Astigmatism Treatment
Regular and irregular astigmatism · Prof. Dr. Fırat Helvacıoğlu, FEBOS-CR · Veni Vidi Eye Clinic, Caddebostan – Kadıköy, Istanbul
Astigmatism is a refractive error that causes blurred vision at all distances because the cornea has a steeper curve in one direction. In astigmatism treatment, glasses and toric contact lenses correct the blur, and in suitable people laser, a toric ICL or a toric intraocular lens can also treat it permanently. However, rapidly increasing astigmatism may be the first sign of keratoconus.
What is astigmatism?
Astigmatism is a refractive error in which light cannot focus at a single point because the cornea (or the eye’s lens) has a steeper curve in one direction than the other. As a result, images appear blurred or shadowed at all distances, and lights scatter at night. In addition, it often occurs together with myopia or hyperopia.
- Regular astigmatism: The cornea has a regular curve, like a rugby ball; glasses, toric contact lenses, laser or a toric intraocular lens can correct it.
- Irregular astigmatism: The shape of the cornea is irregular; the most common cause is keratoconus. Previous surgery and corneal scars can also be responsible. Glasses do not fully correct it, so astigmatism treatment may need specialty contact lenses, cross-linking, corneal ring segments or topography/wavefront-guided laser.
Astigmatism symptoms
- Blurred, shadowed or double vision at near and distance
- Scattering and streaking of headlights and lights at night
- Eye strain, headaches, squinting
- Frequent changes in prescription, especially in the astigmatism value (a warning sign for keratoconus)
Astigmatism treatment options
| Option | Description |
|---|---|
| Glasses | Cylindrical lenses correct regular astigmatism |
| Toric contact lenses | Soft lenses that correct astigmatism and have a design that keeps them from rotating on the eye; for high or irregular astigmatism, rigid gas-permeable, hybrid or scleral lenses are the choice |
| Laser | Laser correction of regular astigmatism is possible with SMILE Pro, No Touch, Q-LASIK or Femto-LASIK; topography/wavefront-guided laser is the preferred choice for irregular corneas and eyes in which refractive and corneal astigmatism do not match |
| Toric ICL | Young adults with high myopia and astigmatism who are unsuitable for laser (phakic intraocular lens (ICL)) |
| Toric lens | The toric lens corrects astigmatism at the same time during cataract or smart lens surgery; toric EDOF and toric trifocal models are available |
Meta-analyses have shown that in cataract patients with corneal astigmatism, toric lenses reduce residual astigmatism and improve uncorrected distance vision compared with non-toric lenses. In addition, the agreement between refractive and corneal astigmatism is important in laser astigmatism treatment; if the difference is large, we plan the treatment according to corneal measurements.
For contact lens wear, the doctor determines the suitable lens type and power at the examination; you then obtain the lens according to this recommendation. In addition, the doctor monitors lens fit and corneal health at regular check-ups.
Can astigmatism be a sign of keratoconus?
Yes. Particularly in young people, an increase in astigmatism at short intervals, inability to see fully clearly with glasses and poorly fitting contact lenses can be the first signs of keratoconus. Corneal topography and tomography detect keratoconus early, and cross-linking can halt its progression. Therefore, every patient with increasing astigmatism should have a corneal map. More: keratoconus.
Frequently asked questions
Yes. SMILE Pro, No Touch or LASIK can correct regular astigmatism in suitable patients. However, irregular astigmatism may require personalised (topography/wavefront-guided) treatment.
The limit depends on corneal thickness and the chosen method. If astigmatism is too high for laser, a toric ICL or a toric intraocular lens can correct it.
Yes. Toric soft lenses suit regular astigmatism, while rigid, hybrid or scleral lenses suit high or irregular astigmatism. The doctor determines the suitable lens at the examination.
Regular astigmatism usually remains similar throughout life, although its axis may change with age. However, if astigmatism increases rapidly over a short period, the doctor should assess the eye for keratoconus.
Yes. A toric intraocular lens can also correct astigmatism during cataract surgery.
References
- Hao LH, Pei C. Toric versus non-toric intraocular lenses for pre-existing corneal astigmatism: a systematic review and meta-analysis. Front Med (Lausanne). 2026;13:1777267. doi:10.3389/fmed.2026.1777267
- Cheng SM et al. Topography-guided versus wavefront-optimized LASIK for myopia with and without astigmatism: a meta-analysis. J Refract Surg. 2021;37(10):707–714. doi:10.3928/1081597X-20210709-01
- Frings A et al. LASIK for spherical refractive myopia: effect of topographic astigmatism (ocular residual astigmatism, ORA) on refractive outcome. PLoS One. 2015;10(4):e0124313. doi:10.1371/journal.pone.0124313
- Wen D et al. Postoperative efficacy, predictability, safety, and visual quality of laser corneal refractive surgery: a network meta-analysis. Am J Ophthalmol. 2017;178:65–78. doi:10.1016/j.ajo.2017.03.013
This page provides patient information and does not replace an examination or medical assessment. We determine the astigmatism treatment that is right for you after an eye examination and measurements.
Astigmatism treatment assessment
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Caddesi No: 257, Caddebostan – Kadıköy, Istanbul, Türkiye