Astigmatism Management

What is Astigmatism?

It is an abnormality in which the optical surfaces of the eye are shaped like a football (oval) rather than a baseball or basketball (round). Astigmatism is the most common optical problem after myopia (nearsightedness) and hyperopia (farsightedness).

How Does Astigmatism Affect Vision?

When it is uncorrected, astigmatism blurs vision at all distances, near and far.

Is Astigmatism Correction Something New?

No, we have been correcting astigmatism at the time of cataract surgery (and other eye operations) for years. Medicare and private health insurance plans do not cover it.

How Do I Know if I Have Astigmatism?

There is no way if knowing without specific testing. Overall, astigmatism is approximately the sum of what is in the cornea and what is in the lens. Cataract surgery eliminates the lens component of astigmatism. Any amount remaining in the cornea will contribute to reduced image quality without glasses following surgery. Some people have no astigmatism in the eyeglass measurements, yet they have astigmatism in their corneas. The only way of knowing if corneal astigmatism is present is to test for it.

What if I Have No Astigmatism or Only a Small Amount?

Knowing there is little or no corneal astigmatism is just as important as knowing there is a lot because it determines how and where we make the incision.

How is Astigmatism Corrected?

There are three methods. The first involves placing one or more incisions in the steep axis of the peripheral cornea. The second involves modifying the length, depth, and number of the incisions. The third involves implanting a special intraocular lens, called a toric lens. The latter two approaches can be combined to achieve high amounts of astigmatism correction if necessary.

What if I Don’t Have it Corrected?

If you have residual astigmatism after surgery, there is a greater chance you will need glasses or contact lenses to see clearly. Your astigmatism can easily worsen after surgery if it is not measured before surgery and managed appropriately during surgery.

Are There Other Options?

The only other option is to perform your eye surgery without astigmatism correction and evaluate your astigmatism afterward. Astigmatism can be corrected secondarily if you don’t like the initial result. However, this will require a second trip to the operating room, which will not be covered by Medicare or other health insurance. In this case, the cost will be 3 to 4 times higher than if you opted for astigmatism correction during the initial surgery. We are able to discount the cost at the time of initial surgery because we are already in the operating room.

Will I Need Astigmatism Correction in Both Eyes?

Probably. The two eyes are often a little different. We evaluate them independently.

Will I See 20/20 if my Astigmatism is Corrected?

We hope so, but as with all surgery, we cannot guarantee outcomes. There are many variables that affect visual outcomes besides astigmatism (the power of the lens implant, the health of your retina and optic nerve, etc.). The odds of achieving 20/20 visual acuity without glasses or contact lenses are much better if we evaluate and correct your astigmatism than if we don’t.

Is it Recommended for Every Patient?

If your potential vision is good, you should have your astigmatism evaluated and managed. Only if your potential vision is poor (because of advanced macular degeneration or some other eye problem), will correcting astigmatism not be as beneficial.

Should I Have My Astigmatism Treated if My Visual Potential is Poor?

It depends on your eye condition. If you won’t be able to see the big “E” in the eye chart after eye surgery, it really will not help that much to have your astigmatism corrected.

Should I Have My Astigmatism Treated if I am Having Surgery in One Eye Only?

Yes. Your overall vision without glasses will be better even if only one eye is corrected.

What if My Astigmatism is Not Fully Corrected at the Time of Surgery?

You will still need glasses for best distance and near vision. Even if your astigmatism is not fully corrected the quality of your uncorrected vision will be better if your astigmatism can be reduced by any amount.

Will I Need Reading Glasses if I Have My Astigmatism Corrected?

Yes, if you are implanted with a monofocal lens and you opt for distance vision. If you opt for near vision with a monofocal lens you probably will not need reading glasses, but you will need glasses to see clearly for distance. If you opt for a multifocal lens implant you may be able to see clearly in the distance and at near without glasses.

Are There Any Risks or Side Effects?

The only significant risk is that we won’t be able to correct all of your astigmatism and you will need glasses or contact lenses for best vision.

Can I Have Surgery if I Decide Not to Have My Astigmatism Treated?

Yes, you can, but this may result in a less-than-optimal result. State-of-the-art cataract surgery and lens implant surgery involve correcting refractive errors at the time of surgery.

Does Insurance (or Medicare) Pay for Astigmatism Correction?

No, Medicare and other health insurance plans will not pay to reduce corneal astigmatism that exists at the time of cataract surgery.

Why Doesn’t Insurance (or Medicare) Pay for Astigmatism Correction?

Medicare sets trends for the insurance industry. Since Medicare distinguishes between what is medically necessary and what is cosmetic, or purely optional, we are required to handle the cataract removal and astigmatism management differently from the perspective of who pays. Medicare and private health insurers reimburse for cataract surgery. They do not pay for the refractive surgery, which is necessary for astigmatism correction.

Can I Submit the Bill to Insurance (or Medicare) for Reimbursement After I Pay?

Yes, you can, but they will deny payment. If Medicare or an insurance company ask our office for justification for the astigmatism management, we will inform them that the astigmatism correction was done for non-medical or cosmetic reasons.

What do You Charge for Astigmatism Management Service?

Refractive cataract surgery is more involved than cataract surgery alone. It is costly and requires significantly more work to plan and perform than routine cataract surgery.

What is Included in the Astigmatism Management Charge?

There are three components. First, we measure the amount of astigmatism in your cornea by obtaining a corneal topography map before and after surgery. The second component is astigmatism evaluation and surgical planning. This is a cognitive component that accounts for the bulk of the work. The third component is the surgical management. Astigmatic correction requires additional surgical steps. This part is relatively straightforward once the measurement and planning steps have been done.

Why is it That My Friends Who Have Had Surgery Don’t Mention Astigmatism Management?

Many ophthalmologists do not plan for specific refractive outcomes. Dr. McMickle has spent years refining surgical techniques to optimize uncorrected visual acuity. He has developed protocols for the surgical correction of astigmatism. Dr. McMickle believes that correcting astigmatism during cataract surgery is important to achieve the best results. We can’t promise you that you won’t need glasses after surgery, but we will do our best to reduce your dependence on them.

Does it Require Additional Visits?

No, not typically.

Can I Make Payments?

We do have a payment plan. We accept credit cards and participate with CareCredit – patient financing if you opt to pay by this means.

Can I Receive a Refund if My Astigmatism is Not Fully Corrected?

No. As with any surgery, results are subject to individual healing patterns and a host of variables beyond our control. Generally speaking, if the amount if astigmatism remaining in the cornea after surgery is less than 1 diopter, a 20/20 uncorrected postoperative result is possible, barring any other ocular pathology. No guarantees can be made with respect to the final result.

When do I Have to Decide?

We would like you to decide at the time of the scheduled preoperative visit. At a minimum, you will need to let us know a few days before surgery. We need time to plan the surgery and obtain the lens implant.

What do I do if I Want the Astigmatism Management Service?

You should contact Southwestern Eye Associates and make an appointment today!