Astigmatism generally doesn’t get “worse” in a dramatic sense for most people after childhood. However, there are definitely factors that can cause your astigmatism to shift, progress, or become more noticeable over time. It’s not usually about poor habits like reading in dim light or sitting too close to the TV – those are myths. Instead, it’s often tied to changes in your eye’s structure or certain health conditions. Understanding these can help you better manage your eye health.
1. The Natural Progression of Aging
As we get older, our eyes experience a lot of changes, and astigmatism can be part of that natural process. It’s not always a dramatic shift, but rather a slow and steady alteration in the eye’s components.
The Cornea’s Changing Shape
Think of your cornea as the clear, dome-shaped front surface of your eye. For astigmatism to occur, this dome isn’t perfectly round; it’s shaped more like a football. Over many years, the elasticity and structure of this tissue can subtly change. These changes might be due to a combination of factors, including cumulative exposure to UV light, general wear and tear, and even minor, imperceptible stresses on the eye. This gradual reshaping can lead to an increase in your astigmatism prescription, or sometimes a shift in the axis (the direction of the “football” shape). It’s rarely a rapid change, but rather something an optometrist might notice year after year during routine check-ups.
The Internal Lens and Cataracts
Deep inside your eye, behind the iris, there’s another lens – your natural crystalline lens. This lens also plays a role in focusing light onto your retina. Just like the cornea, this internal lens can change over time. As we age, this lens can become less flexible and, eventually, cloudy, leading to cataracts. A developing cataract can induce or change astigmatism. When the lens becomes cloudy, its optical properties change, and this can add an irregular curvature to the eye’s total focusing power. Sometimes, astigmatism might even be caused by a cataract, or an existing astigmatism can become more pronounced or shift its orientation as the cataract progresses. If you’re having cataract surgery, your surgeon will often take this into account and may even use special intraocular lenses (IOLs) designed to correct astigmatism at the same time.
Astigmatism is a common refractive error that can worsen over time due to various factors, including changes in the shape of the cornea or lens. For those looking to understand more about the progression of astigmatism and its potential impacts on vision, a related article can be found at SmilePro Blog, which offers insights into eye health and the importance of regular eye examinations.
2. Keratoconus: A Progressive Corneal Condition
This is a really important factor to be aware of, especially if your astigmatism seems to be progressing more rapidly than expected, particularly in your younger years.
What is Keratoconus?
Keratoconus is a condition where the cornea, instead of maintaining its usual dome shape, gradually thins and bulges outward, taking on a more conical shape. Imagine the surface of a basketball slowly turning into more of a football, but then the football itself starts to get a pointed tip. This irregular, progressive change in the corneal shape directly impacts how light is focused on the retina, leading to blurry and distorted vision. The astigmatism associated with keratoconus isn’t stable; it tends to worsen over time as the cone steepens and becomes more irregular.
When Does it Worsen?
Keratoconus typically starts to manifest during the teen years and can progress steadily through the twenties and even into the thirties. While it’s usually diagnosed in younger individuals, its progression isn’t always linear. Some people experience a rapid worsening, while for others, it might be a slower, more subtle change. If you’re experiencing significantly increasing astigmatism, especially if it’s asymmetric (meaning one eye is much worse than the other or the astigmatism has a very irregular pattern), your eye doctor will likely investigate keratoconus as a possible cause. Early diagnosis and management are crucial for this condition to help slow or halt its progression and preserve vision.
3. The Impact of Eye Rubbing
It might seem harmless, but chronic or vigorous eye rubbing can have real consequences for your corneal health and, consequently, your astigmatism.
How Rubbing Affects the Cornea
The cornea, while tough, is also delicate. Repeatedly rubbing your eyes, especially with a lot of pressure, can exert mechanical stress on its structure. This stress can, over time, contribute to corneal thinning. Imagine constantly pressing on a soft, flexible surface – eventually, it might start to deform. For people who are genetically predisposed to conditions like keratoconus, or even those without a clear predisposition, aggressive eye rubbing can act as a trigger or an accelerant for corneal changes. The friction and pressure can weaken the corneal collagen fibers, leading to a less stable corneal shape.
Link to Astigmatism Progression
When the cornea thins or changes shape due to chronic rubbing, it directly affects the regularity of its surface. This can cause existing astigmatism to worsen, or it can induce new, often irregular, astigmatism. Irregular astigmatism is particularly challenging because it doesn’t have a simple, uniform curve, making it harder to correct with standard glasses or soft contact lenses. It’s a bit like trying to fit a perfectly round lid onto a slightly misshapen jar. If you find yourself rubbing your eyes frequently due to allergies, dryness, or habit, it’s worth discussing this with your eye care professional. They can help address the underlying cause of the irritation and offer strategies to break the rubbing habit.
