Speaker:
Like, like an alarm.
Dr. King:
What kind of clock? Like a wall clock?
Dr. Cha:
Yeah. Like a wall clock. Yeah. Yeah I noticed I don’t have a clock in my living room, so like I had to go get my phone just to know what time it is.
Speaker:
Like your cable box doesn’t have the time on it.
Dr. Cha:
Cable box?
Speaker:
What’s a cable box?
Speaker:
Do you also have Apple TV too?
Dr. King:
Yes. Yeah, we have Apple tv but I don’t, I don’t use it. We don’t use it very often.
Speaker:
Ted Lasso???
Speaker:
Jordan is watching that right now.
Speaker:
Without you?
Speaker:
Yeah
Dr. King:
I hear it’s really good. I like Jason Sudeikis . I dunno why I haven’t started watching.
Speaker:
You need to watch it. It’s like the most happy feeling show ever.
Dr. King:
I need to watch this
Speaker:
Because like I am just cracking up, hilarious
Dr. Cha:
It’s life’s already happy enough. I need to feel something when I watch.
Dr. King:
You have a new girlfriend and you don’t feel anything?
Dr. Cha:
I feel happy already. I need to feel, I need to feel negative emotions to balance it all out.
Speaker:
I can find you some of those.
Dr. King:
Just listen to my life. Buddy.
Dr. King:
So, hi. Welcome to Days of Our Eyes. I’m Dr. King.
Dr. Cha:
And I’m Dr. Cha.
Dr. King:
And just to prove, we do not do this from a script or a plan. Our last episode we talked about the opias.
Dr. Cha:
Yes.
Dr. King:
And all the visual conditions. Hyperopia, Myopia. Presbyopia. We forgot one. We forgot astigmatism. ’cause It’s not really an opia, but it fits in with them. We’re gonna talk about astigmatism today. What is it? How do you get it? What do you do about it? Stick around. We’ll let you know. So astigmatism, what’s the most common,
Speaker:
I’m sorry
Dr. King:
Astigmatism. Now it start over. So what is astigmatism? First of all, it’s the most common reason for wearing glasses in the world. Literally. And we’re not talking about stigmatism. It’s astigmatism. Mm-Hmm. . And there’s no S on the end. It’s not astigmatisms or stigmatisms and it’s not stigmata. Only Christ has the stigmata . It’s astigmatism. Mm-Hmm. . Okay. Dr. Cha. Yeah. How do you explain astigmatism to patients?
Dr. Cha:
It’s not a disease. It’s not a condition.
Dr. King:
Yes, let’s make it very clear, but it’s not, it’s not a disease.
Dr. Cha:
The idea is that nothing in this world is perfect. Right.
Dr. King:
Except me
Dr. Cha:
Except Dr. King. Of course. And so that means our eyeball shape isn’t always a perfect circle as well. We talked about for, you know, myopia, nearsightedness, hyperopia, farsightedness. The light doesn’t exactly land where it needs to precisely
Dr. King:
Right. Doesn’t land on the phobia, on the retina.
Dr. Cha:
Right. For astigmatism instead of the entirety of light coming in, or all the light coming in, kind of missing the retina, portions can miss it more than others. I would say like 9 out of 10 patients coming in have some kind of astigmatism component to their vision.
Dr. King:
A measurable amount. Yeah. Whether it’s visually significant or not, we can measure a little.
Dr. Cha:
Right, right, right. Whether you like it or not. , I meant subjectively, like when we do the one and two. Yes. So when we look at light, we could think of it largely as a circle when it kind of comes in or circle as in it’s kind of radially symmetrical. It’s just even all the way throughout. But when there’s astigmatism, it’s a little maybe skewed or a little bit more pronounced in one direction or another. And so sometimes our eyes kind of bend light sharper or, you know, not as steeply in one axis or one meridian. Sometimes you can actually have part of the image clearly put onto your retina or the fovea, but half the image or part of the image kind of misses that sweet spot. That’s why we get this kind of, this distortion or kind of star bursting in our vision.
Dr. King:
I talk about, you know, our whole goal is if you want to see clearly, we have to take the whole image and focus it right onto the retina, preferably onto the fovea. The very most sensitive center. In astigmatism, the front portion of the eye is shaped. This is basically the shape your eye grows into is shaped that it actually splits the image. So you get two points of focus and they’re in, they’re 90 degrees opposite each other usually. Okay. So you may have one meridian focused here and the other one focused here. Neither one of ’em are on the retina. So you just see blur. But there’s two points of focus. So what we have to do is collapse those two points of focus into one and land them on the retina. And that’s what astigmatism correction does. So for somebody who is strictly myopic or nearsighted, there’s one number to their prescription.
