What Is Astigmatism, and What Can Be Done About It?

Understanding Astigmatism: The Basics

Astigmatism is a refractive error that occurs when the cornea (the clear front surface of the eye) or the lens inside the eye has an irregular shape. While a normal eye has a spherical cornea—shaped like a basketball—an eye with astigmatism has a cornea shaped more like a football, with one meridian steeper than the other.

This irregular shape prevents light from focusing properly on the retina, the light-sensitive surface at the back of the eye. Instead of all light rays converging at a single focal point to create a clear image, some light rays focus in front of the retina, some behind it, and some directly on it. The result is blurred or distorted vision at all distances.

Common Symptoms of Astigmatism

Many people have some degree of astigmatism, though mild cases may not noticeably affect vision. If you experience any of these symptoms, astigmatism could be the culprit:

• Blurry or distorted vision at all distances
• Eyestrain or discomfort, especially after reading or screen time
• Headaches, particularly after visual tasks
• Squinting to try to see more clearly
• Difficulty seeing at night
• Eye fatigue or irritation
• Need to sit very close to screens or when viewing distant objects

Children with astigmatism might not complain about their vision because they don't know what normal vision looks like. They might show signs like:

• Squinting
• Eye rubbing
• Poor attention during visual tasks
• Sitting too close to screens
• Difficulty with school performance

Read our blog post on common eye problems for school-age children.

Types of Astigmatism

Astigmatism generally falls into several categories based on what's causing the irregularity:

Corneal Astigmatism

The most common type occurs when the cornea has an irregular shape. Instead of being evenly curved in all directions, the cornea is steeper in one direction than the other.

Lenticular Astigmatism

This type of astigmatism is caused by irregularities in the curvature of the lens inside the eye rather than the cornea.

Regular vs. Irregular Astigmatism

Regular astigmatism means the cornea or lens curves more in one direction than the other, but the curvature remains smooth. This is the most common type and is easily correctable with standard glasses, contact lenses, or refractive surgery.

Irregular astigmatism means the cornea or lens has curves that aren't smooth. This may result from an eye injury, certain eye surgeries, or conditions like keratoconus. Irregular astigmatism is more challenging to correct but still manageable with specialized approaches.

Diagnosing Astigmatism

During a comprehensive eye exam at Asheville Vision and Wellness, our doctors can determine whether you have astigmatism and to what degree. Our advanced diagnostic testing includes:

Visual Acuity Testing

This familiar test—reading letters from a distance chart—helps assess how astigmatism might be affecting your vision clarity.

Refraction Test

Using a phoropter (an instrument with multiple lenses), your eye doctor can precisely measure your astigmatism by determining which lens combination provides the clearest vision.

Keratometry and Corneal Topography

These specialized tests measure the curvature of your cornea's surface, creating a detailed "map" that reveals even subtle irregularities that cause astigmatism.

Slit Lamp Examination

This microscope with a bright light source allows your doctor to examine your cornea in great detail, looking for irregularities that might cause astigmatism.

Traditional Treatments for Astigmatism

The good news about astigmatism is that it's highly treatable. Most people with astigmatism can achieve clear, comfortable vision with one of these approaches:

Eyeglasses

Prescription eyeglasses are the simplest and most common treatment for astigmatism. The lenses contain a special cylindrical correction that compensates for the irregular corneal shape, allowing light to properly focus on the retina.

Modern eyeglass lenses can correct astigmatism while also addressing other vision issues like nearsightedness (myopia) or farsightedness (hyperopia). At Asheville Vision and Wellness, we offer a wide variety of frame options to suit your style and budget while effectively correcting your astigmatism.

Contact Lenses

For those who prefer not to wear glasses, several types of contact lenses can effectively correct astigmatism:

• Toric soft contact lenses are specially designed with different powers in different meridians of the lens to correct astigmatism. They typically have a weighted bottom to prevent the lens from rotating on the eye.
• Gas permeable (GP) rigid contact lenses provide a smooth surface over the irregular cornea, effectively neutralizing corneal astigmatism. These lenses allow more oxygen to reach the cornea and often provide sharper vision than soft toric lenses for people with significant astigmatism.
• Hybrid contact lenses combine a rigid center with a soft outer ring, offering both the clear vision of a GP lens and the comfort of a soft lens.

Our eye doctors at Asheville Vision and Wellness can determine which contact lens option might work best for your specific type and degree of astigmatism.

Advanced Correction Options

For those seeking a more permanent solution to astigmatism, several surgical options exist:

LASIK (Laser-Assisted In Situ Keratomileusis)

This popular refractive surgery uses a laser to reshape the cornea, correcting the irregular curvature that causes astigmatism. LASIK can simultaneously correct nearsightedness or farsightedness alongside astigmatism.

At Asheville Vision and Wellness, we offer LASIK evaluations to determine if you're a good candidate for this procedure. We can refer suitable candidates to Woolfson Eye Institute, a trusted partner with extensive experience performing LASIK procedures.

