Astigmatism is a common vision problem caused by an error in the shape of the cornea. With astigmatism, the lens of the eye or the cornea, which is the front surface of the eye, has an irregular curve. This can change the way light passes, or refracts, to your retina, causing blurry, fuzzy, or distorted vision.
In this article, we delve deeper into astigmatism, including types, who’s at risk for it, and how it’s diagnosed and treated.
The two main types of astigmatism are corneal and lenticular. A corneal astigmatism happens when there’s a defect or distortion in the cornea. A lenticular astigmatism happens when there’s a distortion in the lens.
Astigmatisms are sometimes also described as regular or irregular. A regular astigmatism occurs when the eye isn’t completely curved. So instead of being round like a basketball, it might take the shape of a football. This often leads to blurry, distorted vision.
An irregular astigmatism, which is less common, also occurs when the eye isn’t completely round. But unlike a regular astigmatism, where the eye is evenly misshaped, an irregular astigmatism has an uneven curvature. This defect also causes distorted vision and blurriness.
It’s not known what causes astigmatism, but genetics is a big factor. It’s often present at birth, but it may develop later in life. It may also occur as a result of an injury to the eye or after eye surgery. Astigmatism often occurs with nearsightedness or farsightedness.
Sometimes, though, a rare condition called keratoconus causes astigmatism. This eye disease affects the cornea, causing the clear tissue on the cornea to thin and bulge out. This leads to cloudy or blurry vision, and sensitivity to bright lights. The cause of keratoconus is also unknown, but it’s believed to be hereditary, too.
Keep in mind that while reading with low or dim lights can make it harder for eyes to focus, it doesn’t harm vision or cause astigmatism. However, if you already have an eye with astigmatism, and you read in low light, you might notice increased blurriness.
Astigmatism is a type of refractive error. These are common eye disorders that make it difficult to see clearly. The shape of the eye is unable to bend light correctly, and as a result, vision can become hazy, blurry, or doubled.
Nearsightedness (myopia) is a type of refractive error that makes distant objects appear blurry or distorted. Other symptoms can include headaches, eye strain, and squinting. Nearsightedness happens when the eyeball is too long, or when the cornea curves too much.
On the other hand, farsightedness (hyperopia) is an inability to focus on objects up close — but you’re able to see distant objects clearly. This vision problem happens when your eyeball is too short, or when the cornea doesn’t curve enough.
Astigmatism can occur in children and adults. Your risk of developing astigmatism may be higher if you have any of the following:
- a family history of astigmatism or other eye disorders, such as keratoconus (degeneration of the cornea)
- scarring or thinning of your cornea
- excessive nearsightedness, which creates blurry vision at a distance
- excessive farsightedness, which creates blurry close-up vision
- a history of certain types of eye surgery, such as cataract surgery (surgical removal of a clouded lens)
The symptoms of astigmatism may differ in each person. Some people don’t have any symptoms at all. The primary symptoms of astigmatism include:
- blurry, distorted, or fuzzy vision at all distances (up close and far away)
- difficulty seeing at night
- eye irritation
See a doctor if you have symptoms of astigmatism. Some symptoms may also be due to other health or vision problems.
An optometrist or ophthalmologist diagnoses astigmatism through a comprehensive eye exam.
- An optometrist is a doctor who diagnoses vision problems and eye diseases.
- An ophthalmologist is a doctor who provides medical and surgical treatment of vision problems and eye diseases.
There are several tests optometrists and ophthalmologists may use during your eye examination to diagnose astigmatism.
Visual acuity assessment test
During a visual acuity assessment test, your doctor will ask you to read letters from a chart at a specific distance to determine how well you can see the letters.
A refraction test uses a machine called an optical refractor. The machine has multiple corrective glass lenses of different strengths. Your doctor will ask you to read a chart while looking through lenses that are different strengths on the optical refractor. They’ll eventually find a lens that appropriately corrects your vision.
Keratometry is a way for your doctor to measure the curvature of your cornea. They will do this by looking at your eye through a keratometer.
Astigmatism is measured in diopters, which is the optical power of a lens. If your eye doesn’t have astigmatism, you have a diopter of 0. If you have one, though, you’ll likely have a diopter greater than 0.5. Treatment isn’t usually necessary for a slight astigmatism, but you might need contacts or glasses for a diopter measurement of 1.5 or higher.
The only part of an optical prescription associated with astigmatism are the cylinder and axis. The cylinder part of the prescription measures the degree or extent of the irregularity. Doctors use the axis measurements to determine the location of an eye astigmatism on the cornea.
Mild cases of astigmatism may not require treatment. Your doctor may treat astigmatism that causes vision problems by using one of the following methods.
Orthokeratology (Ortho-K) is a treatment that uses rigid contact lenses to temporarily correct the irregular curvature of your cornea. You’ll wear rigid contact lenses for limited periods of time. You may wear them during sleep and then remove them during the day.
Some people have clear vision during the day without corrective lenses when undergoing Ortho-K. The benefits of Ortho-K are only present when using it. Your vision will return to its previous state after stopping Ortho-K.
Your doctor may recommend refractive surgery if you have a severe case. This type of surgery involves using lasers or small knives to reshape your cornea. This will permanently correct your astigmatism.
Common surgeries for astigmatism are:
|Laser in situ keratomileusis (LASIK)||A surgeon cuts a thin flap in the cornea, and then uses a laser to reshape it (before closing the flap).|
|Photorefractive keratectomy (PRK)||A surgeon uses a laser to change the shape of the cornea, which improves how light rays focus on the retina.|
|Laser-assisted subepithelial keratectomy (LASEK)||This eye surgery involves loosening the protective cover over the cornea, and then using a laser to fix an incorrect curvature.|
|Small incision lenticule extraction (SMILE)||A surgeon changes the shape of the cornea by using a laser to create a disc-shaped piece of tissue below the surface of the cornea.|
|Epi-LASIK||In this procedure, a surgeon removes the top or outer layer of the cornea, and then uses a laser to reshape it.|
All surgeries carry some risks. Talk to your doctor about the risks and benefits before getting surgery for astigmatism.
If left untreated, astigmatism can cause complications. For example, a lazy eye (amblyopia) can occur when a person has astigmatism in only one eye, or the astigmatism in one eye is worse than the other, and the condition isn’t corrected. Additionally, astigmatism can sometimes cause eye strain and headaches.
Surgery to treat astigmatism also has risks. Side effects of surgery are often temporary and improve within a few weeks. These include dry eyes, sensitivity to light, and night vision problems.
But other (and more permanent) complications can occur, too, such as vision loss or vision reverting to pre-surgery state.
The exact cause of astigmatism isn’t known, and treatment might be necessary depending on the extent of this eye condition.
Wearing contact lenses or glasses can improve vision, or your eye doctor might suggest surgery. Treatment not only helps vision, it can reduce the risk of complications like a lazy eye, eye strain, and headaches.