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Astigmatism

Astigmatism

I thought it might be useful to talk about astigmatism, a subject I have written and lectured extensively about. Many people seem to know the word, but relatively few seem to have any idea what it really means. It is often perceived as a scary condition like glaucoma (fairly scary) or cataracts (not really that scary) and it makes people anxious when told that they have it, much more so than being told they are nearsighted or farsighted. Astigmatism is actually not a big deal in most cases.

Almost everyone has some amount of astigmatism. Many have lenses that are specially designed to compensate for astigmatism and don't even know it. Most eye doctors prescribe for even the smallest amount of astigmatism, often without mentioning anything about it. Astigmatism is not so easy to explain so most doctors would rather just not talk about it. (You may have noticed that I have yet to attempt describing it.) I have helped countless people eliminate the need for astigmatism-compensating lenses. This is particularly helpful for those wearing contact lenses, as these lenses are much more expensive than regular lenses. The most important reason to treat astigmatism differently is the increased flexibility and efficiency made available by improving the visual system using vision therapy to retrain the brain not only to see more clearly but to operate at a higher level in all activities.

Astigmatism, first mentioned by Sir Isaac Newton in 1727, was first described in published form in 1800 by Thomas Young who discovered that he himself had astigmatism. Donders considered astigmatism to be a relatively rare abnormality. It wasn’t until the 1900s that astigmatism came to be routinely and accurately measured and prescribed. Now it’s all the rage. Simply put, astigmatism causes light to twist as it enters the eye. This causes images to focus more or less in two parts instead of focusing all at once and in one place. People who ‘need’ lenses for astigmatism report images looking doubled, or as having a ghost or shadow image attached to the main image without lenses. A special compensating (usually called “corrective”) lens is used to essentially trick the light into focusing images all at once inside the eye. This only masks the symptom and will not address the possibly more important underlying issues.

My relationship with astigmatism has been long and varied, starting with some doctor’s perceived need for me to wear lenses that “corrected” for it. (The reason I don’t like the word corrective is that if it really corrected anything then it should be fixed at some point; these lenses only compensate or mask the problem.) That relationship went through a dramatic transformation during my time in optometry school. That transformation became the foundation upon which my subsequent interactions with my own patients are built. My approach to prescribing lenses for astigmatism remains unique.

There are some people who seem incapable of being satisfied without a lens that addresses their astigmatism. However, there are many more who actually have a measurable amount of astigmatism, and are oblivious to the fact because for them it presents little if any obstacle to optimal performance, comfort or seeing clearly. There are also those who have lenses designed for astigmatism, but who do not seem to need these lenses. Each of these people should be handled differently, but this generally is not the case. They are all likely to end up with astigmatism lenses…with varying results.

“The specific cause of astigmatism is unknown. It can be hereditary and is usually present from birth. It can change as a child grows and may decrease or worsen over time.”
                    according to the American Optometric Association website

I find the statement above less than satisfying, though accurate. Astigmatism remains a fairly slippery subject in many ways. Most eye doctors treat it as a very simple matter and are happy to prescribe compensating lenses whenever they measure it. It doesn’t seem to matter whether or not the person can see better. Sometimes these lenses result in better comfort, which is obviously a good thing. However, in many of these cases vision therapy can also improve comfort and make the visual system much stronger overall, and for a long time - usually permanently.

So if you want the easy way out, compensating lenses might be just what you need. But if you want more, or if the lenses still leave you with some of the problems they were supposed to fix, you will want to find a behavioral optometrist who can provide you with more options.

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