Astigmatism Q&A

Questions were answered by Burt Dubow, OD and Charles Slonim, MD

Q: Does astigmatism go away? — E., New York

A: Sorry, no. In fact, it usually gets worse with age...but slowly. It is probably partly hereditary and partly environmental. Studies have shown that people who move their eyes in a certain direction a lot, like scanning columns of numbers, will develop certain kinds of astigmatism. High amounts of astigmatism are commonly found in groups with lower socio-economic status, poor diets, etc. But not all astigmatism is explainable. Some is even internal rather than corneal, which complicates contact lens fitting a bit. Fortunately, it is not a fatal condition! — Dr. Dubow

Q: My father has a stigmatism and wears bifocals. Is there any chance he could ever wear contacts? — B.J.E., Florida

A: Absolutely. We have been able to correct astigmatism (it is one word, meaning "lack of point focus") for many years with both rigid gas permeable and soft toric lenses. And the need for bifocals because of presbyopia is no longer a hindrance either, as there are both rigid and soft bifocal contact lenses for this as well. In fact, there are even disposable contact lenses that correct presbyopia!

A very common technique is to prescribe the lenses so one eye takes the lead at distance and the other eye at near. This is called monovision, and it is very successful with most patients. A number of U.S. presidents have worn monovision.

Tell your dad to see his eye doctor for more information. — Dr. Dubow

Q: I have astigmatism. Would you recommend wearing contact lenses or just glasses? — R.M., California

A: It's your choice. Both contact lenses and glasses compensate for astigmatism, which is a condition where the eyes are football-shaped, causing light to focus to a blur on the retina. — Dr. Dubow

[Read more about toric contacts for astigmatism.]

Q: Could you please explain what is meant by the term "mixed astigmatism," and if this condition can be treated with LASIK? Thank you. — F.G., California

A: An astigmatism refers to an irregular curvature of the cornea. Typically, this irregular curvature is best described as an egg shape, where one curvature is flat (end to end of the egg) and the second curvature, which is perpendicular to the first, has a steeper curvature (around the belly of the egg).

A mixed astigmatism or irregular astigmatism is best described when those two curvatures are not perpendicular to each other. This would make for a very unusual shaped egg. This type of astigmatism can be treated with LASIK when the degree of irregularity is small. The predictability of the final result is not as good as with the regular astigmatism. — Charles B. Slonim, MD, FACS

Q: I have had a pterygium removed twice from one eye, and I have another on the other eye. The scar tissue has made my astigmatism worse. What are the possibilities of wearing contacts, and what kind would be the best? — D.H., Texas

A: Contact lenses are a possibility, but it depends on the amount and characteristics of your astigmatism. — Dr. Slonim

Q: My eye doctor told me in my exam that my astigmatism got worse. Is this normal? I heard that astigmatism's not supposed to change. — T.J., Minnesota

A: OK, who's been blabbing about astigmatism again? Not supposed to change? Oops, you heard wrong!

Astigmatism, which means "no point" in Greek, I think, is a common vision error. In fact, most people have some. When you have astigmatism, light does not focus to a single point in your eye. Instead, it focuses to a blur because the eye is oval or football-shaped. And it can and does change throughout your life, usually for the worse with age. But astigmatism is not a disease and can be compensated for with glasses, contact lenses or refractive surgery. — Dr. Dubow

Q: Are there contact lenses for astigmatism that I can sleep in? My wife has the convenience of sleeping in contacts, but she does not have astigmatism like I do. — Rob, North Carolina

A: Heaven forbid that your wife should see more than you do upon awakening! In fact, there are several options for those with astigmatism who want to sleep in contact lenses. One option is toric soft contact lenses for astigmatism, which come in either disposable or non-disposable materials and designs. A second option, rigid gas permeable (RGP) lenses, offer more oxygen than soft lenses and can compensate for most astigmatisms, including very large amounts.

The FDA has approved a number of contact lenses for up to six days of continuous wear and one brand of toric extended wear contact lenses for up to 30 days of continuous wear. I recommend rinsing your eyes with saline before going to sleep and upon waking, to get rid of the debris and bacteria that can accumulate on and under your lenses. This helps prevent problems.

It is very important to work with a skilled eye care practitioner when wearing extended wear contact lenses — there is more risk when you sleep in lenses. However, done properly, it is great to be able to wake up and see. Just remember... you will be seeing your wife very clearly first thing in the morning... are you sure you really want to? Just kidding, honey... ouch!... ouch! — Dr. Dubow

[Read more about extended wear contacts.]

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[Page updated January 2009]