4. Eye Injuries and Trauma
An unexpected blow or injury to the eye or surrounding area can definitely throw off the delicate balance of your eye’s optics, sometimes leading to new or worse astigmatism.
Direct Corneal Trauma
A direct injury to the cornea itself, such as a poke, scratch, or blunt force trauma, can alter its perfectly smooth and regular curvature. If the injury causes scarring or changes the tissue structure, the cornea might heal with an irregular surface. This irregularity directly translates into astigmatism, and it’s often an “irregular astigmatism,” which can be more difficult to correct with standard vision aids. Even minor corneal abrasions, if they are deep or affect the central vision, can potentially leave behind some degree of irregular astigmatism. The severity of the injury often dictates the extent and permanence of the induced astigmatism.
Eyelid and Orbital Injuries
It’s not just direct corneal impact that matters. Injuries to the eyelids or the bony orbit (the socket around your eye) can also have an indirect but significant effect on astigmatism. For example, if an eyelid is severely swollen, scarred, or positioned incorrectly due to trauma, it can press down on the cornea in an unusual way. This constant, uneven pressure can temporarily or even permanently deform the corneal shape, thereby causing or exacerbating astigmatism. Similarly, fractures to the orbital bones can sometimes subtly alter the eye’s position or the surrounding tissue, indirectly influencing corneal shape. Any significant eye trauma warrants immediate medical attention, not only to save vision but also to address potential long-term complications like astigmatism.
Astigmatism can worsen over time due to various factors, including changes in the shape of the cornea or lens, and understanding these factors is crucial for effective management. For those interested in learning more about the underlying causes and potential treatments for astigmatism, a related article can provide valuable insights. You can read more about it in this informative piece on the topic here. Staying informed can help individuals take proactive steps in maintaining their eye health.
5. The Role of Eye Surgery
| Factor | Description | Impact on Astigmatism | Notes |
|---|---|---|---|
| Corneal Shape Changes | Irregularities or changes in the curvature of the cornea | Increases astigmatism severity | Can be caused by injury, surgery, or keratoconus |
| Age-related Changes | Natural changes in the eye’s lens and cornea with age | May worsen or alter astigmatism | Often gradual and varies between individuals |
| Eye Rubbing | Frequent or vigorous rubbing of the eyes | Can exacerbate corneal irregularities | May accelerate progression in keratoconus patients |
| Eye Surgery | Procedures like cataract or LASIK surgery | May induce or worsen astigmatism | Depends on surgical technique and healing |
| Underlying Eye Conditions | Diseases such as keratoconus or corneal scarring | Can significantly worsen astigmatism | Requires medical management |
| Contact Lens Wear | Improper fit or prolonged use of contact lenses | May cause corneal warping and worsen astigmatism | Regular check-ups recommended |
While eye surgery often improves vision, certain procedures, by their very nature of altering eye structures, can also impact astigmatism, sometimes for the better, but occasionally causing it to worsen or change.
Cataract Surgery Considerations
Cataract surgery involves removing the eye’s cloudy natural lens and replacing it with an artificial intraocular lens (IOL). This procedure is a common cause of changes in astigmatism. Before surgery, precise measurements are taken to select the correct IOL power. If you have astigmatism, your surgeon might offer a “toric IOL,” which is specifically designed to correct existing astigmatism at the time of surgery. However, if a standard IOL is used in an eye with astigmatism, or if the toric IOL isn’t perfectly aligned, new or residual astigmatism can be a side effect. Even with perfect alignment, the healing process itself can sometimes induce minor shifts in corneal curvature. It’s generally a predictable and manageable outcome, but it’s a factor to be aware of.
Corneal Transplantation
For severe corneal conditions like advanced keratoconus or corneal scarring, a corneal transplant (keratoplasty) might be necessary. This involves replacing a damaged portion of the cornea with healthy donor tissue. While life-changing for vision, corneal transplants almost invariably induce some degree of astigmatism. The challenge lies in ensuring the donor cornea integrates smoothly and evenly with the recipient’s eye. Differences in curvature, tension from sutures, and the natural healing process can all lead to significant and often irregular astigmatism after a transplant. Managing this post-operative astigmatism usually involves specialized contact lenses, and sometimes further surgical procedures to refine the corneal shape.
