Astigmatism (eye)

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For the more general class of optical aberrations, see Astigmatism.
Astigmatism
Classification and external resources
ICD-10 H52.2
ICD-9 367.2
MedlinePlus 001015

Astigmatism is an optical defect in which vision is blurred due to the inability of the optics of the eye to focus a point object into a sharp focused image on the retina. This may be due to an irregular or toric curvature of the cornea or lens. The two types of astigmatism are regular and irregular. Irregular astigmatism is often caused by a corneal scar or scattering in the crystalline lens, and cannot be corrected by standard spectacle lenses, but can be corrected by contact lenses. The more common regular astigmatism arising from either the cornea or crystalline lens can be corrected by eyeglasses or toric lenses. A 'toric' surface resembles a section of the surface of a Rugby ball or a doughnut where there are two regular radii, one smaller than the other one. This optical shape gives rise to astigmatism in the eye.[1]

The refractive error of the astigmatic eye stems from a difference in degree of curvature refraction of the two different meridians (i.e., the eye has different focal points in different planes). For example, the image may be clearly focused on the retina in the horizontal plane, but not in the vertical plane. Astigmatism causes difficulties in seeing fine detail or blurred vision. Three options exist for the treatment of astigmatism: spectacles, contact lenses (either hard contact lenses or toric contact lenses), and refractive surgery.

Contents

Types [edit]

Based on axis of the principal meridians [edit]

Blur from astigmatic lens at different distances
  • Regular astigmatism – principal meridians are perpendicular.
    • With-the-rule astigmatism – the vertical meridian is steepest (a rugby ball or American football lying on its side).[2]
    • Against-the-rule astigmatism – the horizontal meridian is steepest (a rugby ball or American football standing on its end).[2]
    • Oblique astigmatism – the steepest curve lies in between 120 and 150 degrees and 30 and 60 degrees.[2]
  • Irregular astigmatism – principal meridians are not perpendicular.

In with-the-rule astigmatism, a minus cylinder is placed in the horizontal axis to correct the refractive error (or a plus cylinder in the vertical axis). Adding a minus cylinder in the horizontal axis makes the horizontal axis "steeper" (or better: makes the vertical axis "less steep") which makes both axes equally "steep". In against-the-rule astigmatism, a plus cylinder is added in the horizontal axis (or a minus cylinder in the vertical axis).

Children tend to have with-the-rule astigmatism and elderly people tend to have against-the-rule astigmatism.

Axis is always recorded as an angle in degrees, between 0 and 180 degrees in a counter-clockwise direction. Both 0 and 180 degrees lie on a horizontal line at the level of the centre of the pupil, and as seen by an observer, 0 lies on the right of both the eyes.

Based on focus of the principal meridians [edit]

With accommodation relaxed:

  • Simple astigmatism
    • Simple hyperopic astigmatism – first focal line is on retina, while the second is located behind the retina.
    • Simple myopic astigmatism – first focal line is in front of the retina, while the second is on the retina.
  • Compound astigmatism
    • Compound hyperopic astigmatism – both focal lines are located behind the retina.
    • Compound myopic astigmatism – both focal lines are located in front of the retina.
  • Mixed astigmatism – focal lines are on both sides of the retina (straddling the retina).

Prevalence [edit]

According to an American study published in Archives of Ophthalmology, nearly three in 10 children (28.4%) between the ages of five and 17 have astigmatism.[3] A recent Brazilian study found that 34% of the students in one city were astigmatic.[4] Regarding the prevalence in adults, a recent study in Bangladesh found that nearly 1 in 3 (32.4%) of those over the age of 30 had astigmatism.[5]

A recent Polish study revealed "with-the-rule astigmatism" may lead to the onset of myopia.[6]

A number of studies have found the prevalence of astigmatism increases with age.[7]

Diagnosis [edit]

Symptoms [edit]

Although mild astigmatism may be asymptomatic, higher degrees of astigmatism may cause symptoms such as blurry vision, squinting, asthenopia, fatigue, or headaches.[8][9][10] Some research has pointed to the link between astigmatism and higher prevalence of migraine headaches.[11]

Tests [edit]

A number of tests are used by ophthalmologists and optometrists during eye examinations to determine the presence of astigmatism and to quantify its amount and axis.[12] A Snellen chart or other eye charts may initially reveal reduced visual acuity. A keratometer may be used to measure the curvature of the steepest and flattest meridians in the cornea's front surface.[13] Corneal topography may also be used to obtain a more accurate representation of the cornea's shape.[14] An autorefractor or retinoscopy may provide an objective estimate of the eye's refractive error and the use of Jackson cross cylinders in a phoropter or trial frame may be used to subjectively refine those measurements.[15][16][17] An alternative technique with the phoropter requires the use of a "clock dial" or "sunburst" chart to determine the astigmatic axis and power.[18][19] A keratometer may also be used to estimate astigmatism by finding the difference in power between the two primary meridians of the cornea. Javal's rule can then be used to compute the estimate of astigmatism.

