Astigmatism
Warsaw · Krakow · Vienna · Zurich
Letters blur and slightly wave — from up close as well as from afar. This is the most common reason why a patient hears in the office: astigmatism. It is not a disease, but rather the shape of the eye: the cornea refracts light in two planes instead of one.
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Astigmatism – in brief
Astigmatism (ametropia) is a vision defect, not a disease. The cornea or lens is shaped more like an ellipse than a sphere, which is why light focuses in two planes instead of a single point. The image is blurred and slightly distorted both up close and far away.
- Symptoms: blurred or “wavy” letters, double contours, squinting, eye strain and headaches when reading, worse night vision (streaky lights)
- How an astigmatic person sees: lines in one axis are sharp, in the other blurred; a pinpoint light looks like a streak – see simulation
- Types: corneal or lenticular; regular (for laser and lens correction) or irregular (e.g., in keratoconus – requires separate diagnosis)
- Diagnosis: corneal topography and keratometry – determine the axis and magnitude of the defect; qualification examination 400 PLN, approximately 90 minutes
- Permanent correction: FemtoLASIK Wavefront (up to 6 D, 12,800 PLN for both eyes), SmartSight (up to 5 D, 13,600 PLN) or SmartSight Nova with eye rotation compensation (15,000 PLN); for high defects ICL Toric lens, after 45 years of age lens exchange with toric implant – 11,000 PLN per eye, toric without surcharge
- Is surgery necessary: no – cylindrical glasses and toric contact lenses correct most cases; the procedure is chosen by people who want to see sharply without them – qualification criteria
How we correct astigmatism – method comparison
| Method | For whom | Price |
| FemtoLASIK Wavefront | up to 6 D cylinder, static cyclotorsion, best axis precision | 12,800 PLN for both eyes |
| SmartSight | astigmatism up to 5 D, also mixed; flapless | 13,600 PLN for both eyes |
| ICL Toric Lenses | high defects with astigmatism – toric without surcharge | 11,000 PLN per eye |
| RLE with toric implant | after 45 years of age, also with coexisting cataract | 11,000 PLN per eye |
Astigmatism – what is it?
Parallel light rays refract in two different planes (e.g., vertical and horizontal), resulting in blurred vision, image distortion and waviness, and poor contrast. Colloquially speaking, an astigmatic person constantly feels as if they are intoxicated: straight lines wave, despite their best efforts they cannot achieve sharp focus, and they have disturbances in their sense of space. This blurred vision significantly hinders daily activities.
It is estimated that about 40% of the population has a defectively structured cornea or lens, and consequently, symptoms of astigmatism. It cannot be avoided – the defect is hereditary, and our lifestyle has no impact on its development. Nearly 50% of patients diagnosed with astigmatism experience such a significant impairment in vision quality and associated comfort in daily functioning that they require ophthalmological assistance.
In uncomplicated cases, cylindrical glasses or toric contact lenses are sufficient. In more difficult cases, it is worth considering laser astigmatism correction, e.g., using the FemtoLASIK method, or undergoing lens exchange surgery.
Symptoms that may suggest the presence of astigmatism
If we visit an ophthalmologist due to blurred vision of details both far and near, we most often hear the diagnosis: astigmatism. Astigmatism is not an eye disease, but a vision defect (“eye characteristic”) where the eye’s optical system cannot properly focus light rays on the retina.
Parallel light rays refract in two different planes (e.g., vertical and horizontal), resulting in blurred vision, image distortion and waviness, and poor contrast.
Colloquially speaking, an astigmatic person constantly feels as if they are intoxicated: straight lines wave, despite their best efforts they cannot achieve sharp focus, and they have disturbances in their sense of space. This blurred vision significantly hinders daily activities.
It is estimated that about 40% of the population has a defectively structured cornea or lens, and consequently, symptoms of astigmatism. It cannot be avoided – the defect is hereditary, and our lifestyle has no impact on its development.
Nearly 50% of patients diagnosed with astigmatism experience such a significant impairment in vision quality and associated comfort in daily functioning that they require ophthalmological assistance.
In uncomplicated cases, cylindrical glasses or toric contact lenses are sufficient. In more difficult cases, it is worth considering laser astigmatism correction, e.g., using the FemtoLASIK method, phakic lens implantation, or undergoing lens exchange surgery.
Other ailments accompanying astigmatism
Besides blurred vision both far and near, astigmatism can also manifest with other ailments related to the fact that the patient constantly squints and rubs their eyes to improve vision quality. These include:
- headaches,
- a sensation of dizziness,
- a sensation of amblyopia,
- rapid fatigue when performing tasks requiring visual focus, e.g., when working at a computer or driving.
