Astigmatism Correcting Surgery

Astigmatism Correcting Surgery is the discipline of refractive surgery that deals with correcting regular and irregular astigmatism.  Regular astigmatism is generally congenital and when stable can often be corrected with traditional methods.  If regular astigmatism exists without hyperopia or myopia, often an incision in the steep meridian of the cornea can correct this with a laser or a metal or diamond knife.  Dr. Malitz follows several nomograms (tables) that determine the length and placement of the incisions to correct various magnitudes of astigmatism.  This procedure is often done with cataract surgery to reduce or eliminate multiple focal points and blurred vision from refractive errors while eliminating the blur caused by a cloudy lens (cataract).  With larger magnitudes of astigmatism, PRK or LASIK can be used.  Custom treatments correct up to 3 units (diopters) traditional laser surgery corrects up to 6 units (diopters).  With larger degrees of astigmatism,  the treatment tends to regress and the initial treatment deliberately overshoots the treatment with the expectation of healing and regression.  If there is too much regression the incisions can be reopened (blunt tickle), additional incisions can be added closer to the center of the cornea, the incisions can be lengthened or the laser can be used to supplement the initial LRI or AK incisions (Limbal Relaxing Incisions) or Astigmatic Keratotomy.  CK (Conductive Keratoplasty) can be used to correct astigmatism but it is not FDA approved for this purpose and is unpredictable and temporary.  A newer method of correcting astigmatism uses PRLI (penetrating limbal relaxing incisions).  This is generally only done in an operating room and in conjunction with cataract surgery.  This utilizes a blade of known width and creates a full thickness incision, similar to the incision created the cataract surgery.   If the astigmatism is associated with trauma, corneal scarring or degenerative diseases, it is often irregular.  Suture removal after trauma or cataract surgery or corneal transplantation can reduce or eliminate astigmatism.  Compression sutures or wedge excisions can create or reduce astigmatism.  If astigmatism is created 90 degrees away from the steep meridian of a regular shaped cornea, this can steepen the cornea and create a round shape reducing or eliminating astigmatism.  Dr. David Malitz is an expert at correcting astigmatism and has corrected over 20 units of astigmatism.  Fortunately the majority of the population has lower magnitudes of astigmatism.