laser eye surgery for astigmatism

Astigmatism and Laser Eye Surgery – A Guide

Astigmatism is a common vision condition that affects 60% of people. It occurs when the cornea is irregular or rugby ball-shaped, causing distorted, blurred vision.

Many people wonder if laser vision correction is an option for correcting astigmatism or perhaps lens surgery, e.g. refractive lens exchange (RLE).

In this comprehensive guide, we’ll cover everything you need to know about having laser eye surgery with astigmatism, including your eligibility, so you will discover if you are suitable for laser correction or another of the various treatment options.

LASIK eye surgery is the most common procedure and is considered a safe procedure. Modern technology has produced a very high success rate and without serious complications. LASIK is most suited to high prescriptions and typically is a permanent solution to wearing contact lenses or glasses.

We’ll cover more on how to find the best laser eye surgeon and which private clinic to choose. Most centres offer a free consultation and a range of vision correction options.

What is Astigmatism?

Astigmatism is a refractive error that causes poor vision at all distances. It happens when the cornea has an irregular, rugby ball-shaped curve rather than a round, spherical shape found on the front surface of a normal eye.

When light enters the eye, the irregular curve causes rays to focus incorrectly on the retina, resulting in distorted vision. Long-sighted patients can also have this condition.

It is most commonly found together with short-sight or long-sight. Distance vision and reading vision are blurred, as this refractive error affects all vision ranges. Unless the condition is very mild, wearing glasses or contacts is necessary to provide a clear image.

You can have completely normal eye health. However, having thin corneas in addition can indicate a condition called keratoconus. Such patients find they are developing astigmatism during their teens and twenties and become progressively short-sighted.

There are three main types of astigmatism:

  • Myopic: Occurs together with short-sightedness.

  • Hyperopic: Occurs together with long-sightedness.

  • Mixed: The eye is short-sighted on one axis but long-sighted when measured at 90 degrees away.

Astigmatism often occurs alongside nearsightedness (myopia) or farsightedness (hyperopia). The degree of astigmatism can vary from mild to quite severe.

How Common is Astigmatism?

Astigmatism is an extremely prevalent vision condition. Research shows:

  • About 60% of people have some degree of it, 30% mildly, and another 30% have a significant amount.

  • Over 5% of people have high astigmatism.

  • It typically develops in childhood.

  • There may be a family history.

  • It may worsen slowly over time.

The high prevalence of this condition means millions of people are affected, requiring them to wear glasses.

What Are the Symptoms of Astigmatism?

The most common symptoms of astigmatism include:

  • Blurry vision at all distances

  • Headaches or eye strain

  • Squinting or tilting the head to see more clearly

  • Difficulty seeing details up close or far away

  • Glare, halos, or starbursts around lights

  • Fatigue when doing visual tasks

The severity of symptoms depends on the degree of astigmatism. Mild cases may cause minimal disruption, while severe cases can significantly impact daily activities.

How Do We Diagnose Astigmatism?

Astigmatism is easily diagnosed through a standard eye exam. The key tests are:

  • Refraction test: Measures your prescription for glasses or contacts by determining whether you are nearsighted, farsighted or have an astigmatism.

  • Keratometry: Measures the cornea’s curvature to check for irregularities.

  • Corneal topography: Creates a detailed map of the cornea’s surface to identify any irregularities.

  • Slit lamp exam: A slit lamp is used to examine the front structures of the eye.

Once diagnosed, the degree of astigmatism can be measured in diopters. This determines the necessary correction.

How is Astigmatism Treated?

There are several options for treating astigmatism. Broadly, they fall into two groups:

  1. Using an external lens to correct focus, either glasses or contacts.

  2. Refractive surgery to make a permanent solution for clear sight, all performed under local anaesthetic. Surgery can be one of three types:

    • Laser eye treatment

    • Replace the eye’s natural lens and insert an intraocular toric IOL lens. This lens surgery is called Refractive Lens Exchange or lens replacement surgery.

    • Insert an Implantable Contact Lens (ICL)

Let’s look at each option in more detail. Each method has its pros and cons, and we will discuss each.

