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College of Optometry
2nd semester 2017-2018

Clinical Assessment and Management of a Astigmatism

Gellez,Charmaine hazel R..


Dr. Cecilia Yu, O.D

Clinic Teacher

 Myopia- also known as near-sightedness and short-sightedness, is a condition of
the eye where the light that comes in does not directly focus on the retina but in
front of it, causing the image that one sees when looking at a distant object to be
out of focus. It does not affect focus when looking at a close object.
Simple myopia, more common than other types of myopia, is characterized by an eye
that is too long for its optical power (which is determined by the cornea and crystalline
lens) or optically too powerful for its axial length. Both genetic and environmental
factors, particularly significant amounts of near work, are thought to contribute to the
development of simple myopia.
■ Astigmatism is a refractive condition in which the eye’s optical system is
incapable of forming a point image for a point object. The refracting power of the
optical system varies from one meridian to another. Astigmatism can be
classified in three ways:
– Regular or irregular
– Contributing ocular component ( Anterior Cornea, Posterior Cornea, &
Crystalline Lens )
– With respect to Orientation ( ATR, WTR, Oblique )
– With respect to the refractive error
 Simple Myopic Astigmatism
 Simple hyperopic Astigmatism
 Compound Myopic Astigmatism
 Compound Hyperopic Astigmatism
 Mixed Astigmatism

A 21 year old, Accountancy student, female was brought to the clinic for
consultation on Feb 3,2018. The patient complained of intermittent blurring of vision @
far with specs and constant blurring of vision w/o specs when using cell phone and
watching TV for about 1 hr. She had an no associated complaint Having 2 pair of
glasses. She Started wear since 2015 she changed it because of high power of
spectacle lenses then lastly her glasses she used since 2017 with an Rx of OD:-
2.00Dsph=-0.50Dcyl x90 OS:-1.5ODsph. The patient had no history of ocular trauma or
eye disease. Both parents are spectacle wearer of having 1 pair of reading glass and
her sister also using glasses. No history of ocular trauma or ocular disease in the family.
The patient is generally healthy. Her Father had a history of hypertensive. No history of
medication and hypersensitivities
Subjective Examination Results
Distance Near
OD 20/200 J2
OS 20/200 J2
OU 20/100-1 J2

 Corneal Reflex Test results are centric.

 Physiologic Diplopia is present
 Results for Version and Duction are Smooth, Accurate, Full, Extensive
 Results for Saccades are Fast and Accurate

 External Examination- Slit Lamp Biomicroscopy: No significant findings
 Internal Examination- Direct Ophthalmoscopy: No significant findings

Objective Refraction

Vertical Horizontal Mires Corneal

Meridian Meridian Astigmatism

OD 43.50 42.50 Clear and -0.50 Dcyl


43.00 42.50 Clear and -0.50 Dcyl



VT 4 OD -2.00 Dsph =-0.50

Dcyl x180

OS -1.50 Dsph =-0.50

Dcyl x 180
Subjective Refraction

Subjective Refraction
OD -2.25 Dsph –0.25Dcylx90 20/20
OS -1.50 Dsph= -0.25Dcyl 20/20
OU 20/20

Tests for Convergence and Phoria

Near Point of

 Convergence Excess is less than 6 cm

 Convergence Insufficiency is more than 10 cm

With Rx Without Rx
Distance exo Orthophoria
Near exo Orthophoria
Results Normal Range
VT 3 Habitual Ortho Ortho- 2 exo N
Phoria at Far

VT 8 Induced Phoria 2 exophoria Ortho- 2 exo N

at Far


OD 9 10 9
OS 8 9 10

OU 15 11 12

Amplitude of Accommodation

OD 12.50
OS 12.50
OU 1.50

-2.00 +1.75
• Spectacle lenses multicoated lenses for computer use

Give the full correction of:

OD -2.25 Dsph –0.25Dcylx90

OS -1.50 Dsph= -0.25Dcyl


-Patient will be given patient education using EYEGLASSES there will be a follow up

. Patients education will be given on and taking good care of her glasses..

Contact lenses for astigmatism
Toric contact lenses correct for astigmatism issues that arise from a different
curvature of the cornea or lens in your eye (referred to as regular astigmatism, corneal
astigmatism or lenticular astigmatism).
In these cases, the cornea or lens is curved so that the refraction of your eye differs
between the vertical and horizontal planes. This causes blurry vision and trouble seeing
fine details. Sometimes, vertical lines will appear to tilt.
The ability for toric contact lenses to provide different refractive powers on the vertical
and horizontal orientations addresses this specific peculiarity that causes astigmatism.
Different types of toric contacts
Toric contact lenses also address other visual corrections, and come in every wear
schedule. You can have toric dailies and other disposable toric contact lenses — you
can even have colored toric contact lenses.
Soft toric contact lenses are more comfortable and easier to manage, but need extra
care in fitting to stay in place
Advantages & Disadvantages
The advantages of a soft toric contact lens include easy adaptability, as comfort
is usually quite good even initially. Other advantages of soft toric lenses include:
• Extended wear option –allowing up to thirty days of continuous (overnight) wear
• Eye color –soft torics are available in various colors that can change even the
darkest eyes to a variety of colors
• Convenient replacement schedules –conventional lenses allow you keep the
same lenses for a year, or the more common "disposable lenses' allow you to wear for
one month, 2 weeks, or only once and throw away, with no need to ever clean them
Their biggest disadvantage is the potential for fluctuating vision.
Daily Care and Usage: What You Should Know
The proper way to care for your lenses depends on which type of toric lens you wear.
Daily disposable torics are said to be the most convenient when it comes to caring for
your contacts. They do not require any extra care products like solutions and cases.