A 46-year-old man complains he cannot read newsprint even when he strains to see. Cycloplegic refraction is +2.50 DS in both eyes and the manifest refraction is also +2.50 DS. His hypermetropia is classified as:
- A Latent hypermetropia
- B Facultative hypermetropia
- C Absolute hypermetropia ✓
- D Pathological (axial elongation related) hypermetropia
Correct answer: C. Absolute hypermetropia
Explanation
Total hypermetropia splits into latent (revealed only under cycloplegia), facultative (correctable by the patient's own accommodation) and absolute (beyond the reach of accommodation). Here the manifest equals the cycloplegic value, meaning none of the error is latent, and at age 46 his residual amplitude cannot overcome +2.50 D, so the whole amount is absolute. Facultative hypermetropia would show a manifest refraction lower than the cycloplegic value because accommodation still clears part of it.
Reference: Parsons' Diseases of the Eye, 23rd ed.
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