Refractive Surgery and Its Outcomes
Procedures like LASIK, PRK, or SMILE aim to correct refractive errors, including astigmatism, by reshaping the cornea. In many cases, these surgeries successfully reduce or eliminate astigmatism. However, in some instances, refractive surgery can cause or worsen astigmatism. This might happen due to incomplete correction, decentered ablation (where the laser treatment isn’t perfectly centered), or, rarely, post-surgical corneal instability like ectasia, which is a weakening and bulging of the cornea. If astigmatism worsens after refractive surgery, it often requires further evaluation and sometimes additional treatment to optimize vision. It’s a complex interaction between the individual’s eye healing response and the surgical precision.
6. Contact Lens Issues
While contact lenses are a fantastic way to correct astigmatism, improper use or certain types of lenses can paradoxically contribute to corneal issues that might lead to worsening or unstable astigmatism.
Improper Fit and Use
Contact lenses are designed to sit on the surface of your cornea. If a lens doesn’t fit correctly – perhaps it’s too tight, too loose, or the wrong base curve – it can exert uneven pressure on the cornea. Over time, this constant, subtle pressure can potentially induce or exacerbate corneal warping, leading to changes in astigmatism. For instance, a soft lens that’s too tight might cause corneal molding. Similarly, sleeping in lenses not approved for extended wear, or not replacing them as recommended, can increase the risk of corneal irritation, inflammation, or even infections. These issues can disrupt the cornea’s integrity and potentially affect its shape.
Corneal Warping (Contact Lens-Induced Keratopathy)
Sometimes, prolonged or improper contact lens wear, particularly with rigid gas permeable (RGP) lenses, can cause temporary or even semi-permanent changes in the corneal shape, known as corneal warpage or contact lens-induced keratopathy. This means the cornea changes shape to conform to the lens, rather than staying in its natural state. When this happens, the astigmatism measured when you’re not wearing lenses might appear to worsen or become irregular. Often, if contact lens wear is ceased for a period, the cornea can return to its original shape, and the induced astigmatism resolves. However, if the warping is significant or long-standing, it can take time to recover, and in rare cases, some residual astigmatism might remain. Regular check-ups with your eye care professional are essential to ensure your lenses fit well and aren’t causing any adverse corneal changes.
7. Genetics and Family History
While astigmatism itself is often hereditary, the tendency for it to worsen, especially due to specific conditions, can also run in families. It’s not always a direct inheritance, but rather an increased predisposition.
Hereditary Predisposition to Astigmatism
It’s well-established that astigmatism tends to run in families. If your parents or siblings have astigmatism, you’re more likely to develop it. This genetic link often accounts for the general presence and even the initial degree of astigmatism. However, genetics can also play a role in whether that astigmatism remains stable or has a higher likelihood of progression or change over time. It’s not about inheriting the exact amount of astigmatism, but rather inheriting the tendency for your eye’s structures to develop or change in certain ways.
Family History of Corneal Conditions
This is particularly relevant when considering conditions like keratoconus. If there’s a family history of keratoconus or other corneal diseases, your risk of developing these conditions – and therefore experiencing worsening astigmatism – is significantly higher. It’s not a guarantee, but it’s a strong indicator. For example, some studies suggest that first-degree relatives of individuals with keratoconus have a higher prevalence of subtle corneal abnormalities. Knowing your family medical history can be a helpful piece of information for your eye doctor, prompting them to monitor your eyes more closely for any signs of progressive corneal changes. This early vigilance allows for timely intervention if a condition like keratoconus begins to manifest, which can make a big difference in managing its impact on your vision.
FAQs
What causes astigmatism to worsen?
Astigmatism can worsen due to a variety of factors, including changes in the shape of the cornea or lens, eye injuries, or certain eye conditions.
Can astigmatism worsen with age?
Yes, astigmatism can worsen with age as the shape of the eye changes over time, leading to an increase in the degree of astigmatism.
Does untreated astigmatism get worse over time?
Untreated astigmatism can potentially worsen over time, as the irregular shape of the cornea or lens may continue to change, resulting in an increase in astigmatism.
Can eye strain make astigmatism worse?
Prolonged periods of eye strain, such as from excessive screen time or reading in poor lighting, can exacerbate astigmatism symptoms but may not directly cause the condition to worsen.
How can I prevent astigmatism from getting worse?
To help prevent astigmatism from worsening, it is important to have regular eye exams, follow your eye doctor’s recommendations for corrective lenses or surgery, and take steps to protect your eyes from injury or strain.
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