PRK (Photorefractive Keratectomy)

Similar to LASIK, PRK uses a laser to reshape the cornea but without creating a flap in the corneal tissue. This might be recommended for people with thinner corneas who aren't good candidates for LASIK.

Toric Intraocular Lenses (IOLs)

For patients undergoing cataract surgery who also have astigmatism, toric IOLs can replace the eye's natural lens. These specialized lenses correct both the cataract and the astigmatism simultaneously.

Living with Astigmatism: Practical Tips

Beyond formal treatment, there are several strategies to help manage the symptoms of astigmatism in daily life:

• Take regular screen breaks. Follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds to reduce eye strain.
• Ensure proper lighting. Good lighting reduces strain when reading or doing close work.
• Keep prescriptions updated. Even small changes in your astigmatism can cause symptoms if your correction is no longer accurate.
• Consider anti-glare coatings on your glasses to reduce halos around lights, particularly when driving at night.
• Stay hydrated and use artificial tears if your eyes feel dry, as dryness can worsen astigmatism symptoms.
• Maintain regular eye exams. Annual comprehensive eye exams can catch changes in your astigmatism before they significantly affect your vision.

Astigmatism in Children

Children can be born with astigmatism or develop it in early childhood. Because children may not know their vision is abnormal, regular pediatric eye exams are crucial for early detection.

Signs that a child might have undiagnosed astigmatism include:

• Squinting or closing one eye to see
• Tilting the head to look at things
• Rubbing eyes frequently
• Complaining of headaches or eye fatigue
• Difficulty reading or concentrating on visual tasks
• Sitting very close to the TV or holding books very close

At Asheville Vision and Wellness, we provide eye exams for children to detect and address astigmatism early, preventing potential learning difficulties related to vision problems.

Read our blog post about headaches and vision issues here. 

Myths and Misconceptions About Astigmatism

Let's clear up some common misunderstandings about this condition:

1. Myth: Astigmatism is rare. Reality: Astigmatism is actually quite common. Most people have some degree of astigmatism, though it may be so mild that it doesn't require correction.
2. Myth: Astigmatism only affects distance vision. Reality: Astigmatism can cause blurry or distorted vision at all distances—near, intermediate, and far.
3. Myth: You can't wear contact lenses if you have astigmatism. Reality: Modern toric and rigid gas permeable contact lenses can effectively correct most cases of astigmatism.
4. Myth: Astigmatism gets worse if you don't wear your glasses. Reality: Not wearing prescribed glasses won't worsen your astigmatism, but it can cause eye strain and discomfort.
5. Myth: Reading in dim light causes astigmatism. Reality: Reading in poor light may cause eye strain but doesn't change your cornea's shape or cause astigmatism.

When to See an Eye Doctor

If you suspect you have astigmatism or are experiencing any symptoms that could indicate a vision problem, it's important to schedule a comprehensive eye exam. You should see an eye doctor if:

• You're experiencing blurry or distorted vision
• You have frequent headaches, especially after visual tasks
• You notice increased eye strain or fatigue
• It's been more than a year since your last eye exam
• You're having difficulty driving at night due to glare or halos around lights
• Your child is showing signs of vision problems

Frequently Asked Questions About Astigmatism

1. Is astigmatism hereditary?

Yes, there appears to be a genetic component to astigmatism. If your parents have astigmatism, you may be more likely to develop it as well.

2. Can astigmatism develop suddenly?

While astigmatism is typically present from birth or develops gradually in childhood, sudden changes in astigmatism can occur after eye trauma, surgery, or with certain eye conditions like keratoconus.

3. Can astigmatism be cured?

Astigmatism cannot be "cured" in the traditional sense, but it can be effectively corrected with glasses, contact lenses, or refractive surgery. These treatments compensate for the irregular corneal shape but don't permanently change it (except in the case of surgery).

4. Will my astigmatism get worse with age?

Astigmatism may change slightly throughout life, but significant progression is uncommon in adults unless there's an underlying condition like keratoconus or corneal disease.

5. Can I prevent astigmatism?

Since most astigmatism is present from birth or early childhood, it generally cannot be prevented. However, protecting your eyes from injury can help prevent traumatic astigmatism.

6. Can I still play sports with astigmatism?

Absolutely! Many athletes have astigmatism and perform at elite levels. Depending on your sport, options like sports goggles, contact lenses, or even refractive surgery can provide clear vision during athletic activities.

Conclusion

Astigmatism is a common vision condition that, when properly diagnosed and treated, doesn't have to limit your visual clarity or comfort. With modern correction options ranging from specialized eyeglasses and contact lenses to advanced surgical procedures, most people with astigmatism can achieve excellent vision.

At Asheville Vision and Wellness, our experienced eye doctors Dr. Sid Morse, Dr. Lisa M. Greene, and Dr. Adam Greene provide comprehensive eye exams to diagnose astigmatism and develop personalized treatment plans. If you're experiencing symptoms that might indicate astigmatism or it's simply time for your annual eye exam, schedule an appointment online or call us at (828) 747-9260.

Clear vision is possible—even with astigmatism. Contact us today and let us help you see your best!