Mm-Hmm. , they’re a minus four 50 sphere, that’s what we call it. In astigmatism, there’s three numbers in their prescription. We have a minus four 50 sphere with 1.5 diopters of cylinder at axis 90. So that tells us where to orient it, that collapses it and puts it on the retina. I think of it as, as this is the shape your eye grew into and we have to put two parts, two different powers into your prescription at a certain orientation, which is the axis to land it on the retina. There is something called irregular astigmatism where the cornea is all wonky that that’s much tougher. You know, they aren’t 90 degrees opposite. It’s not as clean, clear, cut and clean. When we get into specialty contact lenses that can help with that or laser procedures. We’re getting better at reading and coming up with more personalized ways of correcting that. But basic, what we call regular astigmatism. You can correct with spectacles and see very sharply
Dr. Cha:
When I talk to patients and they don’t know if they have astigmatism or not. And if they’re, you know, used to coming to an eye doctor getting prescriptions, I usually ask them, do you have a long prescription or a short prescription? . Yeah. A short prescription just has the sphere. Right. So, you know, largely just myopic or largely just farsighted. Hyperopic. But they have all those extra numbers with the cylinder and the axis. Oh yeah. That’s the astigmatism.
Dr. King:
Yeah. It’s a physics term and for some reason, unbeknownst to me, we’ve never come up with a layman’s term for it. Like myopia. We say nearsighted. Hyperopia, we say farsighted astigmatism, we’ve always just said astigmatism. Instead of double-sided or Yeah. Football eye or oval eye. I don’t know. We just have never come up with a good layman’s term for it. So it sounds scarier than it is.
Dr. Cha:
Can we make up something? I mean, you kind of throw out a few.
Dr. King:
I don’t know. I mean we should. Yeah. I’ve tried in the past. Nothing ever catches on ’cause nobody listens to me.
Video Background:
That is so fetch. Gretchen. Stop trying to make fetch happen.
Dr. Cha:
Yeah. I never go to him for advice. ,
Dr. King:
What, what would you call it though? I mean, I double curved.
Dr. Cha:
I split image or
Dr. King:
Hyperopic myopic. Let’s see. Nearsighted, far-sighted, double-sided.
Dr. Cha:
Double-Sided
Dr. King:
Although then people think they’re walking around seeing two.
Dr. Cha:
Yeah. Yeah. That’s why I didn’t love like
Dr. King:
Shadow eye. Cause sometimes you know, you see the image and then you see the little shadow around it. That’s astigmatism doing that.
Dr. Cha:
Yeah, Shadow Vision,
Dr. King:
You have shadow vision.
Dr. Cha:
That’s kind of cool that people might want it now. It’s like, I want shadow vision.
Dr. King:
Gimme the shadow numbers.
Dr. Cha:
Gimme those extra numbers. ,
Speaker:
Who develops Astigmatisms and how common are they?
Dr. King:
Once again, you said astigmatisms
Speaker:
I know. I was like, wow
Dr. King:
Astigmatism is, it’s not plural. It’s just
Dr. Cha:
It’s it’s like an adjective. You’re not strongs. You’re strong.
Dr. King:
Wow. Exactly.
Speaker:
That’s a good one. Okay. Who develops astigmatism slash How common are they? It? Is it, they?
Dr. King:
It’s it.
Speaker:
Jesus Lord
Dr. King:
You have to educate our home folks in our office. Astigmatism, like I mentioned, it’s the most common reason on the planet for wearing vision correction. It’s actually more common than nearsightedness. However, nearsightedness is catching up.
Dr. Cha:
Gonna have those like tiny imperfections on that from part of the the cornea. And so
Dr. King:
Is it genetic though? Is that where those imperfections come from?
Dr. Cha:
It can be.
Dr. King:
Right. Is it from eye rubbing?
Dr. Cha:
It can be exacerbated by that. Definitely. Yes. Yeah. We kind of touched upon it with keratoconus and, and eye rubbing.
Dr. King:
Don’t.
Dr. Cha:
Yeah, right.
Dr. King:
Yeah. Irregular, crazy astigmatism can develop into keratoconus where the cornea actually becomes deformed.
Dr. Cha:
But yeah, it can be a genetic thing where you know, familially, like their parents have high amounts of astigmatism. Patients, their children will come in with high amounts of astigmatism. Patients come in and say, oh, like I know a friend who has, you know, astigmatism and their glasses are like, you know, incredibly thick and you know, scary looking and I don’t want that. But usually that’s, you know, those are, you know, few and far between.
Dr. King:
Yeah. It’s that it’s all about degree and amount. You know, the higher, the amount of prescription of any kind near myopia, hyperopia, astigmatism, the higher the amount, the thicker the glasses are gonna be. The smaller amount, that’s just not an issue. It does tend to be genetic or inherited or run in families. However, I’m the exception. I, my mom was farsighted, my dad had astigmatism. I’m nearsighted with no astigmatism. There you go. Go figure. I’m one of 5% that has no astigmatism. That’s how common it’s 95% of folks have it. I just remembered that. That’s an old statistic. So somebody will probably prove me wrong. ’cause That’s a really old statistic.
Speaker:
How can astigmatism be corrected?
Dr. Cha:
Huh?
Dr. King:
There’s no correction.
