Diagnosis

Astigmatism is diagnosed by an eye exam. A complete eye exam involves a series of tests to check your eye health and a refraction, which determines how your 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.

Treatment

The goal of treating astigmatism is to improve vision clarity and eye comfort. Treatments are corrective lenses or refractive surgery.

Corrective lenses

Wearing corrective lenses treats astigmatism by counteracting uneven curvatures of your cornea and lens.

Types of corrective lenses include:

  • Eyeglasses. Eyeglasses are made with lenses that help compensate for the uneven shape of your eye. The lenses make the light bend into your 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, including disposable soft; extended wear; rigid, gas permeable; and bifocal.

    Contact lenses are also used in a procedure called orthokeratology. In orthokeratology, you wear rigid contact lenses for several hours a day until the curvature of your eye evens out. Then you wear the lenses less frequently to maintain the new shape. If you discontinue this treatment, your eyes return to their former shape.

    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

Refractive surgery improves vision and reduces the need for eyeglasses or contact lenses. Your 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, your eye surgeon makes a thin, hinged flap in your 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 LASEK, except the surgeon removes the epithelium. It will grow back naturally, conforming to your cornea's new shape. You may need to wear a bandage contact lens for a few days after surgery.
  • Epi-LASIK. This is a variation of LASEK. Your doctor 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.

Other newer refractive surgeries include clear lens extraction and implantable contact lenses. There is no one best method for refractive surgery, and the decision should only be made 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
  • Infection
  • 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, 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 these 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 or a contact lens fitting?
  • 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?