Astigmatism is diagnosed with an eye exam. A complete eye exam involves both a series of tests to check eye health and a refraction, which determines how the eyes bend light. Your eye doctor may use various instruments, aim bright lights directly at your eyes and ask you to look through several lenses. Your doctor uses these tests to examine different aspects of your eyes and vision and to determine the prescription needed to provide clear vision with eyeglasses or contact lenses.
The goal of treating astigmatism is to improve vision clarity and eye comfort. Treatments are corrective lenses or refractive surgery.
Wearing corrective lenses treats astigmatism by counteracting uneven curvatures of your cornea or lens.
Types of corrective lenses include:
- Eyeglasses. Eyeglasses are made with lenses that help compensate for the uneven shape of the eye. The lenses make the light bend into the eye properly. Eyeglasses can also correct for other refractive errors, such as nearsightedness or farsightedness.
Contact lenses. Like eyeglasses, contact lenses can correct most astigmatism. They are available in a variety of types and styles.
Contact lenses are also used in a procedure called orthokeratology. In orthokeratology, rigid contact lenses are worn during the night while sleeping until the curvature of the eye evens out. Then the lenses are worn less frequently to maintain the new shape. If treatment is discontinued, the eye returns to its former shape and refractive error.
Wearing contact lenses for extended periods of time increases the risk of infection in the eye.
Ask your eye doctor about the pros and cons and risks of contact lenses and what might be best for you.
Refractive surgery improves vision and reduces the need for eyeglasses or contact lenses. An eye surgeon uses a laser beam to reshape the curves of the cornea, which corrects the refractive error. Before surgery, doctors will evaluate you and determine if you're a candidate for refractive surgery.
Types of refractive surgery for astigmatism include:
- Laser-assisted in-situ keratomileusis (LASIK). With this procedure, an eye surgeon makes a thin, hinged flap in the cornea. He or she uses an excimer laser to sculpt the shape of the cornea and then repositions the flap.
- Laser-assisted subepithelial keratectomy (LASEK). Instead of creating a flap in the cornea, the surgeon loosens the cornea's thin protective cover (epithelium) with a special alcohol. He or she uses an excimer laser to change the curvature of the cornea and then repositions the loosened epithelium.
- Photorefractive keratectomy (PRK). This procedure is similar to laser-assisted subepithelial keratectomy (LASEK), except the surgeon removes the epithelium. It will grow back naturally, conforming to the cornea's new shape. You may need to wear a bandage contact lens for a few days after surgery.
- Epi-laser-assisted in situ keratomileusis (LASIK). This is a variation of . The surgeon uses a special mechanized blunt blade — instead of the alcohol — to separate a very thin sheet of epithelium. He or she then uses an excimer laser to reshape the cornea and repositions the epithelium.
- Small-incision lenticule extraction (SMILE). This newer type of refractive surgery reshapes the cornea by using a laser to make a lens-shaped bit of tissue (lenticule) below the cornea's surface. The lenticule is then removed through a very small incision. For now, the small incision lenticule extraction (SMILE) procedure is only approved for treating mild nearsightedness.
Other types of refractive surgeries include clear lens extraction and implantable contact lenses. There is no one best method for refractive surgery, and you should make a decision only after a complete evaluation and thorough discussion with your surgeon.
Some of the possible complications that can occur after refractive surgery include:
- Undercorrection or overcorrection of your initial problem
- Visual side effects, such as a halo or starburst appearing around lights
- Dry eye
- Corneal scarring
- Rarely, vision loss
Discuss the potential risks and benefits of these procedures with your eye doctor.
Preparing for your appointment
You may encounter three kinds of specialists as you seek help for various eye conditions:
- Ophthalmologist. An ophthalmologist is an eye specialist with a doctor of medicine (M.D.) or a doctor of osteopathy (D.O.) degree who provides full eye care. This care includes performing complete eye evaluations, prescribing corrective lenses, diagnosing and treating common and complex eye disorders, and performing eye surgery when it's necessary.
- Optometrist. An optometrist has a doctor of optometry (O.D.) degree. Optometrists are trained to provide eye health examinations, prescribe corrective lenses, and diagnose and treat some eye conditions.
- Optician. An optician is a specialist who helps fit people for eyeglasses following prescriptions from ophthalmologists and optometrists. Some states require opticians to be licensed. Opticians are not trained to diagnose or treat eye disease.
No matter which type of eye specialist you choose, here's some information to help you get ready for your appointment.
What you can do
- List any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- List key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking, including doses.
- List questions to ask your doctor.
Preparing a list of questions will help you make the most of your visit. For astigmatism, some basic questions to ask include:
- What is likely causing my symptoms?
- Other than the most likely cause, what are other possible causes for my symptoms?
- What kinds of tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a corneal specialist?
- Will my insurance company pay for surgical procedures?
- Do you have any brochures or other printed material that I can take home with me? What websites do you recommend?
What to expect from your doctor
Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Oct 05, 2021
- What is astigmatism? American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/what-is-astigmatism. Accessed July 13, 2021.
- Yanoff M, et al., eds. Ophthalmology. 5th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed July 13, 2021.
- Astigmatism. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/astigmatism. Accessed July 13, 2021.
- Keshav V, et al. Astigmatism management with intraocular lens surgery. Ophthalmology. 2020; doi:10.1016/j.ophtha.2020.08.011.
- Preferred practice pattern guidelines: Pediatric eye evaluations PPP — 2017. American Academy of Ophthalmology. https://www.aao.org/preferred-practice-pattern/pediatric-eye-evaluations-ppp-2017. Accessed July 13, 2021.
- Astigmatism. American Optometric Association. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/astigmatism?sso=y. Accessed July 13, 2021.
- AskMayoExpert. Refractive laser surgery (adult). Mayo Clinic; 2021.
- Preferred practice pattern guidelines: Refractive errors and refractive surgery PPP — 2017. American Academy of Ophthalmology. https://www.aao.org/preferred-practice-pattern/refractive-errors-refractive-surgery-ppp-2017. Accessed July 13, 2021.