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Management of Residual Astigmatism

Management of Residual Astigmatism

Tuesday, November 29, 2016
by Solomon Eye Associates

Astigmatism is a common occurrence in healthy eyes. It is essentially a natural blurriness that results from an imperfect optical shape of the cornea, or the “window” of the eye. The shape of the cornea is typically round, but with astigmatism it develops in more of an oblong shape instead of spherical, which leads it to mis-focus otherwise healthy vision.

Causes of Astigmatism

Astigmatism is caused by an irregular curvature of the eye's cornea or lens. It is called a refractive error due to the fact that light rays aren’t refracted properly if your cornea or lens isn't smooth and evenly curved. In most cases, people with astigmatism are born with this condition, thus the likelihood of developing astigmatism is inherited. Additionally, sometimes astigmatism can develop after an eye injury, eye disease, or ophthalmic surgery.

Residual Astigmatism

When a spherical contact lens is placed upon the eye to correct existing conditions, such as an intraocular lens implantation (IOL) used in cataract surgery, an astigmatic refractive error often remains uncorrected. Many patients who experience residual astigmatism desire corrective treatment, and it is crucial to determine the exact cause before making decisions about the proper treatment.

Treatments of Residual Astigmatism

If a patient presents with residual astigmatism after the implantation of any IOL, it’s necessary to examine his preoperative and postoperative data to determine whether the astigmatism is naturally occurring or surgically induced.

If ocular surface disease is found to be the cause of residual astigmatism, it can be treated medically with artificial tears, lid treatments, and even steroid drops, all of which help to control ocular surface inflammation. This is the most common cause of residual astigmatism in patients with standard monofocal IOLs, and treating with lubrication and tears can be extremely beneficial in getting the patient back to the pre-operative baseline.

It’s also important to determine whether the patient has residual astigmatism due to pre-existing corneal astigmatism or now has astigmatism that was not identified preoperatively before the IOL implantation.

Prediction and calculation of residual astigmatism is possible if a patient is evaluated for various options and consequences of different lens techniques before fitting. In doing so, the outstanding possibility of poor vision can be reduced and extended post-operative complications can be avoided. Please visit our Interviews page for Dr. Solomon’s webinar presentation on the Management of Residual Astigmatism: Markerless Biometric Guidance vs. Intraoperative Aberrometry.

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