affects many people. The understanding of hyperopia is quite complicated. The term “farsightedness” plays a role that makes people misunderstand what hyperopia really is?
Hyperopia is wrongly called “farsightedness.” I met patients who think that they can see far things better than normal people do, because they have ”farsightedness,” and put a red line under the word “far”.
Farsightedness as a term has no much things to do with the real meaning of the condition “hyperopia.” Hyperopia affects far and near vision of the person. It is true that it affects near vision more than far vision. Also, in its lower degrees, its effect on far vision is not that obvious, but symptoms are that obvious at far and near. Hypermetropia or “hyperopia” is different from “presbyopia.” Presbyopia is the refractive error that solely affects near vision with age and could easily be corrected with a multifocal contact lens.
Hyperopia “Farsightedness” Meaning & Definition
Let us put terms away in our explanation of hyperopia. We don’t want to define hyperopia linguistically here. So, we will not get stuck with terms which may be wrong or, at least, suggest wrong understanding. Let us understand hyperopia “farsightedness” as it is really is before anyone calls it hyperopia or “farsightedness.”
Scientists found that some people eyes do not focus images as normal eyes do. The light rays of images in these people don’t bring to concentrate in the retina (where they are supposed to). They reach the retina before they are focused. Or in other words, if their extension is drawn, they will focus on the retina as you see in the image below.
Hyperopia “Farsightedness” Causes
In hyperopia, the images reach the retina before they are focused for two causes:
- The length of the eye is shorter than normal, and that’s why the light rays of the images reach the retina before they are focused. If the eye has the normal length, these light rays focus will be located in the retina.
- The eye has less ability to bend light ray’s “refraction” than the normal eyes. So, the eye is not able to focus light rays in the appropriate location “the retina” because its refractive power is lower than the “required power.”
Until now, the above words are extremely true and right but not for all circumstances. And here it comes the point. Here it comes the secret key in the understanding of hyperopia.
The above words are correct when the light rays entering the eye are parallel and not diverged — all light rays coming from 6 meters distance or further entering the eye as parallel light rays. All parallel light rays need the same refractive power “eye’s ability to bend light rays” to be focused in the same location in the eye.
When light rays enter the eye from any distance less than 6 meters, the equation changes here. Light rays entering the eye (from less than 6 meters) diverge and not parallel. These light rays need different refractive powers to be focused in the same location in the eye.
Light rays coming from 4 meters distance reach the eye more diverged than light rays coming from 5 meters. Thus, the light rays coming from 4 meters distance need more refractive power than those coming from 5 meters to be focused in the same location in the eye. Also, light rays coming from 3 meters need more refractive power than that needed for light rays coming from 4 meters to be focused in the same location in the eye. The shorter the distance light rays entering the eye (for any distance less than 6 meters), the more refractive power is needed by the eye to focus them in the same location.
For this mission (focusing diverge light rays), Our eyes have a unique ability that enables it to increase its power. This ability occurs by changing the eye lens shape and is called “accommodation.”
Normal Refractive Power
Originally, this mission is required by normal people. The eye has the same normal refractive power to focus all parallel light rays, coming from 6 meters or further, on the retina. For any diverge light rays (coming from less than 6 meters), the eye use “accommodation” to increase its power by the appropriate amount to focus these light rays in the retina.
In very short words, now we know that all people eyes can increase its refractive power “accommodation.“ But as we knew earlier, the eye in hyperopia has less refractive power than normal. So, the secret key is that the eye in hyperopia takes advantage of “accommodation” to compensate for its less power in hypermetropia.
If the eye doesn’t use accommodation, parallel light rays coming from 6 meters or further reaches the retina before they are focused. But in fact, the eye uses accommodation and increases its power to make these light rays focus in the retina. If light rays are coming to diverge (from less than 6M), the eye exerts more accommodation for any nearer distance to focus these light rays in the retina.
So, what’s the problem then? The eye is using its accommodation to correct hyperopia.
But accommodation has limits. So, it can’t correct all degrees of hyperopia.
