Astigmatism

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What is Astigmatism?

Astigmatism is a common eye condition. It is usually caused by the presence of a non-uniform shape to the cornea, with the cornea being more or less steeply curved in particular areas (meridians). The development of abnormalities in the natural lens inside your eye may also cause or contribute to astigmatism.

Normally, the combined refractive properties of the cornea and crystalline lens focus light rays sharply on the retina of your eye. In astigmatism, the lights rays of an object come to focus non-uniformly (a-stigma) in two planes. If short-sightedness (myopia) or long-sightedness (hypermetropia) are also present, the planes may be focused in front of or behind the retina, resulting in blurred vision.

  • Blurred vision for distance, intermediate and near vision
  • Headache after prolonged activities that require visual attention; this is often caused by partially closing the eyelids, as this tends to improve the vision
  • Increased difficulty with night vison, as the enlarged pupil at night-time tends to induce ‘night myopia’

The cause of astigmatism is not fully understood. Genetic factors are considered to play an important role and astigmatism is well known to run in families. High levels of astigmatism can be present in infancy, but it then declines rapidly during development and remain stable in childhood.

Astigmatism and other refractive errors can be diagnosed by your optometrist (optician) or eye doctor. The examination involves a refraction in order to assess the refractive status of the eye.

In the presence of moderate to high levels of astigmatism, a corneal topography scan may be indicated to exclude the presence of keratoconus; this scan maps the shape of the cornea in order to ascertain whether its shape is regular and thus normal. A rapid increase in myopia and astigmatism can also be a sign of keratoconus, a progressive condition in which the cornea becomes weaker and bulges forward; this requires further investigations.

Astigmatism 1
Vision blurred for objects at both short & long distances.

Astigmatism Correction

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How can astigmatism be treated?

Treatment options for astigmatism include glasses, contact lenses and refractive eye surgery.

  • The vast majority of patients with astigmatism use glasses to see better. With moderate to high prescriptions however, glasses can be difficult to adjust to and may reduce the quality of vision with peripheral distortion.
  • Specialised soft toric and rigid gas permeable contact lenses can be used to treat astigmatism as the contact lens compensates for the difference in refractive power across the cornea. Contact lenses also correct co-existing long sightedness or short sightedness at the same time.
  • A more permanent solution to astigmatism can be provided by refractive surgery. Depending on your prescription, eye measurements and visual needs, a variety of procedures are available, including LASIK, SMILE, toric phakic IOL, e.g. ICL, and refractive lens exchange.
  • Laser eye surgery is an excellent treatment modality that reshapes the cornea. In LASIK, excimer laser sculpts the cornea to make its surface and refractive power uniform, correcting the astigmatism. If you have astigmatism and also wear reading glasses, LASIK can incorporate a PRESBYOND blended vision treatment to reduce or eliminate your need for reading glasses. SMILE is a keyhole alternative to LASIK that uses femtosecond laser to reshape the cornea; no flap is created in SMILE, preserving better biomechanical stability of the cornea and allowing a more rapid return to intense physical activities and swimming than with LASIK.
  • A toric Implantable Collamer Lens (ICL) is like a permanent plastic contact lens that is implanted inside your eye, in front of your natural lens. No one can see this phakic lens and you cannot feel its presence in your eye. It is a safe alternative to LASIK and SMILE, but it is usually reserved for higher prescriptions when laser eye surgery may not be the best option.

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