Astigmatism: glasses, contact lenses or laser, and how to know what suits you
Astigmatism can be corrected with glasses, contact lenses or surgery. When each one makes sense, and the test to get before you choose laser.
In short: Astigmatism is corrected with glasses, contact lenses or surgery that reshapes the cornea. What decides it is how much astigmatism you have, whether it is stable and what your cornea looks like. There is one test to get before you consider laser, because it can change the answer completely.
“I have astigmatism” is one of the things I hear most in the office, usually followed by “can laser fix it?” Sometimes the answer is yes. Sometimes it is “not yet.” And there is one case where the right answer is “no, and good thing we checked first.”
This article explains what astigmatism is, the three ways to correct it and who each one suits. The test that separates a yes from a no comes at the end, because it makes more sense once you know how astigmatism works.
What is happening in your eye
Astigmatism happens when your cornea (the clear front layer of the eye) or your lens has a different shape than normal. That shape bends light unevenly as it enters the eye, and the image looks blurry or distorted.
According to the U.S. National Eye Institute, it is a common problem, doctors don’t know what causes it, and there is no way to prevent it. Some people are born with it, many develop it as children or young adults, and some after an eye injury or eye surgery.
The most common symptoms:
- Blurry or distorted vision.
- Squinting to see clearly.
- Headaches and eye strain.
- Trouble seeing at night.
If your astigmatism is mild you may notice nothing, which is exactly what happens with many children: they don’t know they should be seeing better.
That’s the what. Now the three ways to correct it, from the simplest to the one that raises the most questions.
Option one: glasses
Glasses are the most common treatment. They correct astigmatism with a specific prescription and work well in almost every case. If yours is mild, you may not even need them all the time.
Their limit is practical: some people play sports, work around dust or just don’t want to depend on them. For them there is option two.
Option two: contact lenses
There are contact lenses designed for astigmatism. They fit the shape of your eye and correct without frames in the way.
They take discipline: daily cleaning, replacing them on schedule and check-ups. And they don’t suit everyone; some eyes tolerate them poorly, especially with dry eye.
Those two options correct the image without changing your eye. The third does change the eye, and that is why it needs something first.
Option three: laser surgery
Surgery reshapes the cornea so it focuses light correctly. With LASIK or PRK I can correct astigmatism together with any nearsightedness or farsightedness you have. More detail on the LASIK and PRK page.
To qualify, your prescription has to be stable: the U.S. FDA says you are probably not a good candidate if your prescription changed in the past year. Your cornea also has to have the right thickness and shape. Which brings us to the test I mentioned at the start.
The test that comes before any decision
Before considering laser, the cornea has to be mapped with corneal topography or tomography. That test draws the shape of your cornea point by point.
What I look for is whether your astigmatism is regular, the common kind that corrects well, or irregular. Irregular astigmatism, or one that keeps rising year after year, can be the first sign of keratoconus: a condition where the cornea thins out and bulges like a cone. The FDA lists keratoconus among the conditions where the safety of refractive surgery has not been established, and warns that operating on a cornea that is too thin can cause serious complications. So if keratoconus shows up, I don’t recommend laser to get rid of glasses.
That is the “no, and good thing we checked first.” Catching keratoconus early changes the plan: instead of laser to drop the glasses, the goal becomes stopping the disease. More on that in forme fruste keratoconus, the stage almost nobody catches.
If the topography comes back clean, laser is back on the table as a real option.
What if you also have a cataract?
If you already have a cataract or will have surgery soon, astigmatism can be corrected during the same operation with a toric intraocular lens. No separate surgery needed. Details on intraocular lenses.
How to find out which one is yours
You now have the full map: glasses, contacts or laser, plus the test that decides whether laser is for you. Next is measuring your eye.
At an evaluation I check your prescription, how stable it is and the shape of your cornea. Then I tell you which of the three options makes sense for you, and whether laser is one of them. The whole visit can be in English.
Message me on WhatsApp to book at either of my two offices. And if laser is on your mind, read how to know if you are a LASIK candidate first.
Sources: National Eye Institute (NEI, U.S. National Institutes of Health), Astigmatism, last updated December 4, 2024. U.S. Food and Drug Administration (FDA), When is LASIK not for me?, content current as of July 11, 2018. American Academy of Ophthalmology, What Is Keratoconus?. All accessed October 3, 2026.
Last updated:
Want me to look at your case?
Send me a WhatsApp with the reason for your visit. I will tell you whether an evaluation makes sense and which of my two offices to come to, before you make the trip. The whole visit can be in English.