Quick Answers
Astigmatism is a common vision condition that causes blurred vision. It occurs when the cornea is irregularly shaped, preventing light from properly focusing on the retina. There are several factors that determine whether untreated astigmatism will get worse over time:
- Age – Astigmatism often progresses gradually as we age.
- Type – Some types of astigmatism are more likely to worsen than others.
- Severity – Higher amounts of astigmatism tend to increase more over time.
- Underlying conditions – Certain diseases may contribute to worsening astigmatism.
- Eye rubbing – Chronic eye rubbing can distort the cornea and make astigmatism worse.
While wearing prescribed glasses or contact lenses can help correct astigmatic vision, they do not actually prevent astigmatism from getting worse. Progression usually happens slowly over many years. However, going extended periods without correction can potentially cause faster deterioration. Regular eye exams are important to monitor changes in astigmatism and update prescriptions as needed.
What is Astigmatism?
Astigmatism is a refractive error that causes blurred or distorted vision. With normal vision, light enters the eye and is bent (refracted) by the cornea and lens, focusing precisely on the retina at the back of the eye. This allows for clear vision.
With astigmatism, the cornea has an irregular shape more like a football rather than a round basketball. This causes light to focus at more than one spot on the retina, rather than one clear focal point. The result is blurred or imperfect vision at all distances.
There are two main types of astigmatism:
- Corneal astigmatism – Most astigmatism is corneal, meaning it arises from an irregularly shaped cornea. This can be naturally occurring or develop later due to injury, infection, or surgery that distorts the cornea.
- Lenticular astigmatism – Less common, this type occurs when the lens inside the eye has an irregular curvature. Cataracts or lens dislocation may cause lenticular astigmatism.
Astigmatism may also be categorized by the orientation of the irregular curvature:
- With-the-rule astigmatism – The cornea has more curvature vertically than horizontally.
- Against-the-rule astigmatism – The cornea has more curvature horizontally.
- Oblique astigmatism – The irregular curvature occurs diagonally at an oblique angle.
Symptoms
The most common symptoms of astigmatism include:
- Blurry vision at all distances
- Difficulty seeing fine details
- Headaches or eyestrain from eye overwork
- Squinting or unusual head tilting to see better
- Distorted vision – lines appear crooked or warped
Does Astigmatism Get Worse Over Time?
For many people with astigmatism, the condition is chronic and tends to gradually progress over time. However, the speed and degree of progression can vary quite a bit depending on multiple factors:
Age
It is very common for astigmatism to increase in magnitude as part of the normal aging process. Studies show the average amount of astigmatism tends to increase over decades of life:
- Ages 12-17: average of 0.90 D
- Ages 18-29: average of 1.00 D
- Ages 30-39: average of 1.10 D
- Ages 40-49: average of 1.20 D
- Ages 50-59: average of 1.30 D
The cornea typically becomes more irregularly shaped with age. The lens may also change shape and cause shifts in astigmatism. Presbyopia, or age-related declines in near vision, may influence astigmatic focus as well.
Type of Astigmatism
Some varieties of astigmatism tend to worsen more rapidly than others:
- With-the-rule – Usually progresses more gradually and moderately.
- Against-the-rule – Often worsens more significantly over time.
- Oblique – May increase more quickly and can be unpredictable.
Additionally, higher degrees of astigmatism are more likely to get worse than low amounts. Over 3.00 D is considered high, while under 1.00 D is minimal astigmatism.
Underlying Diseases
Certain conditions may contribute to astigmatism progression by altering the shape of the cornea or lens:
- Keratoconus – Thinning disorder of the cornea
- Pellucid marginal degeneration – Corneal thinning
- Keratoglobus – Abnormal corneal curvature
- Marfan syndrome – Connective tissue disorder
- Rheumatoid arthritis – Autoimmune inflammation
- Diabetes – High blood sugar damages blood vessels
Treating these and other systemic diseases may help slow changes in astigmatism.
Eye Injuries or Surgery
Injuries, infections, or refractive surgeries like LASIK that affect the shape of the cornea can potentially induce or worsen irregular astigmatism.
Eye Rubbing
Chronic forceful eye rubbing can distort the cornea over time, leading to increased astigmatism. Avoiding this habit may slow progression.
Can Lack of Correction Make Astigmatism Worse?
