Blurry Vision — Both Near and Far? Your Best Astigmatism Fixes

Q&A with an ophthalmologist
Blurry Vision — Both Near and Far? Your Best Astigmatism Fixes

You usually can tell if you’re nearsighted or farsighted. But it can be harder to realize or notice when everything is blurry, at any distance. In this case, you could have  astigmatism, another common eye defect that affects the shape of your cornea.

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Ophthalmologist Scott Wagenberg, MD, answers five important questions about astigmatism.

Q: How does astigmatism affect your eye?

A: The cornea is the clear outer surface of your eye. Think of the ideal cornea as a baseball. It is typically smooth and round so that light entering the eyes bends (refracts) evenly and creates a sharp, clear image of what you see. With astigmatism, the cornea’s shape is more like a football. Left untreated, it causes blurry vision, headaches and fatigue.

There are two types:

  • Regular astigmatism is more common and causes the football-shaped cornea.
  • Irregular astigmatism means there is no symmetry to the shape of the cornea. Causes include injuries or infections that leave scarring and alter the cornea’s shape, and conditions such as keratoconus, which makes the cornea thinner and more cone-shaped.

Q: What’s the best way to find out if you have astigmatism?

A: If you think you might have astigmatism, have an eye exam. Your ophthalmologist will be able to tell whether you have astigmatism or something else — such as myopia (nearsightedness) or hyperopia (farsightedness). In fact, you may have astigmatism along with either of the others.

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Your ophthalmologist will use a retinoscope (a special flashlight that helps show the eye’s refraction) to diagnose regular astigmatism. For irregular astigmatism, corneal topography provides an image that shows the curve of the cornea. 

Q: What is the best way to treat astigmatism?

A: This depends on you and your preferences, as well as your specific eye issues. There are several options, and your ophthalmologist will help you decide which one will work best. A lot depends on what type of astigmatism you have and whether or not you have cataracts:

  • Regular astigmatism: Ophthalmologists treat regular astigmatism with glasses, contact lenses or laser eye surgery — either LASIK or photorefractive keratectomy (PRK).
  • Astigmatism in people with cataracts: There are several ways surgeons can treat astigmatism in people with cataracts. During cataract surgery, a surgeon makes a “relaxing incision,” either by hand or with a laser to treat astigmatism. (There is an added cost for laser incision.) Implanted toric interocular lenses are another option for people with both cataracts and astigmatism. They treat cataracts by replacing clouded lenses, but they can help reduce or eliminate astigmatism as well. You may no longer need glasses afterward. (There is an added cost for toric lenses.)
  • Irregular astigmatism: For people with irregular astigmatism, ophthalmologists may prescribe a rigid gas permeable contact lens, using the eye’s tear film to fill in the cornea’s irregularity. 

Q: Can you make astigmatism worse if you watch too much television or read too much?

A: No, regular astigmatism isn’t caused by what you do. It is often hereditary — if your family members have it, you or your children are more likely to have it.

Q: Does astigmatism change over time?

A: Yes. If it’s not found and corrected early, children with a severe case sometimes develop amblyopia (lazy eye). When one eye is weaker than the other, the brain favors the eye with the clearer image and vision in the other eye can get worse.

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Regular eye exams are important

Your vision is so important in many aspects of your life — so the best thing to do is stay on top of it. Regular eye exams and yearly vision tests for your children allow doctors to catch new problems early. These visits also allow your doctor to watch for any changes over time.

Your ophthalmologist will want to check your glasses and prescription every one to two years. Talk to your doctor about what’s best for you.

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