  • Glasses: Special prescription lenses can compensate for astigmatism. However, glasses need to be worn constantly.

  • Contact lenses: Soft toric lenses or rigid gas-permeable lenses effectively correct the condition, but they must be worn daily. Toric lenses have a special design that helps them rotate to the correct angle. However, blinking can move and rotate the lens, resulting in intermittent blur.

  • Orthokeratology: A sight correction technique that involves the use of special rigid contact lenses. These lenses are worn overnight to reshape the cornea, improving eyesight throughout the day gently. This non-surgical approach offers a convenient and comfortable alternative to traditional glasses or daytime contact lenses.

  • Laser eye surgery: Laser surgery that permanently reshapes the cornea, the transparent layer at the front of the eye. Laser vision correction is specifically aimed at correcting astigmatism. By precisely sculpting the eye’s front window, laser eye surgery helps to reduce dependency on glasses or contact lenses, providing patients with the freedom and convenience to see clearly without the need for corrective eyewear.

  • Lens replacement surgery: Also known as refractive lens exchange (RLE), is a lens surgery procedure where the natural lens of the eye is replaced with an artificial lens implant. This procedure is often performed to correct refractive errors such as nearsightedness, farsightedness, and astigmatism, as well as to improve eyesight in individuals with age-related cataracts. By replacing the lens, this surgery can not only enhance visual acuity but also reduce dependency on glasses or contact lenses. It is a safe and effective option for individuals looking to improve their overall quality of life and can treat short-sightedness and long-sightedness.

  • Implantable Contact Lenses (ICLs): ICLs are implanted lenses that sit in the front of your eye, behind your iris and therefore not visible. Unlike regular contacts, however, ICLs have no need to be removed and cleaned every day. Toric versions are available to correct astigmatism.

Now, let’s take a closer look at whether laser eye surgery is an option for astigmatism.

Can I Have Laser Eye Surgery If I Have Astigmatism?

Yes, laser correction is a highly effective eye surgery fix for astigmatism. In fact, it is one of the most common conditions treated.

During laser eye surgery, a cool beam laser is used to reshape the rugby ball so that it returns to a natural spherical cornea. This allows light rays to focus properly on the retina again, correcting blurriness and other symptoms.

Several studies have found laser eye surgery to be safe and effective at improving astigmatism:

  • Many patients rate their vision as better than achieved with contacts.

  • 63% higher satisfaction rate with LASIK over contacts.

  • Studies confirm better night vision than with lenses.

  • Results are generally long-lasting if astigmatism is stable.

So, in most cases, laser eye surgery can successfully and permanently correct astigmatism without glasses or contacts.

Different Types of Laser Eye Surgery for Astigmatism

There are several types of laser eye surgery available to treat astigmatism. Also will remove some corneal tissue to effect a change in shape. You must have good eye health.


LASIK (laser-assisted in-situ keratomileusis) is the most commonly performed laser surgery for astigmatism. During LASIK surgery:

  • The surgeon makes a thin flap using a femtosecond laser (formerly with a blade).

  • An excimer laser reshapes the cornea underneath the flap to correct astigmatism.

  • The flap is then repositioned.

  • Eyesight is usually very clear at the next review the morning after surgery.


PRK (photorefractive keratectomy) is one of the surface laser treatments (also called LASEK, transPRK, ASA) that can treat astigmatism without making a flap. Instead:

  • The surface epithelium is removed.

  • The excimer laser sculpts the cornea into a rounder shape.

  • A contact lens is worn while the epithelium grows back over a few days.

  • Your sight improves over the next few weeks


The correct term is lenticule extraction. SMILE is a brand name for this newer laser eye surgery technique for correcting astigmatism (other names are SILK and CLEAR):

  • A thin lenticule is created using a femtosecond laser.

  • This lenticule is removed through a small incision, altering the corneal shape.

  • No flap is created, resulting in a minimally invasive procedure.

Your ophthalmologist can help determine if LASIK, PRK, SMILE or another laser procedure is most appropriate for your astigmatism and eye anatomy.

At present, SMILE can only treat astigmatism and short-sightedness.

