What is Astigmatism?

We are faced with this question on a regular basis.  Astigmatism might be the most misunderstood vision problem.  Even the name is challenging to many people, who incorrectly call it "stigmatism."

Astigmatism is a refractive error, meaning it is not an eye health problem; it simply is a problem with how the eye focuses light, like nearsightedness & farsightedness.

In an eye with astigmatism, light fails to come to a single focus on the retina to produce clear vision. Instead, multiple focus points occur, either in front of or behind the retina (or both).  This causes blurry, distorted vision.

 
When someone has a significant amount of uncorrected astigmatism, they can expect to experience eye strain and headaches, especially after reading and other visually-lengthy tasks.  Ex:  working on a computer for a long period of time without taking breaks.

Squinting is a very common symptom of uncorrected astigmatism as well.

What Causes Astigmatism?

Astigmatism usually is caused by an irregularly shaped cornea.  Instead of the cornea having a symmetrically round shape (like a basketball), it is shaped more like a football, with one meridian being significantly more curved than the meridian perpendicular to it.

(To understand what meridians are, think of the front of the eye like the face of a clock. A line connecting the 12 and 6 is one meridian; a line connecting the 3 and 9 is another.)
The steepest and flattest meridians of an eye with astigmatism are called the principal meridians.

In some cases, astigmatism is caused by the shape of the lens inside the eye. This type of astigmatism is called lenticular astigmatism, to differentiate it from the more common corneal astigmatism.

Types of Astigmatism

There are several types of astigmatism:

  • Myopic astigmatism. One or both principal meridians of the eye are nearsighted. (If both meridians are nearsighted, they are myopic in differing degree.)
  • Hyperopic astigmatism. One or both principal meridians are farsighted. (If both are farsighted, they are hyperopic in differing degree.)
  • Mixed astigmatism. One prinicipal meridian is nearsighted, and the other is farsighted.

Astigmatism also is classified as regular or irregular. In regular astigmatism, the principal meridians are 90 degrees apart (perpendicular to each other). In irregular astigmatism, the principal meridians are not perpendicular. Most astigmatism is regular corneal astigmatism, which gives the eye a football shape.

Irregular astigmatism can result from an eye injury that has caused scarring on the cornea, from certain types of eye surgery or from keratoconus, a disease that causes a gradual thinning of the cornea.

Astigmatism Test

Astigmatism is detected during a routine eye exam with the same instruments and techniques used for the detection of nearsightedness and farsightedness.  Dr. Bogart can estimate your amount of astigmatism by shining a light into your eye while manually introducing a series of lenses between the light and your eye. This astigmatism test is called retinoscopy.

Though many eye doctors continue to perform retinoscopy, this manual procedure has been replaced or supplemented in many eye care practices with automated instruments that provide a faster preliminary test for astigmatism and other refractive errors.  At Carolina Eye Center, we have several machines that can test for astigmatism.

Whether retinoscopy or an automated refraction is performed as a preliminary astigmatism test, Dr. Bogart will refine the preliminary finding with a manual refraction prior to issuing your eye glasses or contact lens prescription.

Astigmatism Correction

Astigmatism, like nearsightedness and farsightedness, usually can be corrected with eye glasses, contact lenses, or even refractive surgery.  In the past, there was no technology to correct astigmatism with LASIK & PRK procedures.  Today, we have advanced technology that can correct most types of this condition!


In addition to the spherical lens power used to correct nearsightedness or farsightedness, astigmatism requires an additional "cylinder" lens power to correct the difference between the powers of the two principal meridians of the eye.

If you wear soft toric contact lenses for astigmatism correction, your contact lens prescription will likewise include a sphere power, cylinder power and axis designation.

Gas permeable lenses can also correct astigmatism. Because these lenses are rigid and optically replace the cornea as the refracting surface of the eye, a cylinder power and axis may or may not be needed, depending on the type and severity of astigmatism correction required.
To find out what your options are to correct your astigmatism, give our office a call:  803-794-0000, and schedule your exam with Dr. Walt Bogart today!

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