Speaker:
Sweet. Perfect
Dr. Cha:
There’s no cure ’cause there’s no disease. , ,
Dr. King:
It can be treated by glasses. There are several types of contact lenses, both rigid gas, permeable and soft, what are called toric lenses. Toric specifically is a term that refers to astigmatism correction. Okay. It can be corrected with LASIK, PRK, all the refractive surgeries these days correct for astigmatism. Used to be, people were told back in the day, oh, you can’t have refractive surgery because you have astigmatism. And that’s not the case anymore. There are limits to amounts on certain types of procedures, but we have ICL lenses, implantable lenses that can correct for higher amounts of astigmatism. So we actually have tons of options for astigmatism. It’s no longer a barrier to surgical correction.
Speaker:
What makes astigmatism different from myopia and hyperopia? Like what’s the main thing that distinguishes it?
Dr. Cha:
When it comes to astigmatism, a lot of times at any range, it’ll always be somewhat blurry.
Dr. King:
Right. Because you’ve split that image without having astigmatism correction. There’s not one crisp, clear image ever on the retina. You can move those two images closer and the back image might be get to the retina or move it further back in the front image. Or you can get it one in back and one in front. That’s called mixed astigmatism. But you never get one solid image right on the retina. That’s one of the big things with astigmatism. It affects both distance and near. And it things in between. It can cause eye strain. One of the most common reasons that we squint, because if you squint, if you think of it, you’re two different curvatures. One this way and one this way. If you squint, you’ve eliminated one of the curvatures, now you have one. And you can find where that one focuses on the retina.
Dr. Cha:
We do find patients that, you know, almost can ignore all those kind of streaking image and you know, they’ll come in, oh, I’ve never worn glasses and you have a good amount of astigmatism and they’ve just been, and they just are, are unaware of the, the degradation or the, like, the diminish the quality of their vision.
Dr. King:
Well if you don’t know any different, so I tell ’em, well you learn to interpret the blur. Because that’s what’s happens to a lot of people, whether it’s uncorrected, nearsighted, and as farsighted or astigmatism, they’re used to it. They’ll go, I don’t know what you’re talking about. I had a patient, I don’t know that the DMV said that I need glasses, but I’m fine. I’ve been driving like this for years and they’re like 20/80. But they’re like, I don’t need anything. Yeah, you do. You just don’t know any better. You don’t know what you don’t know. So you put glasses on, somebody like that and they’re like, oh. And then they’ll come back and tell me, now my eyes are worse because when I take my glasses off I can’t see . I’m like, no, you don’t want to interpret the blur anymore. Your prescription hasn’t changed, but your brain doesn’t want to do all that work.
Speaker:
So that actually takes us into our MythBusters. The first one is 2020 vision is possible with astigmatism. With astigmatism.
Dr. Cha:
With an astigmatism.
Speaker:
With astigmatism.
Dr. Cha:
Yes. Definitely. Yeah. You know, when we talk about your visual potential, you know how well you can possibly see there’s visual potential, right. We wanna make sure the eye’s healthy enough to be able to see, you know, crisp and clear and comfortably 20/20. But that ability to see doesn’t really tell us anything about the kind of prescription you have. Whatever prescription you have, nearsighted, farsighted or astigmatism, assuming everything is healthy, you and normal, you’ll be, you’ll largely be able to see comfortably and clearly. And it is correctable most of the time. Assuming again, there’s nothing else going on with the eye. So… busted
Speaker:
Because I have 20/20. But I know y’all know good and well, I can’t see.
Dr. King:
What’s the quality of the 20/20? You know, the quality of it.
Speaker:
Astigmatism can be outgrown,
Dr. King:
Outgrown. Huh? I’ve seen people grow into it. I’ve seen develop it.
Dr. Cha:
Right. Right.
Dr. King:
I mean, in theory, yes, it could be , it has to do with corneal shape, lens, shape. So, you know, as the visual system develops in childhood, in theory, yes. It could lessen with time. We don’t see that happen a lot, but I, I wouldn’t say it’s not possible.
Dr. Cha:
Sometimes you just get used to it. True. You just don’t notice it as much.
Dr. King:
True. You know, and there are some folks walking around with some uncorrected astigmatism, but it’s a small amount. Mm-Hmm. , they’re not symptomatic. Yeah. Actually, it’s not degrading their vision too much. Mm-Hmm. , you can be 20/20 so maybe they don’t need to wear any correction. Mm-Hmm. , it’s, once again, it’s, it’s digging down. It’s talking to the person and saying, you know, finding out how are you functioning in your daily world. What we really wanna promote in eyecare is clear, comfortable, binocular vision. We’re not here to force people to wear eyewear. It’s really about maximizing your visual efficiency that is gonna give you the best quality of life. It’s a quality of life, life issue. Mm-Hmm. . Mm-Hmm. .
Dr. Cha:
So as long as you’re able to function and do things that you need to do and want to do, that’s what we want
Dr. King:
Comfortably and efficiently. Well, we hope you like what you heard here today. And if you do, please subscribe and follow. If you have any questions, don’t hesitate to put ’em in the Dropbox. And in the meantime, I’m Dr. King. Dr. Cha, we’ll see you next time.