Another rarely used refraction technique involves the use of a stenopaic slit (a thin slit aperture) where the refraction is determined in specific meridians - this technique is particularly useful in cases where the patient has a high degree of astigmatism or in refracting patients with irregular astigmatism.

Treatment [edit]

Astigmatism may be corrected with eyeglasses, contact lenses, or refractive surgery. Various considerations involving eye health, refractive status, and lifestyle determine whether one option may be better than another. In those with keratoconus, certain contact lenses often enable patients to achieve better visual acuity than eyeglasses. Once only available in a rigid, gas-permeable form, toric lenses are now available also as soft lenses. If the astigmatism is caused by a problem such as deformation of the eyeball due to a chalazion, treating the underlying cause will resolve the astigmatism.

Laser eye surgery (LASIK and PRK) is successful in treating astigmatism.[20]

Corneal incisions if properly placed can correct astigmatism. These techniques include Astigmatic Keratotomy (AK) and Limbal relaxing incision (LRI). However these techniques are now being used rarely.[20]

See also [edit]

References [edit]

 This article uses bare URLs for citations. Please consider adding full citations so that the article remains verifiable. Several templates and the Reflinks tool are available to assist in formatting. (Reflinks documentation) (May 2012)
  1. ^ Astigmatism at MayoClinic.com
  2. ^ a b c "Astigmatism at Buzzle.com". Buzzle.com. Retrieved 21 June 2008. [self-published source?]
  3. ^ Kleinstein, R. N.; Jones, LA; Hullett, S; Kwon, S; Lee, RJ; Friedman, NE; Manny, RE; Mutti, DO et al. (2003). "Refractive Error and Ethnicity in Children". Archives of Ophthalmology 121 (8): 1141–7. doi:10.1001/archopht.121.8.1141. PMID 12912692. 
  4. ^ Garcia, Carlos Alexandre de Amorim; Oréfice, Fernando; Nobre, Gabrielle Fernandes Dutra; Souza, Dilene de Brito; Rocha, Marta Liliane Ramalho; Vianna, Raul Navarro Garrido (2005). "Prevalence of refractive errors in students in Northeastern Brazil". Arquivos Brasileiros de Oftalmologia 68 (3): 321–5. doi:10.1590/S0004-27492005000300009. PMID 16059562. 
  5. ^ Bourne, R; Dineen, BP; Ali, SM; Noorul Huq, DM; Johnson, GJ (2004). "Prevalence of refractive error in Bangladeshi adults*1Results of the National Blindness and Low Vision Survey of Bangladesh". Ophthalmology 111 (6): 1150–60. doi:10.1016/j.ophtha.2003.09.046. PMID 15177965. 
  6. ^ Czepita, D; Filipiak, D (2005). "The effect of the type of astigmatism on the incidence of myopia". Klinika oczna 107 (1–3): 73–4. PMID 16052807. 
  7. ^ Asano, Kazuko; Nomura, Hideki; Iwano, Makiko; Ando, Fujiko; Niino, Naoakira; Shimokata, Hiroshi; Miyake, Yozo (2005). "Relationship Between Astigmatism and Aging in Middle-aged and Elderly Japanese". Japanese Journal of Ophthalmology 49 (2): 127–33. doi:10.1007/s10384-004-0152-1. PMID 15838729. 
  8. ^ Astigmatism[unreliable medical source?]
  9. ^ Astigmatism symptoms and treatment on MedicineNet.com
  10. ^ http://www.hipusa.com/eTools/webmd/A-Z_Encyclopedia/astigmatism%20symptoms.htm[dead link] HIPUSA Astigmatism symptoms
  11. ^ Harle, Deacon E.; Evans, Bruce J. W. (2006). "The Correlation Between Migraine Headache and Refractive Errors". Optometry and Vision Science 83 (2): 82–7. doi:10.1097/01.opx.0000200680.95968.3e. PMID 16501409. 
  12. ^ http://www.hipusa.com/eTools/webmd/A-Z_Encyclopedia/astigmatism%20treatment.htm[dead link] HIPUSA Astigmatism treatment
  13. ^ http://www.stlukeseye.com/eyeq/Keratometry.asp[dead link] Keratometry
  14. ^ Corneal Topography and Imaging at eMedicine
  15. ^ Graff, T (1962). "Control of the determination of astigmatism with the Jackson cross cylinder". Klinische Monatsblatter fur Augenheilkunde und fur augenarztliche Fortbildung 140: 702–8. PMID 13900989. 
  16. ^ Del Priore, LV; Guyton, DL (1986). "The Jackson cross cylinder. A reappraisal". Ophthalmology 93 (11): 1461–5. PMID 3808608. 
  17. ^ Brookman, KE (1993). "The Jackson crossed cylinder: Historical perspective". Journal of the American Optometric Association 64 (5): 329–31. PMID 8320415. 
  18. ^ Basic Refraction Procedures[unreliable medical source?]
  19. ^ http://www.nova.edu/hpd/otm/nbeo/refract1.htm[dead link] Introduction to Refraction
  20. ^ a b Azar, Dimitri T. (2007). Refractive surgery (2nd ed. ed.). Mosby Elsevier. ISBN 9780323035996. 

External links [edit]

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