Astigmatism Severity Scale

Overview: What is Astigmatism?

Astigmatism refers to a common eye condition where the curvature of your cornea (the clear front cover of your eye) or natural lens is irregularly shaped. As a result, your vision to be blurry at all distances—both near and far.

This refractive error occurs because your eye cannot focus light properly. Light should focus directly onto your retina, the light-sensitive surface that lines the back of your eye.

If your cornea is shaped more like a football than a soccer ball, your eye won’t be able to focus light rays at a single point. If the eye’s lens curvature changes, this can worsen your astigmatism. This can happen in adulthood and with naturally occurring cataracts.

Types of Refractive Errors

There are three different types of refractive errors, including astigmatism:

• Myopia (Nearsightedness) — This occurs when your eye focuses light in front of the retina, so you have trouble seeing objects that are far away.
• Hyperopia (Farsightedness) — This occurs when your eye focuses light behind the retina, so you have trouble seeing objects that are nearby.
• Astigmatism — This occurs when your eye focuses light at different points both in front of and behind the retina, so you have trouble seeing objects both far away and close up.

You can inherit corneal errors like astigmatism through your genetics or develop. It may also develop after the following:

• Eye injury
• Eye surgery
• Eye disease like keratoconus

Effects of Astigmatism on Visual Impairment

Whether you’re born with it or it develops later in life, the symptoms of astigmatism generally include the following:

• Blurry vision
• Trouble seeing objects both close up and far away
• Fluctuating vision
• Eye strain
• Squinting
• Headaches
• Difficulty seeing at night
• Seeing glare and halos at night
• Seeing shadowy images

If you only have a mild case of astigmatism, you may not notice any of the above symptoms or require correction. However, if you do need treatment, options are available, including corrective eyeglasses, contact lenses, and refractive surgery.

If you leave it alone, astigmatism can get better or worse over time. If you have vision problems, you should see your eye doctor to take an eye exam and discuss your options to help you achieve clear vision.

Summary

Astigmatism is an eye condition caused by an irregularly-shaped cornea. People with astigmatism have blurry vision from both near and far distances. Mild forms of astigmatism usually do not require correction. For those with severe astigmatism, contact lenses, eyeglasses, or surgery may be needed.

5 Types of Astigmatism

Astigmatism can be broken down into five categories. Here’s what you should know about each of them:

1. Simple Myopic Astigmatism

Simple myopic astigmatism refers to when the light hits two focal points: one before the eye’s retina and one on the eye’s retina.

2. Simple Hyperopic Astigmatism

Simple hyperopic astigmatism happens when light comes to two focal points: one directly on the eye’s retina and one behind the eye’s retina.

3. Compound Myopic Astigmatism

Compound myopic astigmatism happens when the light hits two focal points at two different locations in front of the eye’s retina.

4. Compound Hyperopic Astigmatism

Compound hyperopic astigmatism refers to when the light comes to two different virtual locations behind the eye’s retina.

5. Mixed Astigmatism

Mixed astigmatism happens when rays of light hit two focal points: one before the eye’s retina and one behind the eye’s retina.

Astigmatism Severity Scale

Not all astigmatism is the same. Astigmatism can vary in severity. The degree of astigmatism is measured in diopters.

For context, a perfect eye that has no astigmatism has 0 diopters, but some people have between 0.5 and 0.75 diopters of astigmatism. People who have about 1.5 or more diopters of astigmatism usually opt to have corrective treatment such as glasses, contacts, or eye surgery.

There are three numbers on any glasses or contact prescription, and the last two refer to astigmatism.

• Spherical indicates whether you are nearsighted (a minus sign) or farsighted (a plus sign).
• Cylinder measures the severity of astigmatism.
• Axis measures where astigmatism is located in degrees from 0 to 180.

Mild Astigmatism: < 1.00 diopter

Mild astigmatism is considered normal. Most people have it and do not need corrective lenses or surgery to see clearly. You may not even notice any symptoms with a mild case of astigmatism.

Moderate Astigmatism: 1.00 to 2.00 diopter

Moderate astigmatism is a little more serious and generally requires corrective lenses or laser surgery in order for you to see clearly. While you may be able to get by without wearing glasses or contacts, chances are that you will notice the symptoms of moderate astigmatism and glasses and contacts can certainly help.

Severe Astigmatism: 2.00 to 3.00 diopter

Severe astigmatism can cause serious symptoms that affect your day-to-day functioning. Blurred vision from severe astigmatism can give you headaches that can take a toll on your health.

Extreme Astigmatism: > 3.00 diopter

Extreme astigmatism will require treatment so that you can see objects both near and far with ease. If you do not treat extreme astigmatism, you will not be able to see clearly at all.

Summary

There are five types of astigmatism: simple myopic, simple hyperopic, compound myopic, compound hyperopic, and mixed. They are categorized into different levels of severity: mild, moderate, severe, and extreme.

What Level of Astigmatism Requires Glasses? 

Because most people have mild astigmatism, wearing glasses or other astigmatism treatment is not typically necessary unless you have moderate astigmatism or worse.

Again, it’s important to schedule regular checkups with an optometrist because astigmatism can change over time. If you wear glasses, you need to be sure that your prescription stays correct.

Can LASIK Fix Astigmatism?

Yes, LASIK (laser in situ keratomileusis) and PRK (photorefractive keratectomy) can fix astigmatism. Both types of laser surgery permanently fix the shape of your cornea so you do not need to wear eyewear for clear vision.

LASIK removes the tissue from the inner layer of the cornea with an excimer laser. On the other hand, PRK removes it from the superficial and inner layers of the cornea.

While LASIK will fix your astigmatism, other refractive errors and vision changes can also develop over time. Your eyes change over time, so you may experience new refractive errors after LASIK surgery.

What Happens During LASIK?

In LASIK surgery, the surgeon will use a mechanical microkeratome (a blade) or a femtosecond laser to cut a flap in your cornea. They’ll leave a hinge at one end of the flap and fold it back to reveal the stroma (the middle section of the cornea).

Then, they'll use pulses from a computer-controlled laser to vaporize a portion of the stroma and replace the corneal flap.

While this may sound painful, the LASIK procedure only takes about 10 minutes per eye — and the laser itself only takes about 20 to 50 seconds to correct your vision, depending on how much correction you need.

Summary

While mild cases of astigmatism do not require correction, moderate to severe ones can benefit from prescription glasses, LASIK, or PRK.

Summary

Astigmatism is an eye condition that causes blurred vision. It can be genetic, occur as early as childhood, or worsen with age. There are different types of astigmatism, and they can can vary in severity. Glasses and LASIK are two options for correcting astigmatism.