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    Astigmatism

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    Diana Phiri
    Astigmatism occurs when parallel rays of light entering the eye do not focus to a single point on the retina due to an irregular curvature of the cornea and/or lens. It can be classified based on etiology and the orientation of the principal meridians. Treatment options include cylindrical lenses, toric contact lenses, and refractive surgery such as PRK or LASIK.

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    Astigmatism

    Uploaded by

    Diana Phiri
    261 views47 pages
    Astigmatism occurs when parallel rays of light entering the eye do not focus to a single point on the retina due to an irregular curvature of the cornea and/or lens. It can be classified based on etiology and the orientation of the principal meridians. Treatment options include cylindrical lenses, toric contact lenses, and refractive surgery such as PRK or LASIK.

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    Astigmatism occurs when parallel rays of light entering the eye do not focus to a single point on the retina due to an irregular curvature of the cornea and/or lens. It can be classified based on etiology and the orientation of the principal meridians. Treatment options include cylindrical lenses, toric contact lenses, and refractive surgery such as PRK or LASIK.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    261 views47 pages

    Astigmatism

    Uploaded by

    Diana Phiri
    Astigmatism occurs when parallel rays of light entering the eye do not focus to a single point on the retina due to an irregular curvature of the cornea and/or lens. It can be classified based on etiology and the orientation of the principal meridians. Treatment options include cylindrical lenses, toric contact lenses, and refractive surgery such as PRK or LASIK.

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    Download as PPT, PDF, TXT or read online from Scribd
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    Astigmatism

    Walter Huang, OD Yuanpei University Department of Optometry

    Definition
    When parallel rays of light enter the eye (with accommodation relaxed) and do not come to a single point focus on or near the retina

    Optics
    Power in the horizontal plane projects a vertical focal line image Power in the vertical plane projects a horizontal focal line image

    Optics
    Refraction of light taking place at a toric surface: the conoid of Sturm

    Etiology
    Cornea

    The cornea has an unequal curvature on its anterior surface

    Etiology
    Lens

    The crystalline lens has an unequal curvature on its surface or in its layers

    Etiology
    It is due to a distortion of the cornea and/or lens The refracting power is not uniform in all meridians The principal meridians are the meridians of greatest and least refracting powers The amount of astigmatism is equal to the difference in refracting power of the two principal meridians

    Classification
    Based on etiology Based on relation between principal meridians Based on orientation of meridian or axis Based on focal points relative to the retina Based on relative locations of principal meridians or axes when comparing the two eyes

    Corneal Astigmatism
    When the cornea has unequal curvature on the anterior surface

    Lenticular Astigmatism
    When the crystalline lens has an unequal on the surface or in its layers

    Total Astigmatism
    The sum of corneal astigmatism and lenticular astigmatism

    Regular Astigmatism
    When the two principal meridians are perpendicular to each other Most cases of astigmatism are regular astigmatism The three types are with-the-rule, againstthe-rule, and oblique astigmatism

    Irregular Astigmatism
    When the two principal meridians are not perpendicular to each other Curvature of any one meridian is not uniform Associated with trauma, disease, or degeneration VA is often not correctable to 20/20

    With-The-Rule (WTR) Astigmatism


    When the greatest refractive power is within 030 of the vertical meridian (i.e., between 060 and 120 meridians) Minus cylinder axis around horizontal meridian The most common type of astigmatism based on the orientation of meridians

    With-The-Rule (WTR) Astigmatism

    Against-The-Rule (ATR) Astigmatism


    When the greatest refractive power is within 030 of the horizontal meridian (i.e., between 030 and 150 meridians) Minus cylinder axis around vertical meridian

    Against-The-Rule (ATR) Astigmatism

    Oblique (OBL) Astigmatism


    When the greatest refractive power is within 030 of the oblique meridians (i.e., between 030 and 060 or 120 and 150)

    Oblique (OBL) Astigmatism

    Simple Astigmatism
    When one of the principal meridians is focused on the retina and the other is not focused on the retina (with accommodation relaxed)

    Simple Myopic Astigmatism


    When one of the principal meridians is focused in front of the retina and the other is focused on the retina (with accommodation relaxed)