While an adult will immediately seek ophthalmological help, in the case of a child, it may take a long time before we realize that headaches, reluctance to read, or problems with motor coordination are not neurological or psychological, but are related to vision problems. Therefore, it is crucial to conduct preventive ophthalmological examinations in school-aged children.
Astigmatic vision disorders can significantly contribute not only to academic failures but also exclude a child from their peer group and become a cause of socialization problems. If short-sightedness or long-sightedness is added to astigmatism – which often happens during adolescence – the child may be terrified by the intensity and pace of changes related to the development of vision defects.
Appropriate ophthalmological care and the selection of adequate glasses or contact lenses eliminate the problem and allow the child to maximize their potential.
Do astigmatism symptoms change with age?
The prevalence of astigmatism with a power of at least 1.00 diopter cylinder ranges from 30% in children aged 0–4 weeks, to 50% during the first year of life, increasing to a maximum of 60% in the 1.5–2.5 year range and decreasing to 20–40% in children aged 5 years. Its power also decreases on average by about 2.25 diopters cylinder in children aged 0–4 weeks to about 1.00 diopter cylinder at 5 years of age.
It is difficult to detect astigmatism in preschoolers, because in the period from four to seven years of age it tends to decrease, but already at school age it can start to show the alarming symptoms described above, which parents do not associate with vision problems at all.
In people aged 20-40, astigmatism evolves in such a way that it is difficult to predict the direction of changes in the defect. However, after the age of 40, a certain correlation is observed: it involves a gradual decrease in the value of astigmatism in eyes with simple astigmatism and an increase in eyes with inverse astigmatism.
Astigmatism and Cataracts – Modern Treatment Methods
The solution is the implantation of toric artificial intraocular lenses. They are implanted during cataract removal surgery, eliminating both problems – cataracts and astigmatism – simultaneously.
Simple astigmatism (direct astigmatism) – when light refraction in the vertical plane is stronger than in the horizontal plane; it tends to occur at birth and may result from the “collapse” of the still developing eyeball’s cornea
Inverse astigmatism – when the conditions of light refraction are reversed, i.e., stronger light refraction occurs in the horizontal plane; it appears as a result of significant stiffening of the upper eyelid tarsus, which presses on the horizontal meridian of the cornea, especially in an eye characterized by its low rigidity.
After the age of 60, astigmatism and cataracts often occur simultaneously. This results in a dangerous combination that significantly reduces the quality of life for older people and their safety (e.g., making it difficult to cross the street, estimate the distance to an approaching vehicle, or descend stairs).
How is astigmatism diagnosed?
Several tools are used to diagnose astigmatism.
A keratoscope (Placido disc), which is a disc with black and white circles, allows observing the shape of the reflections of the circles on the cornea. Manual keratoscopes are increasingly less common, as ophthalmologists and optometrists have computer videokeratographs (digital) at their disposal – the examination uses an image of the Placido disc projected onto the corneal surface, which is then recorded by a camera, sent to a computer, and analyzed.
The result of the examination is a corneal map, a cross-section of the corneal surface, and a map of digital values of corneal curvatures. Specialists also still use Javal’s ophthalmometer (keratometer), a manual keratometer used to measure corneal curvatures in two main sections.
These measurements allow for precise determination of the magnitude and axes of astigmatism. Manual keratometry is the gold standard in assessing the power and axis of astigmatism for toric lens calculation.
Astigmatism and its varieties
Ophthalmologists and optometrists use various classifications of astigmatism.
Classification by the position of focal lines relative to the retina
| Type of astigmatism | Characteristics |
| Myopic | One focal line lies on the retina, the other in front of the retina |
| Hyperopic | One focal line lies on the retina, the other behind the retina |
| Compound Myopic | Both focal lines are located in front of the retina |
| Compound Hyperopic | Both focal lines are located behind the retina |
| Mixed | One focal line in front of the retina, the other behind the retina |
Classification by the source of the defect in the eye’s optical system
| Type of astigmatism | Characteristics |
| Corneal | Most common (approx. 98% of cases); results from an irregular corneal shape |
| Lenticular | Caused by an irregular lens shape |
| Mixed (corneal-lenticular) | Coexisting corneal and lenticular irregularities |
Classification by Corneal Curvature (Regularity)
| Type of astigmatism | Characteristics |
| Regular | Difference in refractive power between two main perpendicular sections |
| – Regular simple | Cornea steeper in the vertical section |
| – Regular inverse | Greater refractive power in the horizontal plane |
| – Regular oblique | Greatest refractive power in the range of 31°–59° or 121°–149° |
| Irregular | Absence of two main perpendicular sections or more than two present |
Astigmatism – a defect requiring precise diagnosis
In specialized literature, we will find a greater number of classifications and names for individual varieties of astigmatism. It is a complex defect and requires precise diagnosis. The more complicated the defect, the greater the probability that laser astigmatism correction will be necessary.
