Astigmatism and the performing arts professional
Being the UK’s only eye care specialists who work in the performing arts, we understand first-hand how eye disorders and refractive errors can negatively impact a career. This blog series aims to highlight common eye conditions that performers encounter. Musicians, presenters, dancers, camera operators, sound technicians and singers are just some of the performing arts professionals we’ve assisted to see the music.
Most vision problems can be attributed to refractive errors. Over 61 percent of people in the UK have some sort of vision problem that requires corrective action. Over 10 percent use contact lenses regularly, and more than half wear glasses.
The four most common types of refractive error are:
- Myopia or Short-sightedness. Myopia results from light focusing just short of the retina due to the cornea or the eyeball being too long.
- Hyperopia or Long-sightedness. Generally, hyperopia is a result of the eyeball being too short from front to back, or of problems with the shape of the cornea (the top clear layer of the eye) or lens (the part of the eye that helps the eye to focus).
- Presbyopia or Old Sight. Presbyopia is caused by a hardening of the eyes crystalline lens, which occurs with ageing. As our lenses become less flexible, they can no longer change shape to focus on close-up images.
- Astigmatism or rugby ball-shaped eyes. Astigmatism causes blurred distance and near vision due to a curvature abnormality in the eye. A person with astigmatism either has an irregular corneal surface or a lens inside the eye that has mismatched curves.
Astigmatism: An overview
Astigmatism can pose a major concern for some performing arts professionals. This article explores how performers can cope with Astigmatism and how it may be managed and treated. Astigmatic refractive disorders can have career-limiting consequences. Some conditions, such as keratoconus result in severe astigmatism which can distort a performer’s vision and sometimes leads to musculoskeletal problems.
Astigmatism can pose many challenges for performers, presenters, and musicians. Furthermore, the shape-changing nature of the condition not only presents a variety of challenges but also presents numerous obstacles.
What is astigmatism?
The first step to understanding astigmatism is to understand how the normal (non-astigmatic) eye works so that you can see clearly. As light enters the eye two of the eye’s most powerful structures bend the light rays onto the retina. The clear outer covering of the eye called the Cornea bends light rays before they pass further into the eye through the pupil. Next, the crystalline lens bends the light rays some more so that all the light rays come together (converge) to form a perfect focal point on the retina.
Astigmatism is a common refractive error that affects nearly two thirds of the population. Those with astigmatism have corneas that aren’t perfectly round. As a result of the Cornea’s non-symmetrical shape, light rays converge to more than one focal point. This can lead to blurred vision both up close and at a distance due to multiple focal points formed by light rays. There are five different types of astigmatism and it is possible to have both astigmatism and other refractive errors.
With all types of astigmatism light rays come together to form not one but two focal points. The mere fact that there are two focal points formed, instead of just one (in the normal seeing eye) creates vision problems.
The big 5
First Type – simple myopic astigmatism
Simple myopic astigmatism is characterised by light arriving at two focal points: one on the retina, one before it.
Second Type – simple hyperopic astigmatism
Second, simple hyperopic astigmatism has two focal points: one on the retina and the other behind the retina that would be a virtual point.
Third Type- Compound Myopic Astigmatism
The third is compound myopic astigmatism, which occurs when light meets two focal points, both before the retina, but at different locations before the retina.
Fourth Type – Compound Hyperopic Astigmatism
As Probably as you guessed, the fourth type of astigmatism is called compound hyperopia, which means that light strikes two focal points at once, both in a virtual location behind the retina.
In the fifth type of astigmatism, light is directed to two focal points, one of which is in front of the retina, the other at a virtual position behind.
#SeeTheMusic and more
Astigmatism is a shape-changing refractive disorder. Images appear stretched or sometimes have an unusual orientation. Some symptoms include:
- Vision that is blurry or distorted
- Night vision problems
Many people are born with Astigmatism, but experts don’t know why, although it does seem to be hereditary. The condition can also be caused by an eye injury, an eye disease, or surgery.
A condition called keratoconus can sometimes cause astigmatism by thinning and changing the shape of the clear front part of the eye (the cornea). Contact lenses will probably be needed often to wear at the same time as glasses.
Performers visual demands
Performers are required to use one or more of the following skills:
- Rapid changes in focus. Changing focus between objects at different distances rapidly and accurately is vision focusing. A musician, for instance, needs to read the music on the stand, look at the conductor and other members of the ensemble all at different distances clearly and accurately.
