Astigmatism: Concerns About Keratoconus and Eye Health

Worsening astigmatism raises concerns about keratoconus?

Hello, doctor.
I went to the hospital for an examination in March this year and found that my astigmatism in both eyes has increased by 100 degrees, while my myopia has not changed.
According to my follow-up records, the last time I got glasses was three to four years ago.
My astigmatism was around 100 degrees, and six years ago, it was only 50 degrees.
I was concerned about having keratoconus, so I underwent a corneal examination, and the doctor said my cornea is still within the normal range, but I need to be monitored regularly.
It has not yet been determined if I have keratoconus.
I actually don’t often rub my eyes, but I used to dislike wearing glasses, so I only wore them in class.
I often squint while walking, using my phone, or watching TV.
There was a period when I stayed up late and used my phone in insufficient light, and I wonder if that contributed to the increase in my astigmatism.
This year, the doctor prescribed me new lens powers: RIGHT SPH -1.50 CYL -2.50 AXIS 170; LEFT SPH -1.00 CYL -3.50 AXIS 10.
However, when I went to the optical shop to get my glasses, I found that the prescription was too strong at first.
Initially, my eyes focused normally, but my right eye's muscles felt strained and uncomfortable.
The optician helped reduce the astigmatism a bit, to about 25 to 75 degrees.
Is this acceptable, meaning the astigmatism is not fully corrected? Should I have it fully corrected instead?
I have been wearing the glasses consistently for over seven months now.
After adapting to these glasses, my vision for near objects remains clear even after prolonged focus, but the ciliary muscle in my right eye tends to tense up and fatigue easily.
However, this only happens in my right eye.
When I cover my left eye and look at nearby text, the right eye's muscles relax significantly.
There is no impact on my distance vision with both eyes, and it remains clear.
If the prescription is strong, do I need to exert more effort with the ciliary muscle to focus, or could it be due to the fact that the prescriptions for both eyes are not fully corrected?
I have been wondering if my astigmatism has indeed worsened.
How can I determine if my astigmatism has increased? I am quite worried about it continuing to increase.
What can I do to prevent further increases in astigmatism? Would you recommend wearing orthokeratology lenses? At what severity does astigmatism become keratoconus? Since it has been over six months since my last follow-up, is it time for another visit? I hope you can provide some answers.
Thank you.

Miss Hsieh, 20~29 year old female. Ask Date: 2022/11/05

Dr. Cai Wenyuan reply Ophthalmology

Astigmatism is not severe, so regular monitoring is sufficient.

Reply Date: 2022/11/05

More Info

Hello! Thank you for your detailed inquiry regarding your concerns about astigmatism, keratoconus, and overall eye health. It’s understandable to feel anxious about changes in your vision, especially when it comes to conditions like astigmatism and the potential for keratoconus. Let’s break down your concerns and provide some clarity.

Firstly, astigmatism occurs when the cornea (the clear front surface of the eye) is irregularly shaped, causing blurred or distorted vision. Your recent increase in astigmatism of 100 degrees in both eyes is significant, and it’s good that you’ve been proactive in seeking medical advice and monitoring your condition. The fact that your corneal examination showed normal results is reassuring, as keratoconus typically involves a progressive thinning and bulging of the cornea, which can lead to more severe vision problems.

Regarding your prescription, it’s common for optometrists to adjust the cylinder (CYL) and axis values to optimize your vision. If your optometrist reduced the astigmatism correction slightly, it may have been to enhance comfort and reduce strain on your eye muscles, especially if you were experiencing discomfort with the full prescription. It’s essential to find a balance between clarity and comfort. If you feel that your vision is acceptable with the adjusted prescription, it may be suitable for you. However, if you notice that your vision is still not as clear as it should be, or if you continue to experience discomfort, it may be worth discussing with your eye care provider about returning to a stronger correction.

Your experience of muscle tension in your right eye when reading closely could be related to several factors, including the degree of astigmatism, the strength of your prescription, and how your eyes work together. When one eye has a significantly different prescription, it can lead to eye strain, especially during tasks that require prolonged focus. Regular breaks, proper lighting, and ensuring that your prescription is as accurate as possible can help alleviate some of this strain.

As for preventing further increases in astigmatism, there are several strategies you can adopt:
1. Limit Eye Strain: Ensure you take regular breaks when using screens or reading. The 20-20-20 rule is helpful: every 20 minutes, look at something 20 feet away for at least 20 seconds.

2. Proper Lighting: Ensure that you have adequate lighting when reading or using screens to reduce strain on your eyes.

3. Avoid Rubbing Your Eyes: Even if you don’t frequently rub your eyes, being mindful of this can help prevent irritation and potential changes in corneal shape.

4. Regular Eye Exams: Continue with your regular eye check-ups to monitor any changes in your vision or corneal shape.

Regarding the use of orthokeratology lenses (corneal reshaping lenses), they can be beneficial for some individuals with myopia and astigmatism, particularly in children and young adults. However, the decision to use these lenses should be made in consultation with your eye care professional, who can assess your specific situation and determine if they are appropriate for you.

Keratoconus typically develops gradually, and while there is no specific degree of astigmatism that directly leads to keratoconus, significant changes in corneal shape or thickness can be indicators. Regular monitoring is crucial, and since it has been six months since your last check-up, it would be advisable to schedule a follow-up appointment to reassess your corneal health and vision.

In conclusion, it’s essential to maintain open communication with your eye care provider, follow their recommendations, and address any concerns you have during your visits. Your proactive approach to your eye health is commendable, and with regular monitoring and care, you can manage your astigmatism effectively. If you have further questions or concerns, don’t hesitate to reach out to your eye care professional. Thank you for your inquiry, and I hope this information helps you feel more at ease regarding your eye health!

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