Astigmatism

Last updated April 21, 2016

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What are the other Names for this Condition? (Also known as/Synonyms)

Astigmia
Cylindrical Refractive Error

What is Astigmatism? (Definition/Background Information)

Astigmatism is an eye disorder caused by the irregular shape and curvature of the cornea
or lens. It is classified as a refractive error of the eye
Refraction is the bending of light when it passes through an object. Therefore, refractive
error denotes a condition wherein the shape of ones eyes does not allow the light to bend
correctly, leading to blurred vision
Individuals with Astigmatism have an unusually shaped cornea, and the light is focused
on 2 different planes, which creates a blurred vision. The condition usually affects
children and adolescents between 5-17 years of age, and adults over the age of 30 years
There are many types of classification of Astigmatism. Chiefly, it is classified into the
following two types:
o Corneal Astigmatism (due to abnormal curvature of the cornea)
o Lenticular Astigmatism (due to abnormal curvature of the lens)
A family history of the condition, premature birth, low birth weight, and a recent eye
surgery are some known risk factors for the development of Astigmatism
Important causes for the condition include abnormal curvature and shape of the cornea or
lens due to a variety of factors, such as keratoconus, which can result from injury to the
eye
Some common symptoms associated with this condition include blurring of vision, eye
strain, headache, and dizziness. Astigmatism can lead to the development of amblyopia,
also known as lazy eye
Treatment for this condition depends upon its severity. While mild cases of Astigmatism
may not require any treatment, the use of contact lenses or surgery, may be used to
correct refractive errors successfully
Contact lenses used for the correction of the condition can lead to abrasion of the cornea.
Corrective surgery may also potentially lead to infections, redness, and vision problems
Reading in proper light, avoiding eye strain, getting ones eyes examined regularly if one
is at risk for Astigmatism, are some known methods for preventing this eye condition
Astigmatism is known to change with age, and therefore, adjustment of lenses or other
treatment measures may be required. The prognosis is considered to be good, if one keeps
up with treatments and has a regular follow-up. Surgery is generally reported to correct
the condition
Who gets Astigmatism? (Age and Sex Distribution)

Like many other refractive errors of the eye, Astigmatism is observed worldwide. There
is no racial or ethnic group preference observed
Children between the age group of 5 and 17 years, and adults over the age of 30 years are
reported to be vulnerable to Astigmatism

What are the Risk Factors for Astigmatism? (Predisposing Factors)

Some risk factors known to be associated with Astigmatism include:

Having a family history of the condition

Pre-term birth; low birth weight
Advancing age
Eye surgery, such as a cataract surgery, may result in Astigmatism
Corneal scarring due to injury
Corneal thinning
Pre-existing refractive errors of the eye such as myopia (near-sightedness) or
hypermetropia (far-sightedness)
Severe allergies resulting in constant rubbing of the eyes
Diabetes

It is important to note that having a risk factor does not mean that one will get the condition. A
risk factor increases ones chances of getting a condition compared to an individual without the
risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is
always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Astigmatism? (Etiology)

The possible causes for the two types of Astigmatism (corneal and lenticular) include:

Corneal Astigmatism:
o Oval-shaped cornea
o Scarring of the cornea due to injuries or surgery to the eye (trauma)
o Keratoconus : A disorder of the eye causing the cornea to thin and changing it to a
conical shape
Lenticular Astigmatism:
o Variation in the shape of the lens
o Diabetes

Astigmatism can also be classified as regular and irregular depending upon the measured
curvature of the eye:
 Regular Astigmatism: The most common cause of this type of disorder is a congenital
defect (Congenital Astigmatism)
Irregular Astigmatism: The most common causes include scarring of the cornea and
thinning of the cornea due to corrective eye surgery

Some healthcare providers also classify Astigmatism into the following categories:

Myopic Astigmatism: If both the angles of Astigmatism (as measured using optical
instruments) are nearsighted (or myopic), the condition is called Myopic Astigmatism
Hyperopic Astigmatism: If both the angles of Astigmatism (as measured using optical
instruments) are farsighted (or hyperopic), the condition is called Hyperopic Astigmatism
Mixed Astigmatism: If one angle is nearsighted and the other angle is farsighted, then the
condition is called Mixed Astigmatism

What are the Signs and Symptoms of Astigmatism?

Some characteristic signs and symptoms of Astigmatism include:

Blurred vision or distorted vision

Eye strain
Dizziness
Headaches
Constant closing of ones eyes
Ability to view and focus clearly, only when part of an eye is closed during an optical
examination

How is Astigmatism Diagnosed?

The diagnosis of Astigmatism may involve the following tests and exams:

Visual acuity test: In this test, letters are arranged in lines with each line containing
different sized letters
Astigmatic dial test: Under this method the lines are arranged in a semi-circle for
checking vision
Examination with a keratometer, also known as ophthalmometer, which helps in
measuring:
o The light reflected from the surface of the cornea
o Radius of the curve of cornea
o Degree of abnormality in the curve of cornea
Eye examination with a keratoscope: Also known as Placidos disk, it is used to observe
corneal reflex through the lines and circles marked on the disk. Light is used to create
rings on the disc and the gap between the rings will give the variations in the curvature
and the degree of Astigmatism
Regular and periodical eye checkups: It is highly recommended that children should
undergo a thorough eye check up from four years of age and adults should have a regular
and periodic eye check up once in two years
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may
perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Astigmatism?

Some potential complications associated with Astigmatism include:

Amblyopia, also known as lazy eye, it is impaired vision in one eye

Corneal abrasions: The use of contact lens to treat Astigmatism may lead to irritation and
abrasion to the cornea, especially when the contact lens is not cleaned and maintained
properly

The side effects of surgery may include:

Infection
Inflammation
Redness to the eye
Severe vision problems

How is Astigmatism Treated?

