Yes, you can have both conditions in the same eye. Myopia (nearsightedness) blurs distant objects because the eye is too long or the cornea curves too steeply. Astigmatism blurs or distorts vision at all distances because the cornea is irregularly shaped, like a football rather than a sphere. When both occur together, it is called myopic astigmatism, one of the most common refractive error combinations. A single pair of glasses or toric contact lenses can correct both at once.
What Is Myopia (Nearsightedness)
Myopia is a refractive error in which the eyeball is longer than average, or the cornea is excessively curved. Light entering the eye converges in front of the retina rather than directly on it. The result: nearby objects appear sharp, while anything at a distance looks blurry.
The American Academy of Ophthalmology classifies myopia by severity: mild (up to -3.00 diopters), moderate (-3.00 to -6.00 D), and high (greater than -6.00 D). High myopia carries greater risk of retinal complications over a lifetime.
A landmark meta-analysis of 145 studies by Holden et al., published in Ophthalmology, projected that by 2050, 4,758 million people (49.8% of the world’s population) will have myopia, with 938 million having high myopia. This represents more than double the 2000 prevalence of 1,406 million (22.9%). (Holden et al., 2016) The study was conducted in collaboration with the Brien Holden Vision Institute following a joint WHO-BHVI global scientific meeting on myopia, which formally recognized myopia as a public health priority.
In the United States, the National Eye Institute estimates that about 41.6% of Americans are currently nearsighted, up from 25% in the early 1970s.
What Myopia Patients Typically Describe
Patients with myopia usually notice the problem in school-age years: difficulty reading the board from the back of the classroom, squinting to see road signs while in the passenger seat, or struggling to recognize faces across a room. The near distance stays clear, which is why many myopic patients go undiagnosed until a routine eye exam.
Symptoms of Myopia
- Blurry vision for distant objects (signs, screens, faces across a room)
- Squinting to bring far objects into focus
- Headaches after extended time on activities requiring distance vision
- Eye strain or fatigue by end of day
Risk Factors
- Genetics: having one myopic parent roughly doubles the risk; two myopic parents raises it significantly further
- Time indoors: children who spend less time outdoors develop myopia at higher rates
- Sustained near work: extended reading, screen time, or studying without breaks is associated with faster progression in children and adolescents
- Age of onset: myopia that begins earlier in childhood tends to reach higher final prescriptions
What Is Astigmatism
Astigmatism occurs when the cornea (or, less commonly, the crystalline lens) has an irregular curvature. Rather than the uniform sphere of a normal eye, an astigmatic cornea is shaped more like an egg or a football: steeply curved in one meridian, flatter in another. This irregular shape prevents light rays from converging at a single focal point on the retina. Instead, two focal lines form, producing blurred or distorted vision at all distances.
According to the American Optometric Association, astigmatism is among the most common refractive errors and can exist alongside myopia or hyperopia in the same eye.
A 2023 systematic literature review in Optometry and Vision Science reported that astigmatism affects between 8% and 62% of the general population depending on the diagnostic threshold used, with an aggregate estimate close to 40% of adults globally when clinically relevant levels are considered. (Zhang et al., 2023, PMC10045990)
Corneal vs. Lenticular, Regular vs. Irregular
Astigmatism is categorized in two ways:
- By location: corneal astigmatism originates at the cornea (most common); lenticular astigmatism originates in the lens
- By regularity: regular astigmatism follows a consistent axis and corrects well with cylindrical lenses; irregular astigmatism, often caused by keratoconus or corneal scarring, cannot be fully corrected with standard lenses and may require specialty contact lenses or surgery
How Astigmatism Appears on Your Prescription
Every prescription that corrects astigmatism contains two additional values beyond the sphere (SPH):
- Cylinder (CYL): the power of astigmatism correction. A value of 0 means no astigmatism; any non-zero value indicates astigmatism present.
- Axis: a number from 1 to 180 that indicates the orientation of the cylinder correction. The lens must be positioned at this exact angle to work correctly.
To understand all the fields on your prescription, see our guide on how to read your prescription.
Symptoms of Astigmatism
- Blurry or distorted vision at all distances, near and far
- Difficulty distinguishing lines at certain orientations (letters like “H” or “T” may appear slightly warped)
- Halos or starbursts around lights at night, particularly around headlights or streetlights
- Eye strain and headaches, especially after reading or screen time
- Difficulty with low-contrast or low-light environments
Myopia vs. Astigmatism: Side-by-Side Comparison
This table covers the core differences. If you are trying to identify which condition you might have, note that these can and often do coexist.
