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You Have Many Options When Managing Astigmatism




“Managing astigmatism” sounds simple, right? You get the right pair of glasses or contact lenses to correct your eyesight, and you learn to live with vision that’s somewhat blurry whenever you’re not wearing them.

Managing astigmatism

Yet there are surgical options that can minimize or nearly eliminate astigmatism. With those, you may see well using simple nonprescription reading glasses or magnifiers. And you’ll see somewhat better with no assistance at all.

What Is Astigmatism, Anyway?

Vision blurs when your cornea (the clear front layer of your eye) and/or your lens (the inner part that helps you focus) have a different shape than normal. Common symptoms of astigmatism include not only blurriness and the need to squint but headaches, eyestrain and difficulty seeing at night. Mild astigmatism may include only a couple of symptoms.

Doctors don’t know exactly what causes it – it’s not necessarily inherited – and most people with astigmatism develop it later in life, rather than at birth. It can also follow trauma to the eye or eye surgery.

Going Beyond Glasses and Contacts

Some patients don’t want the ongoing expense or inconvenience of spectacles and contact lenses. For them, refractive surgery may work best. Options include:

  • LASIK. A surgeon makes a flap in the cornea, uses an excimer laser to sculpt the shape of the cornea and then repositions the flap.
  • Photorefractive keratectomy (PRK). In this refractive procedure, the surgeon removes the epithelium, which will grow back naturally and conform to the cornea's new shape. The same excimer laser as LASIK is applied to the cornea to sculpt the shape of the cornea.
  • Small-incision lenticule extraction (SMILE). This procedure, meant to treat mild near-sightedness, uses a laser to create a lens-shaped bit of tissue (lenticule) below the cornea's surface. The doctor then removes the lenticule through a small incision.

Innovations in the Last Decade

Eye doctors tell patients not to expect perfection: Astigmatism won’t be reduced to zero by surgery. But they have tools to get your vision as close as possible to where you’d like it to be.

Patients who undergo cataract surgery may choose a toric intraocular lens (IOL) implant at the same time to counteract corneal astigmatism after surgery. Cataract surgery with a toric lens implant is almost the same as cataract surgery with a conventional IOL, with this difference: Surgeons make measurements beforehand to choose the most beneficial toric IOL power and proper orientation of the implant. Toric IOLs carry peripheral markers that let the doctor see the orientation of their correction. The surgeon can rotate the lens during the surgery so the astigmatism correction is properly aligned.

Doctors can also make peripheral corneal limbal relaxing incisions (LRIs), a technique performed to improve astigmatism without significantly affecting the eye’s spherical focus. In this procedure, a surgeon makes incisions in the peripheral cornea with a diamond knife or femtosecond laser. These incisions flatten the cornea there and steepen it 90 degrees away. The length and depth of the incisions determine the amount of astigmatism corrected.

When it comes to managing astigmatism, not all patients will be good candidates for all procedures. This is especially true for those with other eye problems. Some procedures, such as the toric IOLs, won’t be covered by insurance. A doctor who performs an eye exam will measure refractive error – the way in which the shape of your eye keeps light from focusing correctly on the retina – and let you know what you can do to bring astigmatism down to the most manageable level.

Have More Questions? See a Specialist.

For help with managing astigmatism, schedule a consultation at Horizon Eye Care by calling 704-365-0555 Monday-Thursday, 8 a.m. to 5 p.m., or Friday, 8 a.m. to 3 p.m. The optical department closes on Fridays at 2:30 p.m.

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