A mild case of Astigmatism may not need any special medical attention. In other cases,
following are the treatment measures for Astigmatism:

A refractive error can be corrected with the help of corrective lenses which allow the
image to fall properly on the retina. Corrective lenses may be in the form of eyeglasses or
contact lenses
The types of contact lenses that can be used in the treatment include:
o Soft toric contact lenses
o Gas permeable contact lenses
o Hybrid contact lenses
Laser eye surgery, such as:
o Photorefractive keratectomy (PRK) for Astigmatism
o Laser epithelial keratomileusis (LASEK) for Astigmatism
o Laser in situ keratectomy (LASIK) for Astigmatism

How can Astigmatism be Prevented?

Some known measures for preventing Astigmatism include:

Avoiding eye strain

Reading in proper light
Avoiding excessive rubbing of the eyes: Treating severe allergies can eliminate constant
rubbing of the eyes, which is a risk factor for Astigmatism
Following a healthy diet that includes fruits and vegetables
 Doing eye exercises for improving vision and reducing refractive errors, upon
recommendation by a healthcare specialist
Keeping the eye safe from injuries
Getting ones eyes examined regularly

What is the Prognosis of Astigmatism? (Outcomes/Resolutions)

Astigmatism is a treatable condition through corrective eyewear or surgery and the

prognosis is generally excellent
However, the condition could change with age and accordingly, corrective measures
might need to be kept up to avoid eye strain or other complications

Additional and Relevant Useful Information for Astigmatism:

Many individuals have a combination of Astigmatism and nearsightedness or

Astigmatism and farsightedness
Laser in-situ keratomileusis (Lasik) is a procedure to improve vision by reshaping the
cornea, using excimer (ultraviolet) laser

The following article link will help you understand laser in-situ keratomileusis surgical
procedure:

http://www.dovemed.com/laser-in-situ-keratomileusis-lasik/

What are some Useful Resources for Additional Information?

The American Ophthalmology Society

655 Branch Street, San Francisco, California 94109
Phone: (415) 561-8578
Fax: (415) 561-8531
Email: admin@aosonline.org
Website: http://www.aosonline.org

References and Information Sources used for the Article:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002010/ (accessed on 04/04/2016)

http://www.nlm.nih.gov/medlineplus/ency/article/001015.htm (accessed on 04/04/2016)

http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/astigmatism (accessed on
04/04/2016)

http://www.mayoclinic.org/diseases-conditions/astigmatism/basics/definition/con-20022003
(accessed on 04/04/2016)

Helpful Peer-Reviewed Medical Articles:

Mookherjee, S., Bhattacharjee, A., & Sengupta, M. (2015). The Aging Eye. Journal of
ophthalmology, 2015.

Ozdemir, O., Tunay, Z. O., Acar, D. E., & Acar, U. (2015). Refractive errors and refractive
development in premature infants. Journal Franais d'Ophtalmologie, 38(10), 934-940.

Prssinen, O., Kauppinen, M., Kaprio, J., Koskenvuo, M., & Rantanen, T. (2013). Heritability of
Refractive Astigmatism: A Population-Based Twin Study Among 63-to 75-Year-Old Female
TwinsHeritability of Refractive Astigmatism. Investigative ophthalmology & visual science,
54(9), 6063-6067.

Wall, P. B., Lee, J. A., Lynn, M. J., Lambert, S. R., Traboulsi, E. I., & Infant Aphakia Treatment
Study Group. (2014). The effects of surgical factors on postoperative astigmatism in patients
enrolled in the Infant Aphakia Treatment Study (IATS). Journal of American Association for
Pediatric Ophthalmology and Strabismus, 18(5), 441-445.

Wang, L., He, M., & Ellwein, L. (2014). Prevalence of astigmatism in school-aged children: a
multi-country refractive error study in children. Investigative Ophthalmology & Visual Science,
55(13), 3640-3640.

Waltz, K. L., Featherstone, K., Tsai, L., & Trentacost, D. (2015). Clinical outcomes of TECNIS
toric intraocular lens implantation after cataract removal in patients with corneal astigmatism.
Ophthalmology, 122(1), 39-47.

Klijn, S., Reus, N. J., van der Sommen, C. M., & Sicam, V. A. D. (2015). Accuracy of a novel
specular reflection technique for measurement of total corneal astigmatism. Investigative
Ophthalmology & Visual Science, 56(7), 1903-1903.

Koch, D. D., Jenkins, R. B., Weikert, M. P., Yeu, E., & Wang, L. (2013). Correcting astigmatism
with toric intraocular lenses: effect of posterior corneal astigmatism. Journal of Cataract &
Refractive Surgery, 39(12), 1803-1809.

Wall, P. B., Lee, J. A., Lynn, M., Lambert, S. R., & Traboulsi, E. I. (2013). The effects of
surgical factors on postoperative astigmatism in patients enrolled in the Infant Aphakia
Treatment Study. Journal of American Association for Pediatric Ophthalmology and Strabismus
{JAAPOS}, 17(1), e9-e10.

Koch, D. D., Ali, S. F., Weikert, M. P., Shirayama, M., Jenkins, R., & Wang, L. (2012).
Contribution of posterior corneal astigmatism to total corneal astigmatism. Journal of Cataract &
Refractive Surgery, 38(12), 2080-2087.

Reviewed and Approved by a member of the DoveMed Editorial Board

First uploaded: April 21, 2016
Last updated: April 21, 2016