Astigmatism: Symptoms, Causes, and Treatment

What is Astigmatism?

Astigmatism is a common vision condition caused by an irregular shape of the cornea or lens. This irregular shape prevents light from being properly focused on the retina, leading to blurred or distorted vision at all distances.

To understand astigmatism, it helps to picture a normal eye as being perfectly round, like a basketball. In contrast, an eye with astigmatism is more oval-shaped, resembling a North American football.

There are two main forms of astigmatism:

• Horizontal astigmatism, where the eye is wider than it is tall
• Vertical astigmatism happens when the eye is taller than it is wide.

Astigmatism can occur by itself or alongside other vision issues such as myopia (nearsightedness) or hyperopia (farsightedness). It can be congenital or develop over time due to eye injuries, surgeries, or diseases like keratoconus.

Astigmatism is usually corrected using glasses with cylindrical lenses, toric contact lenses, or surgical procedures like laser eye surgery that reshape the cornea and enhance vision. Regular eye examinations are important to diagnose astigmatism and determine the best treatment method.

Here are the degrees of astigmatism:

Mild Astigmatism: < 1.00 diopters

Moderate Astigmatism: 1.00 to 2.00 diopters

Severe Astigmatism: 2.00 to 3.00 diopters

Extreme Astigmatism: > 3.00 diopters

Causes of astigmatism

Astigmatism, also known as corneal curvature, is a common vision disorder caused by an irregular shape of the cornea or, in some cases, a curvature of the lens in the eye. The following are the causes of astigmatism:

• Genetic Predisposition: Astigmatism can be hereditary and is often detected from birth.
• Corneal Shape: The most common cause of astigmatism is a cornea that has an oval shape instead of a symmetrical spherical shape.
• Eye Injuries: Injuries that scar the cornea can cause or exacerbate astigmatism.
• Eye Surgery: Certain eye surgeries, particularly those involving the cornea, may result in astigmatism.
• Corneal Diseases: Diseases such as keratoconus, where the cornea becomes thin and cone-shaped, can cause astigmatism.
• Lens Curvature: Less commonly, astigmatism can be caused by an uneven curvature of the lens in the eye, known as lenticular astigmatism.
• Unusual Lid Pressure or Corneal Deformation: Constant pressure on the eye or cornea, such as from prolonged sleeping face down with the face on a pillow, can also lead to a change in corneal shape.
• Aging Process: As we age, natural structural changes in the cornea and lens can lead to astigmatism.

It is important to note that astigmatism often occurs along with other refractive errors such as nearsightedness or farsightedness. An eye examination can identify astigmatism and recommend appropriate corrective measures such as glasses, contact lenses, or surgical procedures.

Astigmatism symptoms

The symptoms of astigmatism become more pronounced when the curvature is severe. Mild astigmatism is quite common and often goes unnoticed as it has minimal effects. Severe curvatures can lead to blurred vision at both near and far distances, as well as headaches and eye pain. In children, untreated astigmatism can lead to permanent vision impairments.

Astigmatism is classified into two main types: regular and irregular. Regular astigmatism, where the cornea’s curvature follows a specific pattern, is the most common and can usually be corrected with glasses or contact lenses. Irregular astigmatism is more complex, as the cornea is shaped differently at various points, making correction more difficult.

The symptoms of astigmatism include:

• Distorted or blurred vision at all distances
• Headaches
• Eye strain
• Difficulty seeing in low light
• Frequent blinking or eye rubbing

Diagnosis for astigmatism

Eye doctors use advanced tools to detect astigmatism during a thorough eye exam.

• Vision Chart: You will be asked to read letters from a chart. This tests visual acuity or the sharpness of your sight from certain distances.
• Phoropter: Here you look through a large, binocular-like device and tell your doctor which letters you can see more clearly. Based on your answers, your doctor will write a prescription to provide you with the clearest possible vision.
• Autorefractor: This device measures astigmatism and other vision issues. The device functions by emitting a light into the eye and analyzing the changes in the light as it reflects off the back of the eye.
• Keratometer: A keratometer measures the curvature of your cornea. The doctor may also conduct a corneal topography scan to detect surface irregularities on the cornea.

The phoropter, used during an eye exam, helps the doctor determine whether glasses or contact lenses are necessary. A phoropter helps your eye doctor determine your prescription for glasses or contact lenses.

Treatment Options

Astigmatism can be corrected in various ways, including:

• Glasses: Cylindrical lenses in glasses correct the cornea’s uneven curvature.
• Contact Lenses: Toric contact lenses are specially designed to address astigmatism.
• Laser Eye Surgery: Procedures like SMILE PRO or FemtoLASIK permanently reshape the cornea to correct astigmatism.
• Phakic Intraocular Lenses: In this method, a lens is implanted in the eye without removing the natural lens.