Methods of astigmatism treatment
As mentioned, in uncomplicated cases, astigmatism only requires spectacle correction or the use of toric contact lenses.
More complicated cases (e.g., irregular astigmatism), although easily diagnosed thanks to the current state of knowledge, are difficult or impossible to correct with spectacle lenses.
Glasses are sometimes insufficient even for a user with regular astigmatism. Despite correctly chosen cylindrical lenses (which have different refractive powers in the main perpendicular meridians/planes, meaning they focus light at two different points), the patient may still experience disturbances in spatial vision and have difficulty judging distances and object dimensions.
These symptoms make it difficult, for example, to drive a car. In such cases, the ophthalmologist prescribes wearing only toric contact lenses. They can correct practically 99% of astigmatism cases. The optical zone of such lenses has different refractive powers in the main perpendicular planes and focuses light at two different points, thus correcting the vision defect caused by astigmatism.
If neither spectacle lenses nor contact lenses yield the desired result, traditional surgical methods, such as the aforementioned implantation of intraocular toric mono-, bi-, or trifocal lenses – or laser surgery – must be considered.
Laser astigmatism correction
The advantage of the modern laser used in astigmatism treatment at the SwissLaser clinic is very precise correction possible thanks to the application of so-called static cyclotorsion compensation.
Astigmatism surgery is performed using the following methods:
Femto-LASIK (All-Laser-LASIK)
Thanks to a precise femtosecond laser, the surgeon makes an incision in the cornea, creating a thin flap 0.1 mm thick. An excimer laser is then used to reshape the previously exposed cornea for a few seconds, after which the flap is closed again; it attaches and forms a protective barrier for the cornea.
LASIK
A two-stage technique; the cornea is incised with a scalpel (microkeratome), and then the corneal surface is reshaped to properly focus the image on the retina.
LASEK/PRK
The procedure involves lifting (LASEK) or removing (PRK) the upper cellular layer of the cornea (epithelium), and then appropriately reshaping the underlying corneal tissue using an excimer laser. The goal of the procedure is to appropriately reshape the central corneal surface with a laser beam so that it precisely focuses the image onto the retinal surface.
Expert comment
“In astigmatism, the axis determines the outcome – an error of a few degrees can negate half the effect. That’s why we compensate for static cyclotorsion: the system recognizes eye rotation between the sitting examination and the lying procedure and automatically corrects the axis.”
Dr. med. Victor Derhartunian, FEBO, FWCRS
– refractive surgeon, over 25,000 laser procedures
Frequently Asked Questions (FAQ)
What is astigmatism and how does it affect vision?
Astigmatism is a vision defect where the eye’s optical system does not properly focus light rays on the retina – they refract in two different planes. This results in blurred vision, image distortion and waviness, and poor contrast, both far and near. Headaches and rapid eye fatigue when working at a computer or driving are also common.
What does laser astigmatism correction at SwissLaser involve?
We perform astigmatism surgery using methods such as Femto-LASIK, LASIK, and LASEK/PRK, reshaping the central corneal surface with a laser so that it precisely focuses the image on the retina. The advantage of the modern laser used in our clinic is very precise correction possible thanks to static cyclotorsion compensation. The appropriate method is chosen individually after a detailed diagnosis.
What to do if astigmatism is too high for laser correction?
An alternative is the implantation of a toric ICL phakic lens or lens exchange with the implantation of an intraocular toric lens – mono-, bi-, or trifocal. In older individuals where astigmatism coexists with cataracts, a toric lens is implanted during cataract removal surgery, solving both problems simultaneously. Toric multifocal lenses also offer complete independence from glasses.
How are astigmatism diagnostics and qualification performed?
Astigmatism is a complex defect requiring precise diagnosis – we use, among others, a computer videokeratograph, which creates a detailed corneal map, and keratometry, which is the gold standard in assessing the power and axis of astigmatism for toric lens calculation. Based on these measurements, the doctor determines the magnitude and axes of the defect and selects the correction method. A comprehensive qualification examination costs 400 PLN.
How much does surgical astigmatism correction with toric lenses cost?
The implantation of a toric Visian ICL EVO/EVO+ phakic lens (Myopic Toric or Hyperopic Toric) and refractive lens exchange with a Premium toric implant each cost 11,000 PLN per eye – the same as spherical variants. Procedures are performed in Warsaw and Krakow. The National Health Fund does not reimburse them; installment payment through Santander Consumer Bank is possible.
Does astigmatism always require surgery?