- Vision fixation: The ability to read sheet music, regardless of how fast its tempo.
- Peripheral vision: The ability to see and observe out of the corner of your eye when looking at a fixed object such as sheet music on the stand. In an orchestra, a player must be able to see both their stand partner or another member of their section even when they may be unable to alter their head position due to their instrument.
- Focusing regulation: The ability to retain eye coordination during high-speed activities or while under high physiological pressure.
The above demands can place a lot of pressure on the performer, especially when their vision isn’t up to par.
Effective treatment of Astigmatism
Astigmatism presents unique challenges when wearing spectacles due to the changes of orientation and image size and shape. Astigmatism is most commonly corrected by corrective spectacle lenses, which are curved to counteract the shape of the cornea or lens that’s causing blurred vision. If you look directly ahead, they are effective. Depending on how much correction you need, they might make the floor or walls look tilted.
This effect should go away as you get used to them. If you have severe astigmatism, it might take a week or so. Start by wearing the glasses first thing in the morning, for a few hours at a time, and adjusting slowly. If your vision doesn’t get better, go back and see your optometrist and dispensing optician.
You can also use contact lenses, but you’ll likely need toric contacts. You will still need prescription spectacles as you need to rest your eyes a couple of days a week. Over wearing contact lenses can cause more problems than it solves.
If you blink, all contact lenses will rotate. The soft toric lenses used for astigmatism are designed to return to the same spot each time.
If your astigmatism is severe, rigid gas-permeable contact lenses (RGP) can often provide a better correction. However, they are not as comfortable as the soft toric contact lenses and it takes time to build up your wear time.
Laser eye surgery
It is slightly more difficult to perform laser eye surgery to treat astigmatism than to treat myopia or hyperopia. This is because astigmatism requires correction in more than one place in the eye, due to the irregular curvature of the cornea or lens. Even so, it remains a relatively straightforward procedure that has a high success rate. In fact, it is thought that up to 90% of patients achieve 2020 vision, depending on the type of surgery they have.
In general terms laser eye surgery to correct astigmatism is divided into two types:
The laser epithelial keratomileusis (LASEK) procedure is similar to PRK, but involves softening the cornea with alcohol to remove a flap of tissue and reposition it afterward, and changing the shape of the cornea with a laser.
Laser in situ keratoplasty (LASIK) – this procedure is similar to LASEK, but the corneal flap is smaller. When it comes to treating hyperopia that is related to corneal contour, LASIK is quite effective. Most LASIK patients achieve a vision of 6/12 or better, which means they will no longer need glasses or contact lenses to see clearly on a daily basis. But you may still need help with sight reading. The likelihood of LASIK success has increased due to the development of wavefront scanning technology, so today’s LASIK patient can expect even better results.
The majority of these procedures are performed in an outpatient setting. The local anaesthesia numbs your eyes while the procedure is performed, which usually takes less than 30 minutes
LASIK and LASEK are typically the preferred methods owing to their painless nature, and because you can usually see again within a few hours or days after the procedure. As a word of caution, it can sometimes take up to a month for vision to stabilise.
Lens implant surgery
Lens implants are another option for treating hyperopia. A small incision is made in the cornea to implant an artificial lens into your eye to focus light more clearly onto the retina.
This procedure is suitable for those with extreme hyperopia or who struggle to wear glasses or contact lenses. Lens implants fall into two categories:
Phakic implants replace your natural lens without removing your natural eye lens; they are usually preferred by younger people with a normal natural vision for reading
Refractive lens exchange (RLE) is an operation similar to cataract surgery in which the natural lens is removed and replaced with an artificial one.
It is typically done under local anaesthesia, and the procedure can usually be done the same day. The procedure is usually done separately for each eye.
These treatments are beneficial to both performers and amateurs. They all, however, have limitations and side effects. As performers ourselves our unique perspective enables us to offer balanced, impartial advice.
Our optical specialists understand the demands of professional musicians and performing arts professionals. Working in collaboration with our dispensing opticians and optometrists, we are able to assist musicians. It is surprising how many musicians are unaware of the many solutions available to them.
With the precision of our performing arts eye exams, the expertise of our optometrists and dispensing opticians and their access to cutting edge diagnostic equipment and dispensing procedures our unique approach can help to resolve hyperopic performing arts practitioners vision problems.
Contact: To find out more about Allegro Optical, the musicians’ opticians go to; https://allegrooptical.co.uk/services/musicians-optical-services/