Also, different distances need different powers. Nearer distances need more powers, and that’s why hyperopia is famous to be the problem of near.
With all that, accommodation is exhausted with time. As we know, accommodation’s basic function is near work in normal people. Using it for functions other than what is normally made for leads to “symptoms.”
Hyperopia “Farsightedness” Symptoms
When the eye uses accommodation for distance tasks in hyperopia, accommodation is exhausted with time and this cause eye strain and headaches.
Accommodation is capable of correcting low degrees of hyperopia and makes the vision clear at a distance. However, it can’t alter higher degrees of hyperopia, and blurred distance vision is occurring.
Near vision tasks require more refractive power and the eye in hyperopia has less refractive power than normal. This makes hyperopia causes more problems in close tasks. Near vision is blurred constantly or after few periods of near work in hyperopia. Also, eye strain and headaches are more evident in near tasks because the doubled role required by accommodation.
Also, age is an important factor in the symptoms of hyperopia because the amplitude of accommodation decreases with age. Younger persons have more amplitude of accommodation and thus can compensate higher degrees of accommodation with fewer symptoms. Also, lower degrees of hyperopia may present in young persons with no symptoms.
However, older persons have a lower amplitude of accommodation, and thus can’t compensate for hyperopia as younger people do. Low degrees of hyperopia may present with no symptoms until the person reaches 30 years age or older.
So, how hyperopia is treated?
Hyperopia “Farsightedness” Treatment
- Eyeglasses: your eye doctor will prescribe eyeglasses. The prescription contains a number of the power of the lens that will correct your hyperopia. This lens power will increase your eye’s refractive power to focus images on the retina.
- Contact lenses: with the same idea of spectacle’s lenses, contact lenses rest on your cornea and correct your hyperopia. Contact lenses have some advantages over glasses which are:
- Cosmetic appearance: as some people don’t like how they look when wearing glasses and colored ones can even enhance your looks.
- Optical advantages: the quality of images reach the eye is better in contact lenses than in glasses especially in high hyperopia (over 6 Diopters hyperopia). Also, contact lenses are a better choice when there is a considerable difference between the amount of hyperopia in each eye.
- Refractive Surgery: this treatment alternative gives you the freedom to have clear corrected vision without wearing glasses or contact lenses. The most commonly used procedures nowadays are:
- PRK: in this procedure, the surgeon reshapes your cornea by applying laser directly on it. This increases the power of the cornea and makes the eye able to focus images on the retina.
- Lasik: In this procedure, the surgeon makes a flap in the outer cornea. He then applies laser pulses to the intermediate corneal tissues to correct the hyperopia.
- ICL (Implantable Collamer Lens): This is a new procedure invented to correct refractive errors. An intraocular lens is implanted in the eye that corrects your hyperopia.
Readership surveys consistently find readers want local news and anything presented in narrative form. Currently sought after by editors, the narrative has come in, and out of fashion since Charles Dickens wrote for newspapers. Critics have called creative non-fiction, literary non-fiction, new journalism or feature writing.
Other than his two novels, Tom Wolfe writes narrative non-fiction. Sebastian Junger used narrative non-fiction to write The Perfect Storm.
Elements of Narrative
Narrative non-fiction borrows some, not all, of the techniques of fiction. It specifically uses narrative form, character, setting, and voice. It may also use foreshadowing and flashback.
The narrative has two forms or structures – two-part and three-part.
Two-part narrative, used for very brief pieces, follows the ancient form of the joke. It has a premise and a punch line. The writer has located that valuable ending, the punch line. The premise anticipates that punch line. A vast array of conventions exists to foreshadow the punchline in the premise.
The three-part narrative has a structure, a beginning, middle and end, known in fiction as complication, action, and resolution. In the complexity, a sympathetic character encounters something unexpected. The best complications involve basic emotions and facts of life: love, hate, pain, death, disability, extreme danger. In the middle, the character or characters take action to overcome the complication. The ending must resolve the complication – the character wins or loses the struggle.
