Astigmatism: What Laser Eye Surgery Can and Can’t Correct

If you have been told you have astigmatism, you may have assumed laser eye surgery is not an option for you. It is actually one of the most common questions we hear:

“Can laser eye surgery fix astigmatism?”

In many cases, yes.

Laser eye surgery can treat astigmatism in suitable eyes, usually at the same time as correcting short-sight or long-sight. The important part is understanding what type of astigmatism you have, how strong it is and, most importantly, whether your cornea is suitable for treatment.

What is astigmatism?

Astigmatism is a common refractive error that can make vision look blurred or distorted at both distance and near.

A simple way to picture it is to think of the front of the eye. A cornea without significant astigmatism has a more evenly rounded curve. With astigmatism, the curvature is different in one direction compared with another. An eye with astigmatism is often described as being more rugby ball shaped than soccer ball.

Because the surface is not evenly curved, light entering the eye does not focus neatly at one point on the retina (the back of the eye). This can lead to blurry vision, eye strain, headaches and difficulty seeing fine detail, particularly at night.

Astigmatism commonly occurs alongside myopia (short-sight) or hyperopia (long-sight), which is why many glasses and contact lens prescriptions contain several numbers and signs (+ / -).

Can laser eye surgery correct astigmatism?

For many people with regular astigmatism, yes.

Laser eye surgery works by changing the shape of the cornea so that light entering it, can focus more accurately on the retina (inside back of the eyeball). Treatment is customised to your individual prescription and corneal measurements rather than applying the same correction to every patient.

At Insight Eye Clinic, the main laser vision correction procedures are SMILE, LASIK and PRK.

SMILE laser eye surgery can correct short-sight with astigmatism in suitable patients. It is a minimally invasive, flapless procedure and is our most commonly performed type of laser eye surgery.

LASIK can correct short-sight, long-sight and astigmatism in suitable eyes.

PRK can also correct patients with short-sight, long-sight and astigmatism. PRK may be recommended when corneal shape, thickness or other measurements make a surface laser treatment more appropriate.

The aim is not simply to “remove the astigmatism”. Your surgeon considers the entire prescription, corneal shape and thickness, eye health, age and the visual result you are hoping to achieve.

What can’t laser eye surgery correct?

This is where a thorough assessment becomes particularly important.

Laser eye surgery may not be suitable when astigmatism is irregular rather than regular. Irregular astigmatism can occur when the corneal surface is uneven because of conditions such as keratoconus, previous eye injury, corneal scarring or some previous eye procedures.

In these situations, reshaping the cornea with standard laser vision correction may not provide a sufficiently predictable or safe result.

There are also limits to how much corneal tissue can be safely removed. The higher the prescription, the more corneal tissue to be removed. A high level of astigmatism does not automatically rule out treatment, but corneal thickness, curvature and the overall prescription all need to be considered together.

Laser eye surgery also cannot prevent or slow down normal age-related changes to the eyes.

For example, presbyopia: the gradual loss of near focusing ability that usually becomes noticeable in your 40s, is a separate issue from astigmatism. Cataracts are also caused by changes to the natural lens inside the eye. Correcting astigmatism with laser does not stop either of these changes from occurring later.

What if I am not suitable for laser eye surgery?

Not being suitable for SMILE, LASIK or PRK does not necessarily mean there are no other options for reducing your dependence on glasses or contact lenses.

Depending on your age, prescription and eye health, alternatives such as an implantable contact lens (ICL) or refractive lens exchange (RLE) may be more appropriate. Most lens-based treatments incorporate astigmatism correction.

This is why it can be helpful to have an assessment at a clinic that offers multiple forms of refractive surgery. The most appropriate treatment can vary significantly from one person to another.

How do we know whether your astigmatism is suitable for laser treatment?

Your glasses prescription is only the starting point.

Before recommending laser eye surgery, detailed scans are required to map the shape of the cornea and assess factors including corneal thickness, curvature, prescription stability, eye history and overall eye health.

These measurements help your surgeon determine whether your astigmatism is regular, whether your cornea is structurally suitable for treatment and which procedure may provide the most appropriate visual outcome.

At Insight Eye Clinic, our refractive surgeons assess patients individually and offer SMILE, LASIK and PRK laser eye surgery, as well as ICL and RLE options when laser treatment is not the most suitable choice.

So, can you have laser eye surgery with astigmatism?

Yes – but the degree of the astigmatism and other factors matter too.

Having astigmatism alone does not mean you are unsuitable for laser eye surgery. In fact, astigmatism is routinely treated as part of modern laser vision correction.

The more important question is whether your particular prescription and eye measurements can be corrected safely and predictably.

If you are researching laser eye surgery in Perth and have astigmatism, a comprehensive suitability assessment can show you what options may be available for your eyes.

Insight Eye Clinic offers refractive surgery consultations at our Subiaco and Westminster clinics, with treatment recommendations based on your individual eye measurements, lifestyle and vision goals.