Serving San Jose, Hayward, Castro Valley & Concord
Astigmatism is present when the cornea is steeper in one meridian than it is in the opposite 90° meridian, thus being shaped more like a football than a basketball. This usually occurs “naturally”, but may result from prior surgery such as LASIK, EPI-LASEK, PRK, LASIK, RK or cataract surgery.
The surgical correction of astigmatism can be done with the femtosecond or excimer lasers, or using a precision diamond scalpel. Astigmatism surgery “relaxes” the cornea in the steeper meridian, which results in a decrease in astigmatism. We can perform these incisions in association with cataract surgery or LASIK or following prior RK ,LASIK or cataract surgery in order to “fine-tune” the vision.
Diamond scalpel astigmatic keratotomy ( AK ) has been performed since the late 1970’s and its effects are well studied. Dr. Mandel has performed thousands of AKs since 1983. The success rate is high and serious complications are rare. Side effects are also low.
Today, most astigmatic surgery is performed with the Excimer laser or the femtosecond laser at the time of LASIK or PRK or during cataract surgery.
The lower the amount of astigmatism, the more accurate the procedure (this is also true of astigmatic correction with the laser). Below 1.50 diopters, the success rate (uncorrected visual acuity 20/40 or better) is more than 95 percent and enhancement procedures are required in less than 10 percent of cases. For over 2.50 diopters, the success rate begins to drop, and is about 50 percent. Accordingly, the need for enhancements increases to about 50 percent.
The procedure takes less than five minutes, is painless (topical anesthetic drops are very effective), and post-operative discomfort is usually minimal. Most patients describe a “foreign body” sensation for one to two days. Very few people experience significant pain. Return of vision occurs within a week, and usually remains quite stable with little or no regression.
Side Effects of Astigmatic Keratotomy (AK)
Side effects are not common and may include mild fluctuation of vision; some glare and light sensitivity, mild haze or “ghost images”, and recurrent erosions (where the cornea develops tiny recurrent surface breakdowns causing discomfort for one to two days at a time).
Using the scalpel (NOT the laser), a microperforation of the cornea into the inside of the eye occurs in about 1 percent of cases and rarely causes any problem. Usually, the only treatment required is antibiotic drops for four to five days and no rubbing of the eye for two weeks. Occasionally, if a perforation occurs, a contact lens or sutures are required to treat the perforation.
Infections, significant overcorrection or under correction, loss of correctable vision, irregular astigmatism, significant corneal scars, and macroperforation of the cornea requiring a suture to close the incision are all quite rare. Exceedingly rare is a perforation that results in the introduction of bacteria into the eye causing a serious, potentially blinding, internal eye infection. Again, this CANNOT occur with the laser.
Schedule a Consultation Today
If you suffer from astigmatism, it is important to know that there are modern treatments available to help correct your vision. Dr. Mark R. Mandel and the team at Ophthalmic Medical Associates, Inc. are experienced providers of astigmatic keratotomy. To schedule a consultation or learn if you may be a candidate, contact the practice at one of our four convenient locations in Hayward, San Jose, Castro Valley and Concord, CA.