The complication requires a sympathetic character. Sympathetic does not necessarily mean likable. It means someone with a character trait or traits the reader can relate to. The sympathetic character must have a determination, or at least a readiness, to act. The character must have the motivation to overcome the complication. No motivation, no story.
In some great stories, the setting becomes so strong critics call it another character. Every story must have a setting or settings. This seems obvious, but, reports need little or no setting. A report of a governmental body making a decision in the seat of government takes place in that amorphous seat of government here or there or somewhere else. Narrative requires specific place. Sonia Nazario’s Pulitzer Prize-winning story ”Enrique’s Journey” in the LA Times could only happen in the boy’s journey from Honduras to the U.S. to find his mother.
Many fiction writers have said, find the voice, you’ve found the story. Beyond choosing first-person, second or third, the writer has to find a tone appropriate to the story. Junger narrates The Perfect Storm in a third-person voice as coldly objective as the nor’easter of his subject. Wolfe narrates Electric Kool-Aid Acid Test in the excessive language appropriate to the times of that subject.
Two Key Ideas of Narrative
- Always look for endings.
- Don’t let the facts get in the way of a good story.
A report has no beginning or end, only middle. A story has a beginning, middle, and end. Beginnings, great and small, happen every day. Middles occupy the majority of people’s lives. The writer of the story always looks for endings. Endings indicate story. With the ending, the storyteller works backward through the middle to locate the beginning.
Accessory facts attach to nearly every good story. Too many of these facts, related to but not essential to the core story, can weigh it down until it devolves into a report. Accessory facts have a place, but not in the story. They belong in sidebars or graphics.
Putting it together
Narrative non-fiction needs some type of outline and extensive re-writing. Any experienced reporter can open the notebook and write. The narrative writer has to spread out the material gathered through reporting and find the best path through. The outline can take many forms, from a simple list to index cards pinned to a corkboard or wall. The first draft shows what the outline could not imagine. The fourth draft improves the third.
The development of the technologies used in modern contact lenses is something far more significant than can be dealt justice in this article. We are fortunate today to have an unprecedented amount of options for managing vision defects at our disposal! Glasses and contact lenses can both be manufactured in record time and volume and made available at prices that are within reach, for all socioeconomic levels. This is the first time in history that vision correction has been so easy and effective; it’s important to stress that, while we’re comparing the merits of different types of contact lenses today, neither rigid nor soft lenses can be called a bad choice. They’re simply different solutions for similar problems.
Modern rigid, gas-permeable lenses, what you’ll be buying when you ask for hard contact lenses, are a major step up from previous hard lenses. A hard lens consists of a small, finely shaped piece of a firm, rigid, transparent polymer; the most common such material is polymethyl methacrylate (PMMA). PMMA is marketed under a wide variety of names. For instance, you’re probably familiar with Plexiglas. Plexiglas is PMMA. Treated appropriately before being put into service, PMMA is a durable, cost-effective, and completely safe material and an ideal choice for a contact lens. It is gas-permeable, as with all materials used for hard lenses in the current day, which is important.
Lenses which are non-gas permeable don’t allow oxygen to reach your cornea. When wearing such lenses for extended durations, such as overnight, there’s a real risk of corneal hypoxia. That’s nasty business! Among other things, corneal hypoxia carries a risk of causing corneal ulcers. I’ll spare you the clinical details, but it’s safe to say that there’s a real risk of a permanent decrease in vision. It is a very positive thing that contemporary hard lenses don’t have this problem anymore!
Now, let’s discuss the merits of hard lenses. Chief among these would be their rigidity. Hard lenses sit on top of the eye and don’t necessarily have to conform to its exact shape. As a result, they can correct defects like astigmatism, which soft lenses cannot. If you have astigmatism, hard lenses aren’t just your best bet for contact lenses; they’re your only bet! Soft lenses won’t do the job you need them to. None of the other points matter under these circumstances: hard lenses work, soft lenses don’t. That’s not saying that soft lenses are an inferior product, they just have their pros and cons, much like hard lenses.
