Can Lasik fix astigmatism and make vision better in general?
Lasik for Astigmatism?
Doctor Answers (9)
The dreaded "Astigmatism"
Years ago, the correction of astigmatism was one of the greatest hurdles to a terrific LASIK result. Now, with amazing advances in laser mapping and technology, astigmatism has become a routine treatment. Patients, however, love to talk about their astigmatism as if it were some dreaded disease(like "Rheumatism")! Nothing could be further from the truth.
Astigmatism can make wearing contact lenses very difficult, but that does not mean LASIK will be so. Once all of the measurements are completed, the surgeon can sit down with you and allay your fears regarding your "dreaded" malady.....relax....we can handle it!
Astigmatism can be fixed by LASIK
In a perfect world, all eyes would have a nice spherical shape and be perfect optical lenses. In the real world, it is amazing that as many eyes are as good as they are. And the eye is formed during development there is a seam and to make a perfect eye is very difficult and not always accomplished.
The eye has a shape like a football on end when astigmatism is present, and this scatters light rays traveling through it so that simple optics cannot correct it. This is why soft contact lenses will help but only to a limited degree the patient with astigmatism. In the case of glasses, there are distortions created by the lenses that look like a fun house mirror when they are rotated around and looked through. These distortions make wearing glasses in severe astigmatism a suboptimal solution.
LASIK can fix astigmatism, even fairly bad cases of astigmatism to totally remove it or at least reduce it to a level where it is not much of a problem. Some patients who have their astigmatism fixed can see better than they could with glasses or contact lenses. It is one of the really helpful areas for LASIK surgery. In addition, the astigmatism repair can be accompanied by treatment of any near or farsightedness at the same time.
Of course, one has to be a candidate for LASIK in general and astigmatism treatment in particular. Some people with astigmatism have other conditions such as keratoconus where LASIK is not helpful, so it is important to have the astigmatism evaluated by a LASIK expert.
LASIK for Astigmatism
In fact modern EXCIMER laser technology is capable of correcting what are called “higher order aberrations”, tiny little imperfections in vision that cause halos, glare, starbursts and are not correctible with glasses or contacts. This means that LASIK with modern EXCIMER lasers utilizing wavefront optimized treatment patterns can even deliver better vision than is possible to achieve with glasses or contacts!
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Lasik for Astigmatism?
Patients with large amounts of astigmatism are some of the happiest LASIK patients that I treat. My wife had about 5 diopters of astigmatism when I treated her 12+ years ago. The treatment has dramatically changed her life. Patients with astigmatism see well only through the optical center of their glasses and when they move their eyes behind the lens, images become blurry. The same person wearing contact lenses has blurry vision every time that they blink. When the correction is placed directly on the cornea, the quality and quantity of vision can be improved. I receive great hugs from my high astigmatism patients. Those with extreme amounts of astigmatism may require more than one treatment to achieve the desired result.
LASIK Great for Astigmatism
LASIK is great for astigmatism and can even sometimes correct types of astigmatism that glasses or contacts cannot.
Astigmatism is not a Disease
Astigmatism is not a disease, but more nearsightedness or farsightedness in one meridian or "axis" than the opposite 90 degrees. A good example given is the cornea is shaped like a "football" and the laser reshapes the cornea to round. As long as the cornea is normal by topographic mapping, up to 6 D or units of astigmatism can be corrected. A CustomWavefront LASIK can be performed as well for astigmatism. It is important that IR, or Iris Registration is used to properly align the treatment. When a person is supine the head or eye can rotate, called cyclorotation. The VISX CustomVue is my choice of laser since it uses the Iris Registration to rotate the treatment to correct for any cyclorotation - this makes correcting Astigmatism more accurate.
LASIK vs LASEK for astigmatism
If you have a low to moderate amount of astigmatism, either LASIK or LASEK can successfully eliminate that. I know this personally as both a surgeon and patient, as I had 1.50 diopters of astigmatism before my LASIK in 1999, and got rid of it totally (although I needed to be "double-carded" or my myopia shot first, then another treatment card inserted into the laser to treat my astigmatism, because this was so long ago it was before FDA approved the COMBINED treatment of myopia PLUS astigmatism ALL AT ONCE.
HOWEVER, if you have EXTREME astigmatism, like more than 3 diopters, LASEK works better, because there is no flap, which does not actually conform correctly to the underlying bed. The laser in ALL procedures works by evaporating corneal tissue; thereby changing it's shape. You can imagine if you change the shape of the bed (the part under the flap) and make it round, like a basketball, instead of oval like a football, AND THEN PUT BACK THE FLAP YOU DIDN'T CHANGE THE SHAPE OF, not only will it not lie back down correctly, it will MASK the effect of the new (correct) surface a bit, and also may NOT CONFORM properly, causing wrinkles or striae which can DISTORT vision and cause DIPLOPIA OR DOUBLE VISION.
This is TOTALLY AVOIDED WITH LASEK as there is NO FLAP TO MASK OR DISTORT THE NEW CORRECT SURFACE YOU GET after the laser. So I can treat up to 4, 5, or even 6 diopters of cylinder (astigmatism) with LASEK--or almost TWICE as I could reliably and safely treat with LASIK without striae.
LASIK for astigmatism
Patients are delighted to find out that LASIK doesn't only address their nearsightedness and farsightedness, but it can correct relatively high levels of astigmatism as well. Set up a consultation with your eye doctor to make sure your degree of astigmatism isn't beyond the approved FDA treatment range. All the best!