There are three ways to treat astigmatism: glasses, contact lenses, and surgery.
Glasses and contact lenses for people with astigmatism have an extra component called a toric lens. This bends light to counterbalance the effects of astigmatism. These lenses are usually a bit more expensive.
Toric contact lenses may be slightly heavier on one side. This side slips to the bottom of the eye, ensuring that the right part of the lens is over the right part of the eye. Some people have found these lenses less comfortable than normal lenses. But contact lens technology is improving all the time, so if you found toric lenses uncomfortable in the past, you might not if you try them now.
Surgery treats astigmatism by reshaping the surface of the eye. For people who are also nearsighted, the surgery can correct both the nearsightedness and astigmatism at the same time.
There are a few basic types of operations, which are usually done in an eye clinic:
- laser-assisted in situ keratomileusis (LASIK)
- laser-assisted subepithelial keratomileusis (LASEK)
- epithelial laser in situ keratomileusis (Epi-LASIK)
- photorefractive keratectomy (PRK or PK)
With LASIK, the doctor makes a small cut into the top layer of the cornea, then folds back this layer like a flap. A laser is then used to mould the inner tissue of the cornea underneath into a better shape. The flap is then replaced.
PRK is done with a computer-guided laser. A computer-controlled laser removes the epithelium (the very top protective layer over the cornea in the front of the eye), then reshapes the cornea by ablating (destroying) tissue in the periphery or outer part. The result is a cornea that is shaped to refract (bend) light correctly.
LASEK is a variation of LASIK and PRK. With LASEK, the flap created in the cornea is thinner, and the laser moulds the outer layer of the cornea (the epithelium).
Epi-LASIK is a modified version of LASEK that uses a mechanical device to remove the outer layer of the cornea.
Newer refinements of these procedures are constantly under development. One example is "wavefront" or "custom" LASIK, in which a computer maps the visual problems needing correction, increasing the accuracy of the result.
Surgery can only be performed on uninfected healthy eyes. It's not suitable for children and teenagers, whose vision is still changing.
Eye operations don't always produce the desired results. Study results vary, but most people who have laser surgery have improved vision. It is important to realize, however, that some people do not notice any improvement in their vision, and a few end up with poorer vision.
Laser surgery can reduce the quality of your best corrected vision (the absolute best you could see with the right lenses). It can also impair night vision. In addition, the eye can change again after the operation. Sometimes, it heals from surgery into much the same shape it had before, producing only temporary improvement. Because eye doctors like to err on the side of caution, they may under-correct vision, and you may need follow-up procedures.
Finally, although laser surgery has been around for over 15 years, we still don't know the long-term consequences. While there's no reason to believe they'll have problems, we can't be absolutely sure. It is important to discuss potential complications thoroughly with an eye doctor before opting for laser surgery.
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