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Astigmatism Management FAQs

The Stein Eye Institute at UCLA
What is astigmatism?

It is an abnormality in which the optical surfaces of the eye are shaped like a football (oval) rather than a baseball or basketball (round). Astigmatism is the most common optical problem after myopia (nearsightedness) and hyperopia (farsightedness).

How does astigmatism affect vision?

When it is uncorrected, astigmatism blurs vision at all distances, near and far.

How do I know if I have astigmatism?

There is no way of knowing without specific testing. Overall astigmatism is approximately the sum of what is in the cornea and what is in the lens. Cataract surgery eliminates the lens component of astigmatism. Any amount remaining in the cornea will contribute to reduced image quality without glasses following surgery. Some people have no astigmatism in their eyeglass measurements, yet they have astigmatism in their corneas. The only way of knowing if corneal astigmatism is present is to test for it..

What if I have no astigmatism or only a small amount?

Knowing there is little or no corneal astigmatism is just as important as knowing there is a lot because it determines how and where the surgeon places the incision for the lens surgery.

How is astigmatism corrected?

There are three methods. The first involves placing one or more incisions in the steep part of the peripheral cornea. The second involves modifying the length, depth or number of incisions. The third involves implanting a special intraocular lens, called a toric lens. The latter two approaches can be combined to achieve high amounts of astigmatism correction, if necessary.

What if I don't have it corrected?

If you have residual astigmatism after surgery, there is a greater chance you will need glasses or contact lenses to see clearly. Your astigmatism can easily worsen after surgery if it is not measured before surgery and managed appropriately during surgery.

Are there other options?

The only other option is to perform your eye surgery without astigmatism correction and evaluate your astigmatism afterwards. Astigmatism can be corrected secondarily if you don t like the initial result. However, this will require a second trip to the operating room, which will not be covered by Medicare or other health insurance. In this case, the cost will be 3 to 4 times higher than if you opted for astigmatism correction during the initial surgery. We are able to discount the cost at the time of initial surgery because we are already in the operating room.

Will I need astigmatism correction in both eyes?

Probably. The two eyes are often a little different. We evaluate them independently.

Will I see 20/20 if my astigmatism is corrected?

We hope so, but as with all surgery, we can’t guarantee outcomes. There are many variables that affect visual outcomes besides astigmatism (the power of the lens implant, the health of your retina and optic nerve, etc.). The odds of achieving 20/20 visual acuity without glasses or contact lenses are much better if we evaluate and correct your astigmatism than if we don’t.

Will it take longer to recover from surgery if my astigmatism is corrected?

Probably not. If you have a small amount of astigmatism, or a toric lens is implanted, recovery will be the same as usual. If the incision has to be lengthened, the eye might be a little more irritated the day after surgery. Either way, recovery is fairly quick.

Is it recommended for every patient?

If your potential vision is good, you should have your astigmatism evaluated and managed. Only if your potential vision is poor (because of advanced macular degeneration or some other eye problem), will correcting the astigmatism not be as beneficial.

Should I have my astigmatism corrected if my visual potential is poor?

It depends on your eye condition. If you won’t be able to see the big”E” on the eye chart after eye surgery, it really won’t help that much to have your astigmatism corrected.

Should I have my astigmatism corrected if I am having surgery in one eye only?

Yes. Your overall vision without glasses will be better even if only one eye is corrected.

What if my astigmatism is not fully corrected at the time of surgery?

You will still need glasses for best distance and near vision. Even if your astigmatism is not fully corrected, the quality of your uncorrected vision will be better if your astigmatism can be reduced by any amount. Refractive surgery (e.g. Los Angeles LASIK, PRK, CK) can often be performed to further reduce astigmatism. Your surgeon will discuss which, if any, of these procedures is appropriate for your individual situation.

Will I need reading glasses if I have my astigmatism corrected?

If you opt to receive a monofocal lens implanted in both eyes for distance vision, you will definitely need reading glasses after surgery. If you opt for a multifocal lens implant (see the section on”Multifocal Intraocular Lenses” for answers to FAQs) you may be able to see clearly in the distance and at near without glasses. 80% of patients implanted with the multifocal lenses in FDA clinical trials did not need glasses after surgery for distance or near vision. Of course, not every patient in the trial was spectacle independent. The odds of becoming free of spectacles are better if your corneal astigmatism is low and your eyes are healthy. Another option is an accommodative lens implant which typically provides social near vision (e.g. menus, price tags, cell phones, magazine size print) without reading glasses (see section on”Accommodative Intraocular Lenses”for answers to FAQs).

Are there any risks or side effects?

The only significant risk is that we won’t be able to correct all of your astigmatism, and you will need glasses or contact lenses for best vision.

Can I have surgery if I decide not to have my astigmatism corrected?

Yes you can, but this may result in a less-than-optimal result. State-of-the-art cataract and lens implant surgery involves correcting refracting errors at the time of surgery. You must elect Astigmatism Management if you wish to have a multifocal or accommodative lens implanted or if you wish to have monovision (monofocal implants in both eyes, one for distance and one for near vision). Astigmatism Management is of critical importance to optimize the performance of these lenses and improve your chance of being spectacle independent.

Does insurance (or Medicare) pay for astigmatism correction?

No, Medicare and other health insurance plans will not pay to reduce corneal astigmatism that exists at the time of cataract surgery.

Why doesn't insurance (or Medicare) pay for astigmatism correction?

Medicare sets trends for the insurance industry. Since Medicare distinguishes between what is medically necessary and what is cosmetic, or purely optional, we are required to handle the cataract removal and the astigmatism management differently from the perspective of who pays. Medicare and private health insurance reimburse for cataract surgery. They do not pay for refractive surgery, which is necessary for astigmatism correction.

Can I submit the bill to insurance (or Medicare) for reimbursement after I pay?

Yes you can, but they will deny payment. If Medicare or an insurance company asks thisoffice for justification for the astigmatism management, we will inform them the astigmatism correction was done for non-medical or cosmetic reasons.

Why do you charge for astigmatism correction?

Refractive cataract surgery is more involved than cataract surgery alone. It is costly and requires significantly more work to plan and perform than routine cataract surgery.

What is included in the astigmatism correction charge?

There are three components. First, we measure the amount of astigmatism in your cornea by obtaining a corneal topography map before and after surgery. The second component is astigmatism evaluation and surgical planning. This is a cognitive component that accounts for the bulk of the work. The third component is the surgical management. Astigmatic correction requires additional surgical steps.

Why is it that friends of mine who had surgery don t mention astigmatism correction?

Many ophthalmologists do not plan for specific refractive outcomes.Surgeons at the UCLA Laser Refractive Center have spent years refining surgical techniques to optimize uncorrected visual acuity. Protocols have been developed for the surgical correction o f astigmatism. We believe that correcting astigmatism during cataract surgery is important to achieve the best results. We can’t promise you that you won’t need glasses after surgery, but we will do our best to reduce your dependence on them.

Does astigmatism management require additional visits?

It is possible that your surgeon may wish to see you for an additional visit to assess the post operative stability of the astigmatism correction prior to surgery on the second eye.

Can I receive professional courtesy or a discount?

Sorry, but no. The UCLA Medical Group prohibits professional courtesy or other discounts, even to physician colleagues who are employed at UCLA.

Can I receive a refund if my astigmatism is not fully corrected?

No. As with any surgery, results are subject to individual healing patterns and a host of variables beyond our control. Generally speaking, if the amount of astigmatism remaining in the cornea after surgery is less than 1 diopter, a 20/20 uncorrected postoperative result is possible, barring any other ocular pathology. No guarantees can be made with respect to the final result.

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