#SeeTheMusic and More – Hyperopia and performing arts professionals

Hyperopia  and the performing arts professional

As the UK’s only eye care specialists working in performing arts, we know first-hand how eye disorders and refractive errors can negatively impact a professional’s career. The purpose of this blog series is to highlight common eye conditions that performers encounter. Musicians and presenters, dancers and camera operators, sound technicians and singers have all been among the performing arts professionals that we have assisted to see the music.

Refractive errors are the most common cause of vision problems. Nearly 61 percent of people in the UK have vision problems requiring some form of corrective action, with just over 10 percent regularly using contact lenses, and more than half wearing glasses. 

The four most common types of refractive error are:

  • Myopia or Short-sightedness. Myopia results from light focusing just short of the retina due to the cornea or the eyeball being too long.
  • Hyperopia or Long-sightedness. Generally, hyperopia is a result of the eyeball being too short from front to back, or of problems with the shape of the cornea (the top clear layer of the eye) or lens (the part of the eye that helps the eye to focus).
  • Presbyopia or Old Sight. Presbyopia is caused by a hardening of the eyes crystalline lens, which occurs with ageing. As our lenses become less flexible, they can no longer change shape to focus on close-up images.
  • Astigmatism or rugby ball-shaped eyes. Astigmatism causes blurred distance and near vision due to a curvature abnormality in the eye. A person with astigmatism either has an irregular corneal surface or a lens inside the eye that has mismatched curves. 

Hyperopia: Perspectives and challenges

In this article, we discuss how hyperopia affects performing arts professionals and how to deal with it. Performing arts professionals may suffer career-limiting consequences as a result of refractive errors, eye diseases and disorders. A person with hyperopia has difficulty seeing objects that are close to them clearly, while objects at a distance are easy to see. It could be caused by problems with the lens, the cornea, or both. Hyperopia is the opposite of myopia. And it also poses many challenges for performers, presenters, and musicians.  Their numerous working distances present a series of challenges. The need to see the music on the stand is often the biggest problem. However, seeing the conductor, the audience, the soloist and other sections of the ensemble clearly can all be problematic. 

Hyperopia and does it get better over time?

We should all expect our eyes to change as we age. Those who are hyperopic often need reading glasses at a younger age. Eventually, they might also need glasses or contact lenses to see better at a distance.

Complications of hyperopia

Hyperopia does not typically cause complications in adults. However, some children may experience the following complications:

  • Amblyopia (lazy eye)
  • Strabismus (unaligned eyes)
  • Vision development delays
  • Learning difficulties

A hyperopic spectacle correction will correct the refractive error by moving the image onto the retina and bringing it into focus, but it also induces magnification, which can be problematic in itself. The magnification reduces the field of view and can compromise peripheral vision.

#SeeTheMusic and more

The visual demands of those who work in production are also diverse. Members of the production team must view multiple screens on the video monitor wall in the production control room. Scripts, running orders, and musical scores are also typically reviewed by the team. Focusing at multiple distances can be challenging in a fast-paced environment such as this.

The question we are frequently asked as performing arts eye care specialists is “What makes musicians’ and performers’ eyes so special?”. A performer’s vision isn’t special, but the way they use it is. Performing artists are very similar to athletes in the many visual demands that they are presented with.

All sports, both competitive and non-competitive, require good vision skills, and different sports have different requirements. This is also true for most performers, whether they be professionals or amateurs. Using advanced diagnostic equipment and investigative techniques, Allegro Optical has developed detailed assessments of vision skills for artists and performers of all ages.

What special vision requirements does a performer need? It’s one or more of the following skills:

  • Vision focusing: The ability to change focus quickly and accurately between objects at different distances. For example, a musician needs to read the music on the stand, look at their conductor and other sections of the ensemble all at different distances clearly and accurately.
  • Vision fixation: The ability to read sheet music, often at a fast tempo, no matter how fast it’s moving.
  • Peripheral vision: The ability to see and observe out of the corner of your eye when looking at a fixed object such as sheet music on the stand. In an orchestra, a player must be able to see both their stand partner or another member of their section even when they may be unable to alter their head position due to their instrument.
  • Focusing regulation: The ability to retain eye coordination during high-speed activities or while under high physiological pressure.

