Astigmatism Explained: Understanding Its Progression with Age and Exploring Top Treatment Options

The human eye is a marvel of engineering, enabling us to navigate the world around us. However, various conditions can impair vision, impacting our daily lives. Astigmatism, a common refractive error that distorts vision at all distances, affects a significant portion of the global population.

According to the National Eye Institute (NEI) at the National Institutes of Health (NIH) in the United States, astigmatism affects roughly one in every three Americans (31.1%), translating to around 103.6 million people in the U.S. alone facing blurry or distorted vision due to astigmatism.

The prevalence of astigmatism is similarly high worldwide. A 2020 study published in the journal Optometry and Vision Science estimated that 27.2% of people in the United Kingdom (U.K.) have astigmatism. Vision issues in the U.K. are common, with 2.7 million people living with sight loss, proving how common it can be. 

The Canadian Ophthalmological Society reports that astigmatism is "a very common vision problem" in Canada, affecting a significant portion of the population. 

These figures highlight the widespread nature of astigmatism, which impacts millions of people across the globe and potentially hinders their daily activities. Recognizing the signs and symptoms of astigmatism is not just important; it's crucial for early diagnosis and treatment to ensure optimal vision health, underlining the urgency and necessity of this issue.

Living with Blur: Recognizing the Signs of Astigmatism

Unlike nearsightedness or farsightedness, astigmatism distorts vision at all distances, making objects appear blurry, wavey, or smeared.

The symptoms of astigmatism are often noticed during childhood or adolescence, typically between the ages of 5 and 18. While some individuals might experience noticeable vision problems early on, others may not detect any issues until adulthood. This variability depends on the severity of the astigmatism and how well the other eye compensates for the blurred vision. 

Astigmatism is so common that it's estimated that roughly half of all glasses wearers have this condition – even if they don't realize it yet. 

Astigmatism can worsen over time, though the progression is usually gradual. Several factors can contribute to this:

• Natural Changes in the Eye: As we age, the shape of the cornea, the clear dome at the front of the eye, can naturally change, causing existing astigmatism to become more noticeable.
• Eye Strain: Extensive periods of focusing on near objects, like computer screens or phones, can lead to temporary blurring of vision. While this doesn't worsen astigmatism itself, it can exacerbate its symptoms and create eye fatigue.
• Underlying Eye Conditions: Certain eye diseases, like keratoconus (a thinning of the cornea), can worsen astigmatism by further altering the corneal shape.

Here's a closer look at some common symptoms of astigmatism:

• Blurred or hazy vision at all distances (near, far, and in-between)
• Eyestrain and headaches, particularly after prolonged screen time
• Squinting to see objects clearly
• Difficulty with night vision, seeing halos or glare around lights
• Trouble perceiving details, especially fine lines or text

Unveiling the Blur: Causes and Diagnosis of Astigmatism

While astigmatism affects millions globally, its root cause might seem mysterious. Unlike perfect spheres, the cornea, the eye's transparent front surface, and sometimes the lens can have an irregular curvature in astigmatism. This uneven shape prevents light rays from focusing properly onto the retina, leading to blurred vision.

Here's a deeper dive into the potential causes of astigmatism:

• Genetics: Astigmatism often runs in families, suggesting a strong hereditary component. If a parent has astigmatism, there's an increased chance of a child developing it as well.
• Corneal Shape Abnormalities: The most common cause is an irregularly shaped cornea. Instead of a smooth, round dome, the cornea may be more oval or football-shaped, causing light rays to bend unevenly.
• Lens Shape Abnormalities: In some cases, the lens itself, located behind the cornea, can have an irregular curvature, contributing to astigmatism.
• Eye Injuries: Injuries to the cornea, such as scratches or surgical procedures like LASIK, can sometimes alter its shape and lead to astigmatism.
• Keratoconus: This progressive eye disease causes the cornea to thin and bulge outward, often resulting in significant astigmatism.

Fortunately, diagnosing astigmatism is a relatively straightforward process during a comprehensive eye exam. Here's what you can expect:

• Visual Acuity Test: This standard test involves reading an eye chart from various distances to assess your overall vision clarity.
• Refraction Test:  This test uses a phoropter, a device with multiple lenses, to determine the specific lens power needed to correct your vision. The doctor will have you look through different lens combinations while they project light onto your eyes.
• Keratometry: This test measures the curvature of your cornea to assess its shape and identify any irregularities. A machine called a keratometer shines a light onto your cornea and measures the reflection pattern to create a corneal map.