Glasses

For the correction of astigmatism, cylindrical lenses are used. These special lenses have different refractive powers in different meridians, compensating for the uneven curvature of the cornea or lens.

Cylindrical lenses focus light accurately on the retina, providing a sharp, clear image. This correction significantly improves vision quality and enables affected individuals to perceive their surroundings more precisely.

Astigmatism and Contact Lenses

How Contact Lenses Help with Astigmatism

Contact lenses can be an effective solution for people with astigmatism. Special toric contact lenses are designed to compensate for the uneven curvature of the cornea and thus enable sharp vision. Unlike conventional spherical contact lenses, toric lenses have two different strengths, one for correcting nearsightedness or farsightedness and another for astigmatism.

Advantages of Contact Lenses for Astigmatism

• Improved Vision: Toric contact lenses offer clearer and sharper vision as they are specifically adapted to the individual curvature of the cornea.
• Comfort: Modern toric lenses are made of soft materials, providing comfort and allowing good oxygen flow to the eyes.
• Freedom of Movement: Unlike glasses, contact lenses offer more freedom of movement and are particularly advantageous during sports activities.
• Cosmetic Benefits: Contact lenses do not change appearance and thus offer an aesthetic alternative to glasses.

Types of Contact Lenses for Astigmatism

• Soft Toric Lenses: These lenses are flexible and conform to the shape of the eye. They are ideal for daily use and offer high wearing comfort. ***Best Choice.
• Rigid Gas Permeable (RGP) Lenses: These lenses retain their shape on the eye and can provide very precise correction of astigmatism.
• Daily Lenses: Disposable contact lenses that are changed daily, requiring no cleaning, making them hygienic and easy to maintain.
• Monthly Lenses: These lenses can be worn for an extended period, but they require regular cleaning and maintenance. ***Not Recommended.

Laser Eye Treatment for Astigmatism

Laser eye surgeries are an effective method for correcting astigmatism. Using specialized laser technologies, the irregular curvature of the cornea can be corrected to enable sharp vision. Here are the common procedures for the laser treatment of astigmatism:

Types of Laser Eye Treatment for Astigmatism:

FemtoLASIK / LASIK (Laser-Assisted In Situ Keratomileusis)

• Description: In FemtoLASIK / LASIK, a thin flap is created in the cornea, lifted, and the underlying area is precisely reshaped with an excimer laser. For astigmatism, the cornea is modeled to become more uniform, allowing light to focus correctly on the retina.
• Advantages: Quick recovery and immediate improvement in vision.
• Disadvantages: Possible risks include infections, dry eyes, and light sensitivity.

PRK (Photorefractive Keratectomy)

• Description: In PRK, the top layer of the cornea is removed, and the underlying layer is reshaped using a laser. This method is advantageous for patients with thin corneas where flap creation is not ideal.
• Advantages: Suitable for patients with thin corneas.
• Disadvantages: Extended recovery period, post-operative pain, delayed visual rehabilitation, risk of scar development, risk of dry eyes, light sensitivity, limited correction capacity, tendency for regression, need for adjustments.

LASEK (Laser Epithelial Keratomileusis)

• Description: LASEK is similar to PRK, but the corneal epithelium is placed back on the cornea after laser treatment to aid the healing process.
• Advantages: LASEK and PRK involves less laser depth compared to LASIK, which is beneficial for patients with thinner corneas.
• Disadvantages: Similar to PRK.

SMILE (Small Incision Lenticule Extraction)

• Description:SMILE Pro / Relex SMILE is a minimally invasive procedure where a small, lens-shaped piece of tissue (lenticule) is removed from the cornea. This method is increasingly used for correcting astigmatism.
• Advantages: Minimally invasive procedure, quick recovery. Safe for patients with thin corneas.
• Disadvantages: None

It is important to note that not everyone is suitable for laser treatment. A comprehensive examination by an eye doctor or ophthalmic surgeon is necessary to determine if laser eye surgery is the right choice and which procedure would be best. The doctor will evaluate the individual characteristics of the eye, the extent of the astigmatism, and overall eye health to provide a tailored treatment recommendation.

Costs of Laser Eye Surgery for Astigmatism

The cost of laser surgery to correct astigmatism can vary based on a range of factors. In Germany, the average costs for laser eye surgery to correct astigmatism typically range between 1,250 and 2,500 euros per eye. Several key factors affect this price range.