Effective treatment of Hyperopia

Spectacles

Hyperopia presents unique challenges when wearing spectacles as peripheral vision is often impaired due to the magnification element of a hyperopic lens. There are several disadvantages of spectacles for a hyperopic correction, among them an enlarged retinal image size, peripheral distortions, and a reduced field of vision, which is exacerbated by the magnification. All of which presents the performer with performance-limiting challenges. As Shaun Hooke – Principal Trumpet of the RTE Concert Orchestra said “Uncertainty with your vision is just as serious as a mechanical failure with your instrument. That moment of indecision increases performance pressure, leads to mistakes and stops you from giving your best”.

Thinned and flattened lenses are popular among hyperopes spectacle wearers who aim to improve the appearance of their glasses. These lenses also provide a reduced magnification element and provide a more natural image. Just like the myopic correction discussed in our previous blog, the denser lens materials can produce unwanted chromatic aberration.  Chromatic aberration, also called chromatic distortion or spherochromatism, is a failure of a lens to focus all colours to the same point. 

Contact lenses

Contact lenses can be used to correct hyperopia in cases where spectacles are inconvenient. The lightweight and near-invisible properties of contact lenses make them appealing to performers, but the correction can sometimes be less satisfactory, as contact lenses lack magnification elements. Hyperopic contact lens wearers often complain that they can’t see as well in contact lenses as they can with spectacles.  In addition to a long-wear period and a dry, warm and often dusty environment, wearing contact lenses on stage can also exacerbate dry eyes. Most contact lens wearers experience dry eye symptoms toward the end of the day. Unfortunately, the majority of musicians perform in the evening, so this often coincides with their performances. For musicians, especially those who work as freelancers or session musicians, dry eyes can lead to blurred patches of vision that make sight-reading difficult.

Laser eye surgery

During laser eye surgery, small areas of your cornea are burned away to increase the curvature of the cornea to focus a beam of light on your retina.

In general, laser eye surgery can be divided into three types:

During photorefractive keratectomy (PRK), the cornea is shaped using a laser to remove tissue and reshape it, in order to change its refractive properties

The laser epithelial keratomileusis (LASEK) procedure is similar to PRK, but involves softening the cornea with alcohol to remove a flap of tissue and reposition it afterward, and changing the shape of the cornea with a laser.

Laser in situ keratoplasty (LASIK) – this procedure is similar to LASEK, but the corneal flap is smaller. When it comes to treating hyperopia that is related to corneal contour, LASIK is quite effective. Most LASIK patients achieve a vision of 6/12 or better, which means they will no longer need glasses or contact lenses to see clearly on a daily basis. But you may still need help with sight reading. The likelihood of LASIK success has increased due to the development of wavefront scanning technology, so today’s LASIK patient can expect even better results.

The majority of these procedures are performed in an outpatient setting. The local anaesthesia numbs your eyes while the procedure is performed, which usually takes less than 30 minutes

LASIK and LASEK are typically the preferred methods owing to their painless nature, and because you can usually see again within a few hours or days after the procedure. As a word of caution, it can sometimes take up to a month for vision to stabilise.

Lens implant surgery

Lens implants are another option for treating hyperopia. A small incision is made in the cornea to implant an artificial lens into your eye to focus light more clearly onto the retina.

This procedure is suitable for those with extreme hyperopia or who struggle to wear glasses or contact lenses.

Lens implants fall into two categories:

Phakic implants replace your natural lens without removing your natural eye lens; they are usually preferred by younger people with a normal natural vision for reading

Refractive lens exchange (RLE) is an operation similar to cataract surgery in which the natural lens is removed and replaced with an artificial one.

It is typically done under local anaesthesia, and the procedure can It is typically done under local anaesthesia, and the patient can usually go home the same day. The procedure is usually done separately for each eye

In Summary

Both performers and amateurs can benefit from these treatments. However all the above do have limitations and side effects. As performers ourselves our unique perspective enables us to offer balanced, impartial advice.

Our optical specialists understand the demands of professional musicians and performing arts professionals. Working in collaboration with our dispensing opticians and optometrists, we are able to assist musicians. It is surprising how many musicians are unaware of the many solutions available to them. 

With the precision of our performing arts eye exams, the expertise of our optometrists and dispensing opticians and their access to cutting edge diagnostic equipment and dispensing procedures our unique approach can help to resolve hyperopic performing arts practitioners vision problems.

Contact: To find out more about Allegro Optical, the musicians’ opticians go to; https://allegrooptical.co.uk/services/musicians-optical-services/

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