Astigmatism is one of the most common refractive errors, yet it’s also one of the most misunderstood when it comes to vision correction. Many patients assume that, because their corneas are irregularly shaped, their options for reducing dependence on glasses or contacts are limited.
The good news? Today, several procedures can effectively correct astigmatism. The right one for you depends on factors such as corneal thickness, prescription strength, age, and lifestyle.
At The Omaha and Lincoln Eye and Laser Institute, patients in the Omaha and Lincoln area have access to four proven approaches: LASIK, PRK, EVO ICL, and refractive lens exchange. Keep reading to learn how each one works and who it tends to work best for.
What Is Astigmatism, and Why Does It Affect Your Vision Correction Options?
A typical eye is shaped like a perfect sphere, which allows light to pass through and land directly on the retina at the back of the eye. With astigmatism, the eye is shaped more like a football, curved slightly more in one direction than the other.
That irregular shape causes light to scatter across multiple points on the retina rather than focusing on a single point, leading to blurry or distorted vision at any distance. Most people with astigmatism also have some degree of nearsightedness or farsightedness.
For years, astigmatism was considered a complicating factor for elective vision correction, but that’s largely changed. The procedures available today are designed to address astigmatism directly, and your eye doctor will factor in your corneal shape, thickness, and overall prescription when recommending the approach most likely to give you the best outcome.
LASIK for Astigmatism: A Widely Used and Well-Established Approach
LASIK works by reshaping the cornea using two lasers. The first creates a thin flap in the corneal tissue; the second, an excimer laser, removes microscopic amounts of tissue underneath to correct the irregular curve responsible for your astigmatism. Once the reshaping is complete, the flap is placed back over the eye and heals naturally.
The Omaha and Lincoln Eye and Laser Institute offers iLASIK, a bladeless, fully customized version of the procedure that uses the iDesign wavefront-guided laser system. Because it maps the unique contours of your eye before treatment, iLASIK can address not just astigmatism but also subtler visual imperfections called higher-order aberrations.
These are the kinds of errors that standard glasses and contact lenses cannot correct, and it’s the only technology of its kind available in Nebraska.
Good candidates for LASIK are generally 18 or older, have had a stable prescription for at least a year, and have corneas thick enough to safely create the flap. Patients with severe dry eye or very thin corneas may not qualify. Most people notice significant improvement in vision within 1 to 3 days of the procedure.
PRK: The Right Fit for Patients Who Don’t Qualify for LASIK
PRK, or photorefractive keratectomy, uses the same excimer laser technology as LASIK to reshape the cornea and correct astigmatism. The key difference is in how that laser reaches the tissue.
With PRK, the outer layer of the cornea, called the epithelium, is gently removed before the laser is applied. No flap is created, and the epithelium grows back on its own during recovery.
Because no flap is involved, PRK is often the better choice for patients with thinner corneas, patients who participate in contact sports, those who have had certain prior eye surgeries, or those with mild to moderate dry eye. The tradeoff is a longer recovery: most PRK patients need around a week to recover, compared to a few days with LASIK.
Long-term, the visual outcomes are comparable between the two procedures. If you’ve been told in the past that LASIK isn’t right for you, PRK may still be a path to the clear vision you’re looking for. Your eye doctor can assess whether you’re a good candidate during a comprehensive consultation.
EVO ICL: Correcting Astigmatism Without Changing the Cornea
The EVO ICL takes a different approach entirely. Rather than reshaping the cornea, your eye surgeon places a small, flexible lens inside the eye, just behind the iris and in front of the eye’s natural lens.
EVO ICL is designed for nearsighted patients with mild to moderate astigmatism. It’s a particularly good option for people aged 21 to 60 with thin corneas, dry eyes, or severe nearsightedness. Because no structural changes are made to the cornea, the lens can be removed if your vision needs change over time.
The surgery is short, and the recovery is quick. Most patients notice improved vision almost immediately. The lens also features a built-in UV filter and is made from a biocompatible material. Because the lens sits behind the iris, it’s not visible to you or anyone else without a clinical exam.
Refractive Lens Exchange: The Best Option for Patients Over 40
Refractive lens exchange (RLE) is the procedure most often recommended for patients over 40, especially those experiencing presbyopia, the gradual loss of close-up reading vision that often comes with age. Instead of reshaping the cornea or adding a lens, RLE removes the eye’s natural lens entirely and replaces it with an artificial intraocular lens (IOL) specifically selected to match your prescription and vision goals.
The technique is the same one used in cataract surgery, one of the most commonly performed surgical procedures worldwide. For patients with astigmatism, a toric IOL can correct the irregular corneal curve while the natural lens is replaced, addressing multiple vision problems in a single procedure.
RLE also eliminates the possibility of developing cataracts later in life, since the artificial lens cannot cloud over the way a natural lens can. Recovery is typically smooth and quick. Most patients notice improvement within a few days, though you will need separate procedures for each eye.
People with high prescriptions, significant farsightedness, or presbyopia who aren’t suitable candidates for LASIK or PRK often find RLE gives them the visual freedom they’ve been looking for.
What is the Best Procedure for My Astigmatism?
There is no single procedure that’s right for everyone with astigmatism. Your eye doctor’s recommendation will be determined by several factors: the thickness of your corneas, the severity and type of your astigmatism, your overall prescription, your age, your eye health and overall health, and your vision goals.
The most reliable way to figure out which direction makes sense for you is to sit down with an experienced eye surgeon who can evaluate your eyes directly. Schedule a free consultation at The Omaha and Lincoln Eye and Laser Institute in Omaha or Lincoln, NE today, and find out which option could help you achieve your best vision.