    Simple Hyperopic Astigmatism


    When one of the principal meridians is focused behind the retina and the other is focused on the retina (with accommodation relaxed)

    What Patient Sees


    One meridian is out of focus

    Compound Astigmatism
    When both principal meridians are focused either in front or behind the retina (with accommodation relaxed)

    Compound Myopic Astigmatism


    When both principal meridians are focused in front of the retina (with accommodation relaxed)

    Compound Hyperopic Astigmatism


    When both principal meridians are focused behind the retina (with accommodation relaxed)

    What Patient Sees


    Both meridians are out of focus

    Mixed Astigmatism
    When one of the principal meridians is focused in front of the retina and the other is focused behind the retina (with accommodation relaxed)

    Symmetrical Astigmatism
    The principal meridians or axes of the two eyes are symmetrical (e.g., both eyes are WTR or ATR) The sum of the two axes of the two eyes equals approximately 180

    Symmetrical Astigmatism
    Example

    OD: OS:

    pl -1.00 x 175 pl -1.00 x 005

    Both eyes are WTR astigmatism, and the sum of the two axes equal approximately 180

    Asymmetrical Astigmatism
    The principal meridians or axes of the two eyes are not symmetrical (e.g., one eye is WTR while the other eye is ATR) The sum of the two axes of the two eyes does not equal approximately 180

    Asymmetrical Astigmatism
    Example:

    OD: OS:

    pl -1.00 x 180 pl -1.00 x 090

    One eye is WTR astigmatism, and the other eye is ATR astigmatism, and the sum of the two axes do not equal approximately 180

    Prevalence
    Age

    Infants are born with ATR astigmatism, where the cornea is the source of the astigmatism Preschool children have little or no astigmatism Teenage children demonstrate a shift towards WTR astigmatism Older adults show a shift towards ATR astigmatism

    Prevalence
    Gender

    In general, there are no significant differences between males and females

    Prevalence
    Ethnicity

    Higher prevalence in North Americans, Latinos Asian infants tend to be WTR astigmatism Caucasian infants tend to be ATR astigmatism

    Incidence
    General trend

    For older adults, the average rate of change towards ATR astigmatism is less than or equal to 0.25D every 10 years

    Visual Acuity
    Theoretically, at NO distance does an uncorrected astigmat have a sharp retinal image Clinically, if astigmatism is small (less than 0.50DC), the patient may not notice blur

    Visual Acuity
    Simple or compound myopic astigmatism

    Accommodation may make the retinal image even more blurry Accommodation may improve VA to some extent
    VA is relatively good May not need much accommodation

    Simple or compound hyperopic astigmatism

    Mixed astigmatism

    Spherical and Astigmatic Ametropia


    Uncorrected VA Spherical Astigmatism (D) Refractive Error (D)* 0.50 1.00

    20/30

    20/40
    20/60 20/80 20/120 20/200

    0.75
    1.00 1.50 2.00 2.50

    1.50
    2.00 3.00 4.00 >4.00

    Spherical and Astigmatic Ametropia


    Spherical refractive error (D)*

    Myopia or absolute hyperopia When multiplied by a factor of two, it equals astigmatism (D)

    Symptoms
    Distorted vision at distance and near Letter confusion Asthenopia or ocular fatigue

    Due to constantly squinting to clear up distorted vision

    Headaches Squinting

    Signs
    Decreased visual acuities at distance and near

    Clinical Tests
    Visual acuity tests distance and near Autorefraction Keratometry Retinoscopy

    Most reliable source of information for cylinder power and axis

    Monocular subjective refraction, including Jackson cross cylinder

    Management
    Cylindrical lenses and spherocylindrical lenses in spectacles and contact lenses for simple astigmatism and compound astigmatism, respectively Refractive surgery

    Management
    Spectacles

    Single vision glasses with cylinder

    Management
    Contact lenses

    Toric soft contact lenses Toric rigid gas permeable contact lenses

    Management
    Refractive surgery

    Photorefractive keratectomy (PRK) Laser in-situ keratomileusis (LASIK)

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