No – in uncomplicated cases, cylindrical glasses or toric contact lenses are sufficient, correcting practically 99% of astigmatism cases. However, it sometimes happens that despite correctly chosen lenses, the patient still experiences disturbances in spatial vision and has difficulty judging distances. If neither glasses nor contact lenses yield the desired result, laser correction or toric lens implantation should be considered.
What are the symptoms of astigmatism?
Most commonly, blurred or double contours of letters both near and far, reflexive squinting, rapid fatigue when reading and working at a computer, headaches, and worse night vision – lights appear as streaks or stretched points. High astigmatism causes constant symptoms, while low astigmatism is sometimes only noticed during an eye exam.
How does a person with astigmatism see?
Lines running in one axis are sharp, while in the perpendicular axis they are blurred, which is why a circle may look like an oval, and letters “wave.” Pinpoint light sources stretch into streaks, which is particularly bothersome at night while driving. A detailed simulation is shown in the article “How a person with astigmatism sees.”
Can astigmatism be cured?
The defect cannot be removed by drops or eye exercises, but it can be permanently corrected. A laser (FemtoLASIK Wavefront up to 6 D cylinder, SmartSight and SmartSight Nova up to 5 D) changes the shape of the cornea so that both planes focus light at a single point. For higher defects, we implant a toric ICL lens, and after the age of 45, a toric implant during lens exchange.
Do you have to wear glasses with astigmatism?
For low astigmatism, up to about 0.5 diopters, many patients manage without correction. Higher astigmatism requires cylindrical glasses or toric contact lenses – or permanent laser or lens correction if one does not wish to wear them. Children should wear full correction for proper eye development.
Does astigmatism worsen?
In adults, regular astigmatism is usually stable for years; minor changes appear with age or with cataracts. Rapidly progressing, irregular astigmatism is a warning sign for keratoconus and requires corneal topography – which is why every qualification examination begins with a corneal map.
Does astigmatism in children go away?
Slight, physiological astigmatism in young children may decrease as the eye grows. A higher defect needs to be corrected with glasses to prevent amblyopia from developing. Laser correction is only considered after the age of 18, when the defect has been stable for at least 12 months.
How much does laser astigmatism correction cost?
FemtoLASIK Wavefront 12,800 PLN, SmartSight 13,600 PLN, SmartSight Nova 15,000 PLN – prices for both eyes, identical in Warsaw and Krakow. A qualification examination with corneal topography costs 400 PLN. Installment payment through Santander Consumer Bank is possible.
For the curious: Astigmatism (ICD-10 H52.2, ICD-11 9D00.2) is a refractive error in which the cornea or lens has different power in two perpendicular axes, so the image does not focus at a single point. Regular astigmatism (simple, inverse, oblique) and irregular astigmatism (e.g., in keratoconus) are distinguished. It is measured in cylindrical diopters (D cyl) with the axis in degrees; measurement: keratometry, topography, and tomography of the cornea (MS-39).
Sources
- Read SA, Collins MJ, Carney LG. A review of astigmatism and its possible genesis. Clin Exp Optom 2007;90(1):5–19. doi:10.1111/j.1444-0938.2007.00112.x
- Chuck RS, Jacobs DS, Lee JK et al. Refractive Errors & Refractive Surgery Preferred Practice Pattern. Ophthalmology 2018;125(1):P1–P104. doi:10.1016/j.ophtha.2017.10.003
- Kim TI, Alió Del Barrio JL, Wilkins M, Cochener B, Ang M. Refractive surgery. Lancet 2019;393(10185):2085–2098. doi:10.1016/S0140-6736(18)33209-4
When do we advise against laser surgery?
Not every astigmatism needs to be corrected with a laser. We advise against the procedure or suggest a different path when:
- astigmatism is irregular, e.g., in the course of keratoconus — then we treat the cause: cross-linking or CAIRS rings instead of laser,
- the defect is unstable and has changed in the last year,
- severe dry eye syndrome first requires treatment of the eye surface,
- the cornea is too thin for full correction — a toric ICL lens is an alternative.
Precise corneal diagnostics during qualification determine which path is safe for you — and we state this clearly.
Our patients’ opinions
Google rating: Warsaw 4,8 (reviews: 258) · Krakow 5,0 (reviews: 171). All reviews, unedited and unselected, can be read directly on Google: Warsaw · Krakow.
Related topics
- FemtoLASIK Wavefront – astigmatism axis precision
- Toric ICL lenses – no surcharge
- Refractive lens exchange with toric implant
What is astigmatism — explained by a surgeon
Content fact-checked by Dr. med. univ. (Vienna) Victor Derhartunian, FEBO, FWCRS – specialist in refractive surgery. Last verified: October 2, 2026.