Risks and Benefits of Laser Eye Surgery for Astigmatism

Similar to any refractive surgery or other invasive procedure, laser eye surgery carries both risks and benefits to be carefully considered before making a decision. While the procedure consistently delivers improved eyesight and reduced dependence on corrective eyewear, it’s important to be aware of some potential risks, such as infection, dry eyes, or temporary disturbances during the healing process.

Consulting with a qualified eye specialist can provide a comprehensive understanding of the procedure, helping individuals make an informed choice that aligns with their personal needs and preferences.


  • Dry eyes or eye discomfort

  • Visual fluctuation, glare or halos around lights

  • Undercorrection or overcorrection

  • Infection (rare)

  • Loss of best vision (rare)


  • Eliminate or reduce the need for glasses or contacts

  • Clearer eyesight, especially at night

  • Relief from eye strain or headaches

  • More convenience and freedom in activities

Proper candidate selection and an experienced surgeon help minimize risks and maximize outcomes.

Who is a Good Candidate for Laser Eye Surgery?

The ideal laser eye surgery candidate is someone who:

  • Is 18+ years old with stable astigmatism, short-sight or long-sight.

  • Has no eye diseases or conditions like keratoconus

  • Has a suitable cornea thickness and topography

  • Has realistic expectations about results

  • Is willing to follow pre-op and post-op instructions

  • You may still need reading glasses afterwards if you are 45+ unless you opt for a procedure designed to correct near and far vision together.

Pregnant or nursing women typically need to postpone surgery. Your ophthalmologist will examine your eyes and medical history to determine if you are a good candidate.

How to Prepare for Laser Eye Surgery

Taking these steps can help optimise your laser eye surgery results:

  • Discontinue soft contact lens wear for 1-3 weeks before your consultation and surgery.

  • Have a complete eye exam to measure your prescription stability over the past year.

  • Stop smoking for at least six weeks before and after surgery.

  • Arrange transportation as you cannot drive immediately after surgery.

  • Avoid makeup and fragrances on the day of your procedure.

  • Follow your surgeon’s prescriptions exactly, including drops before surgery.

  • Rest your eyes by limiting screen time in the weeks beforehand.

Thoroughly preparing for surgery, both physically and mentally, can help the procedure and recovery go as smoothly as possible.

What to Expect During Laser Eye Surgery

The excimer treatment itself is quick, painless and safe. Here is the general process:

  • Numbing eye drops are applied to prevent any discomfort.

  • You will lie on a reclined chair under the laser system.

  • A lid speculum holds your eyelids open.

  • Look directly at a target light to keep your eye aligned.

  • The surgeon initiates the laser pulses, which take 2-12 seconds per eye for most prescriptions.

  • You may feel some pressure, but there is mild to no pain.

  • The process is repeated on the other eye.

  • The total procedure time is 10-15 minutes for both eyes.

Your ophthalmologist may give you a mild sedative like Valium (Diazepam) and walk you through what to expect. Listen carefully to their instructions during the procedure.

What to Expect After Laser Eye Surgery

Immediately after surgery, expect:

  • Mild irritation or scratchy feeling in operated eyes

  • Watery eyes with burning or stinging for a few hours

  • Blurriness that may seem worse initially

  • Shields to protect your eyes overnight

  • Use artificial tears as needed

Within the first week, you can anticipate the following:

  • Improved clarity of sight that continues to get better over weeks to months

  • Using medicated eye drops several times a day

  • Wearing goggles while sleeping to protect the eyes

  • Some discomfort akin to rubbing your eyes too hard

  • Avoiding dusty, dirty environments to prevent infection

  • Use artificial tears regularly to protect against dry eyes

Full recovery takes about 4-6 weeks for LASIK and up to 6 months for PRK. Follow all your surgeon’s post-op directions closely.


Laser eye surgery is a proven way to safely, effectively, and permanently correct astigmatism. By reshaping the irregular cornea, laser treatment can significantly improve blurred vision and other symptoms.

If you are tired of glasses and contacts, consider laser eye surgery to correct astigmatism and gain clear eyesight.

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