General EYE ADVICE

Difficulties in Correcting for Astigmatism

As many people nowadays are engaged in highly demanding close work, it is especially important that the optimal correction for astigmatism is prescribed. However, as important as this may be, astigmatism presents the greatest challenge out of all refractive error corrections for the eyecare practitioner. At a meeting of optometrists at the Victorian College of Optometry, I briefly talked on the subject of Meridional Accommodation and Astigmatism. I happened to ask the group of fifty or so optometrists for their opinion on which type of refractive error corrections was associated with the highest number of complaints from their patients. The response was unanimous in favour of astigmatism.

This view also appears to be taken by the authors of a well-known book written for eyecare professionals. The book is entitled "The Fine Art of Prescribing Glasses- Without Making a Spectacle of Yourself" and written by Benjamin Milder MD and Melvin Rubin MD. The following quote is taken from their introduction to the subject of astigmatism where they have managed to convey (on a humorous note) the intractable problems that astigmatism can impose on both practitioner and patient alike. "… The subject of astigmatism tends to make even the most level-headed refractionists a bit paranoid, or why else would we think that astigmats (persons with astigmatism) were put on earth to bedevil us?"

It appears that most complaints, related to unsatisfactory vision prescriptions, involve astigmatism. The reason for this is mainly due to the lack of understanding of what factors influence astigmatism. When these factors become widely understood, the seemingly intractable problem of astigmatism will no longer be an important source of patient-practitioner conflict. In order to adequately understand the cause of malfunctioning of any organ, one must first understand it's normal functioning. This will enable one to confidently correct a problem, as one would be able to anticipate the effect of any intervention or treatment. Thus in the case of the visual system, one would also be able to take preventive measures (prescribe proactively etc) in order to halt any deterioration, or if possible, to ameliorate one's vision in the long term. Examples of such prescribing are given in a scientific paper that I have presented at an international optometric conference entitled Meridional (Astigmatic) Accommodation (Parts I&II). (Eleventh APOC in Korea 1997.) The case examples are in Part II (Clinical Implications of Meridional Accommodation).

Next