Combining these tests allows your eye doctor to diagnose astigmatism and determine its severity accurately. Early diagnosis allows for prompt treatment with corrective lenses, ensuring clear vision and preventing unnecessary eye strain.

Correcting the Blur: Treatment Options for Astigmatism

Living with astigmatism doesn't have to mean blurry vision. Fortunately, there are several effective treatment options available to restore clear vision and improve your quality of life. Here's an overview of the most common methods:

• Corrective Eyewear: Glasses with specially designed lenses called toric lenses are the most common treatment for astigmatism. These lenses have varying curvatures across their surface, counteracting the irregular shape of your cornea and focusing light rays precisely onto the retina. Glasses can be customized for both nearsightedness or farsightedness in combination with astigmatism correction if needed.
• Toric Contact Lenses: Toric soft lenses offer a comfortable and discreet solution for those who prefer contact lenses. Similar to toric glasses, toric contact lenses have varying curvatures to correct the uneven corneal shape. However, proper fitting and hygiene practices are crucial to ensure optimal comfort and eye health with toric contacts.
• Laser Vision Correction: For individuals seeking a permanent solution, laser eye surgery procedures like LASIK or PRK can reshape the cornea, correcting the underlying cause of astigmatism. However, these procedures are not suitable for everyone. Age, corneal thickness, and overall eye health are considered during consultations to determine eligibility. Additionally, laser vision correction typically doesn't cover any nearsightedness or farsightedness you might have, so corrective lenses may still be necessary for reading or other close-up tasks.

Intertwined Strands: Aging, Astigmatism, and Long-Term Care

Our bodies undergo many changes as we age, and our vision is no exception. While astigmatism is common, its impact can become more pronounced and intertwined with the challenges of aging and future long-term care needs.

Blurring Lines: Astigmatism and Daily Activities

Performing Activities of Daily Living (ADLs), such as dressing, bathing, preparing meals, and managing medication, requires clear vision. Astigmatism can significantly hinder these tasks. Blurred vision makes distinguishing between objects, reading labels, or navigating safely difficult, potentially increasing the risk of falls and injuries, leading to a loss of independence and a greater need for assistance with daily tasks, potentially necessitating long-term care services.

A Shifting Landscape: Progression of Astigmatism with Age

While astigmatism often develops during childhood or adolescence, its course can change with age. Studies suggest a shift in the type of astigmatism experienced. "With-the-rule" astigmatism, a more common form in younger individuals, tends to decrease in prevalence. Conversely, "against-the-rule" astigmatism becomes more frequent as we age. This shift can change how a person experiences blurred vision and may necessitate adjustments to their corrective lenses.

A Complex Web: Astigmatism and Coexisting Conditions

Astigmatism rarely exists in isolation. Many older adults grapple with multiple health issues that can further complicate vision problems. For example, cataracts, a clouding of the eye's lens, can exacerbate blurred vision caused by astigmatism. Additionally, certain medications used to manage chronic conditions like diabetes or high blood pressure can have side effects like dry eye, which can worsen symptoms of astigmatism. Managing these coexisting conditions effectively becomes crucial for maintaining optimal vision health.

Long-Term Care Considerations

For individuals with significant vision impairment due to astigmatism, particularly when combined with other health issues, long-term care facilities play a vital role. Better facilities are equipped to provide various levels of vision support, such as:

• Adequate lighting and contrasting colors throughout living spaces to improve visibility.
• Assistive devices like magnifying glasses, large-print materials, and audiobooks to help residents with daily activities.
• Vision rehabilitation training to teach new skills and strategies for maximizing remaining vision.
• Regular eye care to ensure proper management of astigmatism and other vision problems.

Finding quality care can be challenging if you have a loved one who needs long-term care. Using the LTC NEWS Caregiver Directory allows you to search from over 80,000 caregivers, senior communities, and long-term care facilities. The directory is a free and comprehensive way to find the quality long-term care services your loved one deserves. 

• Find Quality Long-Term Care Services Near You

Addressing the challenges posed by astigmatism in the context of aging and long-term care needs can help ensure that older adults maintain a higher quality of life, greater independence, and a sense of safety within their environment.