ASTIGMATISM

Dr Rajvin Samuel 1 1 st yr Pg Ophthalmology

 Definition :
A defect of an optical system causing light rays from a point source to fail to meet in a focal point resulting in a blurred and imperfect image. Rays of light converge forming Focal lines

The word is derived from Greek without and stigma Spot

 Astigmatism begins in the 1 st yrs of life > 1 D This arises from recti muscles pulling upon delicate infant sclera in different gazes This astigmatism helps to attain position of best focus This incidence of astigmatism decreases with age

 A toric lens is a lens with two different powers in two orientations perpendicular to each other

A toric surface resembles a section of the surface of an doughnut where there are two regular radii, one smaller than the other one.

 Conus of Sturm:Geometric configuration of light rays emanating from single point source & refracted by spherocylindrical lens

 Focal interval of Sturm :Distance between 2 focal lines Circle of least diffusion At the dioptric mean of focal lines the cross section of sturms conoid appears as circular patch of light rays best overall focus

 Based on axis of the principal meridians

Regular astigmatism principal meridians are perpendicular
With-the-rule astigmatism Against-the-rule astigmatism 2] Oblique astigmatism

Irregular astigmatism - principal meridians are not perpendicular

 Based on focus of the principal meridians

Simple astigmatism
Simple hyperopic astigmatism Simple myopic astigmatism

Compound astigmatism
Compound hyperopic astigmatism Compound myopic astigmatism

Mixed astigmatism

Regular Astigmatism :
Correctable by Spherocylindrical lenses Etiology :
1. Corneal - abnormalities of curvature [common] 2. Lenticular is rare. It may be: i. Curvatural - abnormalities of curvature of lens as seen in lenticonus. ii. Positional - tilting or oblique placement of lens , subluxation. 3. Retinal - oblique placement of macula [rare]

 Symptoms :

Blurring of vision Asthenopic symptoms Tilting of head Squinting [Half closure of eyelid]

Investigations:
Retinoscopy Keratometry Computerized corneal Tomography Astigmatic fan test Jackson cross cylinder

Irregular Astigmatism
Etiology : Corneal [ Scars , Keratoconus , flap complications, marginal degenration , Lenticular [Cataract maturation]

Symptoms : Defective vision Distorsion of objects Polyopia

Investigations:
- Placido's disc test reveals distorted circles - computerized corneal topography

Treatment :
Optical treatment : RGP contact lenses Hybrid contact lenses Scleral lenses Piggyback lens Phototherapeutic keratectomy Corneal Cross-Linking With Riboflavin and Ultraviolet Irradiation

 Penetrating Keratoplasty [PKP]

Intacs corneal implants

Deep Anterior Lamellar Keratoplasty [DALK] Descemet's Stripping Endothelial Keratoplasty [DSEK]

Residual astigmatism :
The amount of astigmatism that still remains after correction of a refractive error. In the case of correction of corneal astigmatism using rigid contact lens ,lenticular residual astigmatism is exposed.

Treatment
Eyeglasses contact lenses refractive surgery

 Astigmatism correction requires prescription of convex cylindrical lenses at 180 +/- 20 deg or concave cylindrical lenses at 90 +/- 20 deg with the rule and vice versa.

Contact lenses
Toric contact lenses Soft lenses [SL] Rigid gas permeable lenses [RGP] RGP do not conform to the asymmetry of corneal surface but replaces it totally and also provides clarity of vision ,more durable. Soft lenses are more comfortable to wear ,easy to fit, adhere more tightly to cornea .

Refractive surgeries
Astigmatic Keratotomy Photoastigmatic refractive Keratectomy [PRK] Relaxing incisions with compression sutures LASIK surgery

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