Effect of Uncorrected Astigmatism on Vision

PURPOSE: To examine the effect of uncorrected astigmatism in older adults.

SETTING: University Vision Clinic

METHOD: Twenty-one healthy presbyopes, aged 58.9±2.8 years, had astigmatism of 0.0 to -4.0 x 90DC and -3.0DC of cylinder at 90, 180 and 45 induced with spectacle lenses, with the mean spherical equivalent compensated to plano, in random order. Visual acuity was assessed binocularly using a computerised test chart at 95%, 50% and 10% contrast. Near acuity and reading speed were measured using standardised reading texts. Light scatter was quantified with the cQuant and driving reaction times with a computer simulator. Finally visual clarity of a mobile phone and computer screen was subjectively rated.

RESULTS: Distance visual acuity decreased with increasing uncorrected astigmatic power (F=174.50, p<0.001) and was reduced at lower contrasts (F=170.77, p<0.001). Near visual acuity and reading speed also decreased with increasing uncorrected astigmatism power (p<0.001). Light scatter was not significantly affected by uncorrected astigmatism (p>0.05), but the reliability and variability of measurements decreased with increasing uncorrected astigmatic power (p<0.05). Driving simulator performance was also unaffected by uncorrected astigmatism  (p>0.05), but subjective rating of clarity decreased with increasing uncorrected astigmatic power (p<0.001). Uncorrected astigmatism at 45 or 180 orientation resulted in a worse distance and near visual acuity, and subjective rated clarity than 90 orientation (p<0.05).

CONCLUSION: Uncorrected astigmatism, even as low as 1.0DC, causes a significant burden on a patient’s vision. If left uncorrected, this could impact significantly on their independence, quality of life and wellbeing.


Publication date

April 16, 2015


JAMA Ophthalmology

Sponsor Institution



James S. Wolffsohn, PhD, Gurpreet Bhogal, BSc and Sunil Shah, MD
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