Soft lenses, on the other hand, are made from a hydrogel, and most of the market is based explicitly on a silicone hydrogel right now. The hydrogels are semi-solid and very similar to the biological components of your eye in their moisture and consistency. This makes soft lenses more comfortable and easier to get used to. Furthermore, hydrogels, especially the most common silicone hydrogels, have far better oxygen permeability than the materials used in even the most cutting-edge rigid lenses. You can wear an oxygen-permeable rigid lens overnight, but you can wear a continuous-wear soft lens for a month at a time if you absolutely must. The silicone hydrogels are more hydrophobic than some other forms of hydrogels, which slightly reduces their comfort, but they’re still a step up from hard lenses.
What’s more, hydrogels are also offered in a disposable form, so you can simply buy a set of lenses, wear them until the end of their lifespan, and replace them with a new one when that comes to an end. This is far easier than cleaning and maintaining hard lenses, which requires pricey specialized cleaning solutions, and if done wrong can risk causing an eye infection. On the downside, though, soft lenses aren’t as durable as hard ones; as a result, there are environments where it’s simply not possible to wear them.
So, what’s the best choice for your contact lens type? That depends. Talk to your optometrist and consider your personal needs and wants; at the end of the day, the best contact lens is the one that’s most compatible with your eyes and your lifestyle.
In Jodi Picoult’s novel Keeping Faith — religious phenomenon, prior psychological history, and adultery issues complicate the custody battle between the parents of a special little girl named Faith White. Picoult uses this novel not only to question whether it can ever be said that there is one true religion but also to look at what makes a parent fit to raise a child. Keeping Faith is a novel that has readers mystified and wondering right to the very last page, and perhaps even beyond.
What Happens When a Jewish Child Experiences Stigmata and Talks to God?
Religion plays a large role in Keeping Faith. Faith White grew up the child of a Jewish mother and a Christian father, but in her life had no real exposure to either faith. This is what made it particularly surprising when little Faith White began to talk to God and repeat verses from the Bible shortly after her mother and father divorced. When Faith began to experience bleeding such as that Christ would have experienced, heal babies, and even brought her grandmother back to life after doctors had pronounced her death she became the obsession of religious people far and wide.
Can God Be a Woman?
Faith became a household name to people of all religions and could not even step out of her house without being harassed by crowds of people. She was questioned by Rabbis and Priests and became a target for an atheist TV host whose aim in life was to prove God did not exist.
The two ideas that many could not wrap their heads around were the facts that a child who did not believe Jesus was the Messiah could be chosen by a Christian God to display the wounds of Christ and that the God Faith White communed with was showing herself to the child as a woman. The fact that God was a woman made some question whether Faith was talking to God at all or whether her mother was manipulating her to say so. It was also questioned whether or not Faith White’s mother may have been inflicting wounds on the child and this is part of the reason for the subsequent battle.
Can Prior Depression Make a Future Unfit Parent?
A major issue explored in Keeping Faith was whether Faith White’s mother could be declared an unfit mother and assumed to be harming her child because she had a history of mental illness. When Faith’s mother was pregnant with her, she was committed by her husband to a mental hospital where she was treated for depression. Faith’s mother had tried to kill herself after finding out her father had cheated on her. When Faith and her mother walked in on her father with another woman in their own home Faith’s parents decided to divorce. Shortly after this Faith’s religious experiences and stigmata began, and her father implied her mother was repeating her prior breakdown, only this time hurting Faith.
It must be said that there was no evidence of her mother falling apart to the point of being unable to function again even though these claims were made. The court battle that ensued questioned whether a prior illness could predict a future problem and whether Faith should be taken away from her mother because of this.
Keeping Faith is not a light read, but it is a novel that will leave the reader wanting to devour the book in one sitting. Jodi Picoult did a wonderful job defining characters and spinning a tale that was not only valid in today’s society, but also mysterious.
Picoult, Jodi. Keeping Faith. Harper Collins Publishers, 2008. ISBN: 0061374962