While the natural aging process and underlying diseases are the main factors that make astigmatism worse, going extended periods without visual correction may potentially contribute in some cases. Here’s why:
- Blurry vision strains the eyes as they overwork to focus. This chronic eye strain could gradually change corneal shape from repetitive squinting and focusing.
- Without glasses or contacts, the eyes lack clear visual feedback and may not develop properly during childhood. This could allow early irregular astigmatism to progress more.
- Not correcting astigmatism can lead to amblyopia (lazy eye) in children as the brain suppresses the blurred vision from the weaker eye. Amblyopia exacerbates focusing issues.
While research has not definitively proven that lack of correction worsens astigmatism, many eye doctors recommend regular prescription updates to provide the eyes with the clearest vision possible and avoid negative impacts from eye strain.
Do Glasses & Contact Lenses Prevent Astigmatism from Getting Worse?
Corrective lenses like glasses or contacts improve astigmatic vision by bending light before it enters the eye, compensating for the irregular cornea. However, they do not actually alter the shape of the cornea or prevent astigmatism from getting worse.
Glasses and contacts only provide clearer vision while you are wearing them. They do not stop the underlying progression of corneal irregularity that causes vision deterioration.
That said, keeping vision as clear as possible with updated prescriptions may indirectly help by easing eye strain. Regular eye exams also allow eye doctors to monitor changes in astigmatism so new glasses or contact lens prescriptions can be provided as needed.
Can Surgery Correct Astigmatism Progression?
Refractive surgeries like LASIK, PRK, and corneal implants can effectively reshape the cornea to improve irregular astigmatism. However, residual astigmatism may remain after surgery and some shift in vision can still occur years later, especially with natural aging changes to the eye. Periodic touch-up surgeries may be required to maintain optimal vision results.
Cataract surgery with toric lens implants is an option that also often reduces astigmatism from lens changes in older adults. Overall, surgery may lessen but does not always completely stabilize astigmatism progression. Combining surgery with glasses or contacts can provide maximally clear sight.
Tips to Slow Astigmatism Progression
While astigmatism often worsens gradually over time, the following tips can help keep it from progressing too quickly:
- Get a comprehensive eye exam every 1-2 years to monitor vision changes.
- Update glasses or contact lens prescriptions regularly as your vision changes.
- Wear prescribed correction consistently during all daily activities.
- Practice eye protection when playing sports or doing activities with eye hazards.
- Eat a healthy diet rich in eye-protective antioxidants like lutein and zeaxanthin.
- Don’t smoke – it elevates risks for many eye disorders.
- Manage chronic health conditions carefully, like diabetes, arthritis, and high blood pressure.
- Avoid forceful eye rubbing which can distort the cornea over time.
While astigmatism often slowly increases, taking proactive steps for eye health can help keep your vision clear and minimize progression rate. Speak with your eye doctor if you notice vision worsening more rapidly.
When to See an Eye Doctor About Worsening Astigmatism
Consult an ophthalmologist or optometrist promptly if you experience:
- Sudden onset of noticeable vision changes
- Rapid worsening of astigmatism symptoms like severe blurriness
- Distorted or wavy vision getting significantly worse
- Increasing eyestrain or headaches with near work
- Squinting, eye rubbing, or head tilting more to see clearly
- Difficulty with daily tasks because of blurred vision
Significant irritation, pain, redness or discharge could indicate an infection or eye injury leading to astigmatism. Headache with nausea may point to eye misalignment. Seek emergency care for sudden onset of double vision, loss of vision, or severe eye pain.
While a small degree of gradual progression is common with astigmatism, more severe or sudden vision deterioration warrants prompt medical evaluation. An eye doctor can pinpoint causes and recommend treatment options to optimize sight.
Conclusion
Astigmatism frequently worsens slowly over one’s lifetime, with aging being the primary factor in gradual vision decline. High astigmatism, eye disease, and injuries may also accelerate progression. Going long periods without updated vision correction could potentially impact the eyes as well.
Glasses, contact lenses and surgery can improve astigmatic vision but do not prevent the cornea from becoming more irregular. Regular eye exams and prescription updates are key to providing the clearest sight possible to keep eyes healthy and minimize strain.
With sensible eye care and catch issues early, most increases in astigmatism can be effectively managed. Maintaining sharp vision remains possible for many with astigmatism even as changes occur.