Firstly, the choice of clinic plays a significant role. Clinics that utilize cutting-edge technology and employ highly skilled professionals typically charge higher prices. The experience and expertise of the surgeon are also crucial. Surgeons with extensive experience and a high success rate typically charge higher fees, which often lead to better treatment outcomes and higher patient satisfaction.

The technology used is another important cost factor. More advanced laser techniques provide more accurate and safer results, but they are also more expensive. The type of laser used and the technique applied can also influence the overall costs.

Another significant aspect is pre- and post-operative care. Detailed examinations and consultations are required before the actual surgery to ensure the patient is a suitable candidate for the procedure. These pre-surgery examinations and comprehensive post-operative care, including regular follow-up visits and potential touch-ups, can increase the total costs.

It is advisable to consult various clinics and thoroughly compare their offers. A comprehensive consultation with the surgeon is essential to find the best and most cost-effective option. When choosing a procedure, it is important to consider both the cost and the quality of care, along with the expertise of the medical team, to ensure the best outcome.

Choosing the Right Method to Correct Astigmatism

Choosing the appropriate astigmatism correction method, often related to corneal curvature, involves careful consideration of multiple factors:

• Severity of Astigmatism: The strength and type of astigmatism determine whether glasses or contact lenses are sufficient or if surgical correction might be necessary.
• Overall Eye Health: Health factors such as the presence of dry eyes or other corneal diseases can affect the suitability of contact lenses or surgical procedures.
• Lifestyle and Occupational Requirements: Activities that require sharp vision at different distances or occupational activities that necessitate wearing protective eyewear can influence the choice of vision aids.
• Personal Preferences: Some people prefer not to wear glasses, while others may find contact lenses uncomfortable or wish to avoid surgery.
• Experience with Vision Aids: Individuals with prior experience using glasses or contact lenses may have specific preferences that guide their decision.
• Costs and Insurance Coverage: The cost of the different corrective methods and the extent of insurance coverage play an essential role in the decision-making process.
• Risk Tolerance: Since surgical procedures carry inherent risks, the patient’s willingness to accept these risks must be factored in.
• Consultation with Specialists: Eye doctors can provide recommendations based on a thorough examination and analysis of visual needs, based on the latest technology and research.

The decision on the appropriate method should always be made in consultation with an eye doctor who considers the patient’s individual needs and circumstances.

Prevention and Management

Although astigmatism usually cannot be prevented, regular eye examinations are crucial for early detection of vision changes and timely treatment. Regular check-ups with an eye specialist can help monitor eye health and detect any abnormalities that may develop over time. Early detection is especially important in children, as it allows for prompt intervention that can prevent vision problems from impacting their learning and development. Vision issues in children can lead to difficulties in reading, writing, and other educational activities, so ensuring that they receive appropriate eye care from a young age is essential.

Managing astigmatism involves a combination of corrective measures and lifestyle adjustments. For many people, wearing prescribed glasses or contact lenses can greatly enhance vision and reduce symptoms like eye strain and headaches. It’s important to follow the recommendations of an eye care professional regarding the use of these vision aids to ensure optimal results.

In addition to using corrective lenses, certain lifestyle adjustments can help manage astigmatism symptoms. Maintaining good lighting conditions while reading or working can reduce eye strain. Taking regular breaks during tasks that require prolonged focus can also alleviate discomfort. For those who spend a lot of time on digital devices, using screen filters and practicing the 20-20-20 rule—taking a 20-second break every 20 minutes to look at something 20 feet (6 meter) away—can be beneficial.

For individuals considering long-term solutions, surgical options like laser eye surgery may be appropriate. Procedures such as LASIK, PRK, or SMILE can reshape the cornea to address the irregular curvature that causes astigmatism. However, it’s essential to consult with an eye surgeon to determine if you are a suitable candidate for surgery and to understand the potential risks and benefits.

Overall, while astigmatism cannot be entirely prevented, proactive eye care and regular monitoring can help manage the condition effectively. By staying vigilant about eye health and seeking timely treatment, individuals with astigmatism can maintain clear vision and a good quality of life.

Conclusion

Corneal curvature is not a cause for concern but requires attention and proper correction. With modern vision aids and treatment methods, most people with astigmatism can achieve clear and sharp vision. If you notice signs of astigmatism, book an appointment with your eye doctor to discuss suitable treatment options.

Selecting a cost-effective option is important when considering laser eye treatment for astigmatism. At Lasikwelt Laser Center, we offer not only very attractive prices but also versatile financing options for your treatment. We recognize that financial considerations are important for our patients, which is why we are dedicated to providing top-quality vision improvement at an affordable price. Thanks to our customizable financing models, you can flexibly and appropriately manage the costs of your treatment to fit your financial situation.

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