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Astigmatism Q&A

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

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

A: Sorry, no. In fact, sometimes astigmatism 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. There are many types of rigid gas permeable contacts and soft toric contact lenses that correct astigmatism (the correct spelling, meaning "lack of point focus"). 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 commonly used technique to correct both astigmatism and presbyopia is to prescribe contact lenses with a modified prescription 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 contact lenses.

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

Here's a great video that explains 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: In mixed astigmatism, the unequal curvature of the cornea (and sometimes also the lens inside the eye) causes one meridian of the eye to be farsighted and a second meridian (perpendicular to the first) to be nearsighted.

Mixed astigmatism usually can be successfully treated with LASIK, but results might be less predictable than surgical correction of simple nearsighted astigmatism. Your eye doctor can discuss this with you in detail at your LASIK consultation. — Dr. Heiting

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 eyeglasses can correct astigmatism. Refractive surgery, such as LASIK or PRK, also is an option. — Dr. Dubow

[Read more about toric contacts for astigmatism.]

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. Corneal scarring sometimes can cause irregular astigmatism that cannot be fully corrected with contact lenses. — Dr. Slonim

When considering contacts for hard-to-fit eyes, such as eyes with irregular astigmatism and/or corneal scarring, most eye doctors recommend rigid gas permeable (RGP or GP) contact lenses. Other options that can produce excellent results on eyes with distorted corneas include custom contact lenses and extra large GP lenses called scleral contacts. — Dr. Heiting

Q: My eye doctor told me in my eye 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 is a very common vision problem. In fact, most people have some. When you have astigmatism, light does not focus to a single point in your eye. Instead, it causes blurred vision because the front of the eye is shaped more like a football than a baseball. And astigmatism can (and often 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 people with astigmatism who want to wear contact lenses continually, including while they sleep. 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 or GP) lenses, allow more oxygen to reach the cornea than many soft lenses and can correct even high amounts of astigmatism.

There are a number of brands of extended wear contact lenses for astigmatism that have been approved by the FDA for up to six days of continuous wear and one brand (PureVision Toric; Bausch+Lomb) has been approved for up to 30 days.

If you wear contact lenses overnight, I recommend that you rinse your eyes with sterile 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 wear contacts continuously. 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

Please note: If you have an urgent question about your eye health, contact your eye care practitioner immediately. This page is designed to provide general information about vision, vision care and vision correction. It is not intended to provide medical advice. If you suspect that you have a vision problem or a condition that requires attention, consult with an eye care professional for advice on the treatment of your own specific condition and for your own particular needs. For more information, read our Terms of Use.

[Page updated December 2011]