Latent hyperopia as a hidden contributor to post-COVID-19 asthenopia: A cross-sectional study in young adults with normal visual acuity

Background: Post-COVID-19 escalation in digital device use and sustained near work has increased accommodative load in young adults, frequently unmasking latent hyperopia and triggering asthenopia even in those with normal distance acuity. Aim: The aim is to evaluate the magnitude of latent hyperopia in young adults with mild manifest hyperopia and normal acuity, and its association with asthenopic symptoms and near-work habits. Setting and Design: Cross-sectional study conducted in a tertiary outpatient department. Materials and Methods: A total of 271 participants aged 16–35 years with manifest hyperopia (+0.25 to + 1.00 D) and best-corrected visual acuity 6/6 were enrolled. Exclusion criteria included ocular pathology, strabismus, amblyopia, significant astigmatism, or systemic conditions affecting accommodation. All subjects underwent distance and near acuity testing, manifest and cycloplegic refraction, and Royal Air force ruler assessment. Latent hyperopia was defined as the difference between cycloplegic and manifest spherical equivalents. Symptoms were documented using a structured checklist. Statistical Analysis: Descriptive statistics, Pearson’s correlation, Chi-square test, and ANOVA. Results: Latent hyperopia was present in all participants (mean +0.55 ± 0.17 D). Asthenopia was reported by 186 subjects (68.6%), with significantly higher prevalence among those with latent hyperopia ≥ +0.50 D (84.9% vs. 49.2%). Symptom severity correlated with latent hyperopia ( r = 0.46, P < 0.001) and receded near point of accommodation ( r = 0.39, P < 0.01). Longer daily screen exposure was strongly associated with symptoms ( χ 2 = 13.6, P = 0.001). Conclusion: Latent hyperopia is a significant contributor to asthenopia in digitally active young adults. Routine cycloplegic refraction improves diagnostic accuracy, enabling timely optical correction, visual ergonomics guidance, and targeted rehabilitation when necessary.