| Summary: | Purpose: To report a case that had a progressive decrease in the visual acuity caused by a progressive increase in the hyperopia due to a flattening of the cornea. Observations: A 50-year-old woman complained of decreased vision in both eyes. Her decimal best-corrected visual acuity was 1.2 in the right and 0.5 in the left eyes, and the refractive error (spherical equivalent) was +3.75 diopters (D) for the right eye and +6.5 D for the left eye. Slit-lamp examinations showed clear corneas but Descemet‘s folds and fine pigmentations and opacities were present beneath the corneal epithelium in both eyes. Analysis of the corneal shape by anterior segment optical coherence tomography showed that the corneas were flattened, and the corneal refractive power was decreased in both eyes. The large values of the higher-order aberration in the cornea and total eye displayed bilateral irregular astigmatism. She obtained good vision by wearing hard contact lenses but her refractive power continued to decrease for at least 1 year. Conclusions: and Importance: We report a rare case of progressive hyperopia and irregular astigmatism due to a flattening of the cornea. Folds were present in Descemet‘s membrane but the cornea was not edematous. Keywords: Hyperopia, Irregular astigmatism, Corneal shape, Flattened cornea, Anterior segment optical coherence tomography, Higher order aberrations
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