Astigmatism is probably the most misunderstood vision problem. For starters, it's called "astigmatism," not "stigmatism." (You don't have "a stigmatism" you have astigmatism.)
In an eye with astigmatism, light fails to come to a single focus on the retina to produce clear vision. Instead, multiple focus points occur, either in front of the retina or behind it (or both).
Astigmatism usually causes vision to be blurred or distorted to some degree at all distances.
Symptoms of uncorrected astigmatism are eye strain and headaches, especially after reading or other prolonged visual tasks.
Squinting also is a very common symptom.
What Causes Astigmatism?
Astigmatism usually is caused by an irregularly shaped cornea. Instead of the cornea having a symmetrically round shape (like a baseball), it is shaped more like a football, with one meridian being significantly more curved than the meridian perpendicular to it.
(To understand what meridians are, think of the front of the eye like the face of a clock. A line connecting the 12 and 6 is one meridian; a line connecting the 3 and 9 is another.)
The steepest and flattest meridians of an eye with astigmatism are called the principal meridians.
In some cases, astigmatism is caused by the shape of the lens inside the eye. This is called lenticular astigmatism, to differentiate it from the more common corneal astigmatism.
Try these interactive Rx forms to learn what the measurements mean on your eyeglass prescription or contact lens prescription.
Types of Astigmatism
There are three primary types of astigmatism:
- Myopic astigmatism. One or both principal meridians of the eye are nearsighted. (If both meridians are nearsighted, they are myopic in differing degree.)
- Hyperopic astigmatism. One or both principal meridians are farsighted. (If both are farsighted, they are hyperopic in differing degree.)
- Mixed astigmatism. One prinicipal meridian is nearsighted, and the other is farsighted.
Astigmatism also is classified as regular or irregular. In regular astigmatism, the principal meridians are 90 degrees apart (perpendicular to each other). In irregular astigmatism, the principal meridians are not perpendicular. Most astigmatism is regular corneal astigmatism, which gives the front surface of the eye a football shape.
Irregular astigmatism can result from an eye injury that has caused scarring on the cornea, from certain types of eye surgery or from keratoconus, a disease that causes a gradual thinning of the cornea.
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How Common Is Astigmatism?
Astigmatism often occurs early in life, so it is important to schedule an eye exam for your child to avoid vision problems in school from uncorrected astigmatism.
In a recent study of 2,523 American children ages 5 to 17 years, more than 28 percent had astigmatism of 1.0 diopter (D) or greater.
Also, there were significant differences in astigmatism prevalence based on ethnicity. Asian and Hispanic children had the highest prevalences (33.6 and 36.9 percent, respectively), followed by whites (26.4 percent) and African-Americans (20.0 percent).
In another study of more than 11,000 eyeglass wearers in the UK (both children and adults), 47.4 percent had astigmatism of 0.75 D or greater in at least one eye, and 24.1 percent had this amount of astigmatism in both eyes. The prevalence of myopic astigmatism (31.7 percent) was approximately double that of hyperopic astigmatism (15.7 percent).
Astigmatism is detected during a routine eye exam with the same instruments and techniques used for the detection of nearsightedness and farsightedness.
Your eye doctor can estimate the amount of astigmatism you have by shining a light into your eye while manually introducing a series of lenses between the light and your eye. This test is called retinoscopy.
Though many eye doctors continue to perform retinoscopy, this manual procedure has been replaced or supplemented in many eye care practices with automated instruments that provide a faster preliminary test for astigmatism and other refractive errors.
Whether your eye exam includes retinoscopy, an automated refraction, or both, your optometrist or ophthalmologist will perform another test called a manual refraction to refine the results of these preliminary astigmatism tests.
In a manual refraction (also called a manifest refraction or subjective refraction), your eye doctor places an instrument called a phoropter in front of your eyes. The phoropter contains many lenses that can be introduced in front of your eyes one at a time so you can compare them.
As you look through the phoropter at an eye chart at the end of the exam room, your eye doctor will show you different lenses and ask you questions along the lines of, "Which of these two lenses makes the letters on the chart look clearer, lens A or lens B?" Your answers to these questions help determine your eyeglasses prescription.
Astigmatism Correction Options
The axis of astigmatism in eyeglass and contact lens prescriptions describes the location of the flatter principal meridian of the eye using the above 180-degree rotary scale.
In addition to the spherical lens power used to correct nearsightedness or farsightedness, astigmatism requires an additional "cylinder" lens power to correct the difference between the powers of the two principal meridians of the eye.
So an eyeglasses prescription for the correction of myopic astigmatism, for example, could look like this: -2.50 -1.00 x 90.
- The first number (-2.50) is the sphere power (in diopters) for the correction of myopia in the flatter (less nearsighted) principal meridian of the eye.
- The second number (-1.00) is the cylinder power for the additional myopia correction required for the more curved principal meridian. In this case, the total correction required for this meridian is -3.50 D (-2.50 + -1.00 = -3.50 D).
- The third number (90) is called the axis of astigmatism. This is the location (in degrees) of the flatter principal meridian, on a 180-degree rotary scale where 90 degrees designates the vertical meridian of the eye, and 180 degrees designates the horizontal meridian.
If you wear soft toric contact lenses for astigmatism correction, your contact lens prescription will likewise include a sphere power, cylinder power and axis designation.
Gas permeable contact lenses are also an option. Because these lenses are rigid and optically replace the cornea as the refracting surface of the eye, a cylinder power and axis may or may not be needed, depending on the type and severity of astigmatism correction required. The same is true for hybrid contact lenses.
Refractive surgery such as LASIK also can correct most types of astigmatism. Discuss with your eye doctor which procedure is best for you.
Refractive error and ethnicity in children. Archives of Ophthalmology. August 2003.
About the Author: Gary Heiting, OD, is senior editor of AllAboutVision.com. Dr. Heiting has more than 25 years of experience as an eye care provider, health educator and consultant to the eyewear industry. His special interests include contact lenses, nutrition and preventive vision care. Connect with Dr. Heiting via Google+.
[Page updated December 18, 2014]
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