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Archive October 2017 XVIII, No. 10

How to Stamp Out Astigmatism

The 5 keys to surgical success with astigmatism correction.

Curtin Kelley

Curtin Kelley, MD


Curtin G. Kelley, MD REMINDER When ophthalmologist Curtin G. Kelley, MD, treats astigmatism, he puts a sticky note on the operating machine that tells him the lens power and rotation where it should end up.

I've spent my professional life correcting the blurry vision caused by astigmatism, which occurs when the surface or lens of the eye is unevenly curved. Much of that correction happens in the office, with prescribed glasses or contact lenses. But sometimes, the best way to correct astigmatism is through surgery.

One type of astigmatism correction surgery — perhaps the best known — is laser vision correction. This procedure reduces the need for glasses by using a laser to create a flap in the cornea, lifting the flap and reshaping the cornea. In another type of surgery, the flap is created with a manual incision, rather than a laser. Astigmatism correction surgery can also be combined with cataract surgery when the surgeon inserts a corrective toric lenses directly into the eye. There are many conversations to be had — and decisions to be made — before the patient arrives for surgery. Here's what you should know about helping patients get to the post-operative finish line with no more astigmatism.

1 See it
When a patient wants to end her dependence on glasses or contact lenses, one of an ophthalmologist's first steps is to analyze the type of astigmatism the patient has. The 3 primary types of astigmatism are myopic (nearsightedness), hyperopic (farsightedness) or a combination of the two. Because astigmatism can be masked by prior contact lens use, patients should stop wearing their contacts before their baseline astigmatism levels are measured: 1 week for soft daily wear lenses and 3 to 4 weeks for hard, or rigid glass permeable, lenses. This lets the eye unmold for an accurate measurement revealing the patient's true baseline astigmatism. It's also important before surgery to manage any ocular surface diseases. This could mean, for example, treating severely dry eyes before taking measurements and committing to astigmatism correction surgery.

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