| Feature | Myopia | Astigmatism |
|---|---|---|
| Primary cause | Eye too long or cornea too steep | Cornea or lens with irregular curvature |
| What is blurry | Distant objects | Objects at all distances |
| Near vision | Usually clear | May be blurry or distorted |
| Distortion of lines | No | Yes (straight lines may appear curved) |
| Night glare/halos | Uncommon | Common |
| Headaches | After sustained distance viewing | Frequent, in various situations |
| Prescription notation | Sphere (SPH) only, negative value | Sphere + Cylinder (CYL) + Axis |
| Corrective lens type | Diverging (concave) lens | Cylindrical (toric) lens |
| Can they coexist? | Yes, as myopic astigmatism | Yes, as myopic astigmatism |
Can You Have Both? Myopic Astigmatism Explained
Myopia and astigmatism frequently occur together. The anatomical features that elongate the eye (causing myopia) often accompany irregularities in corneal curvature (causing astigmatism). This combination is called myopic astigmatism.
There are two forms:
- Simple myopic astigmatism: one focal point lands in front of the retina (myopia), the other lands on the retina
- Compound myopic astigmatism: both focal points land in front of the retina, which is the more common form
What a Combined Prescription Looks Like
A prescription for someone with myopia and astigmatism in both eyes might read:
| OD (Right) | OS (Left) | |
|---|---|---|
| SPH | -3.25 | -4.00 |
| CYL | -1.50 | -0.75 |
| Axis | 170 | 015 |
The negative sphere values correct the myopia. The cylinder and axis values correct the astigmatism. A single lens handles both simultaneously. Understanding the cylinder and axis values in your prescription is important, especially for frame fitting and lens thickness calculations, because high cylinder lenses can be thicker and heavier than their sphere-only equivalents.
How Each Condition Is Corrected
The same three main approaches correct myopia, astigmatism, and myopic astigmatism. The choice depends on prescription strength, lifestyle, and patient preference.
Prescription Glasses
The most accessible option. For myopia, the lenses are concave (diverging); for astigmatism, they incorporate cylindrical power at the prescribed axis; for myopic astigmatism, both are combined in a single lens.
Patients with high cylinder values should be aware that lens thickness varies across the lens surface, which is why how prescription affects lens thickness matters for frame selection. Wide frames with a high cylinder prescription can produce noticeably thick edges. An index calculator helps estimate this before ordering. You can use a lens thickness calculator to estimate lens thickness based on your prescription and frame size.
See our guide on prescription lenses for a breakdown of lens materials, coatings, and how to match them to your prescription.
Toric Contact Lenses
Standard spherical contact lenses cannot correct astigmatism reliably because they can rotate freely on the eye. Toric lenses solve this with a stabilization mechanism that keeps the cylindrical correction aligned to the axis. They are available in soft daily, bi-weekly, and monthly disposable formats, as well as rigid gas-permeable (RGP) versions.
Toric lenses for myopic astigmatism correct both conditions simultaneously. The fitting process is slightly more involved than for standard contacts because the lens orientation must be verified by the practitioner.
Refractive Surgery (LASIK and PRK)
Both LASIK and PRK reshape the cornea using a laser to permanently correct the refractive error. Both procedures are effective for myopia, astigmatism, and myopic astigmatism.
A 2016 meta-analysis of 67,893 eyes with FDA-approved lasers found that 90.8% of patients achieved 20/20 or better vision and 99.5% achieved better than 20/40 vision after LASIK. (AAO EyeWiki)
| LASIK | PRK | |
|---|---|---|
| Visual recovery | 24-48 hours | 5-7 days |
| Post-operative discomfort | Minimal | Moderate for first few days |
| Preferred indication | Most patients | Thin corneas; contact sports athletes |
| Flap complication risk | Present (low) | None |
| Long-term results | Equivalent | Equivalent |
Candidacy requires stable prescription for at least one to two years, adequate corneal thickness, age 18 or older, and no active eye disease. An ophthalmologist determines candidacy after a full preoperative evaluation.
Why Accurate PD Measurement Matters More with High Cylinder
For glasses wearers, lens placement within the frame depends on pupillary distance (PD). When the optical center of a lens does not align with the pupil, an unwanted prismatic effect is induced. This follows Prentice’s Rule: the induced prism equals the power of the lens multiplied by the decentration in centimeters.
With high cylinder prescriptions, even a small alignment error introduces prism in the meridian of the cylinder. This can cause discomfort, spatial distortion, and visual fatigue that patients often misattribute to their prescription being wrong. Precise PD measurement methods are therefore especially important for patients with significant astigmatism. For practices offering online eyewear fitting, remote PD measurement tools provide the accuracy needed for cylinder corrections.
Myopia in Children: When to Act
Myopia that develops in childhood tends to progress while the eye is still growing, typically stabilizing in the mid-to-late 20s. Higher final prescriptions carry increased lifetime risk of retinal detachment, glaucoma, and myopic macular degeneration.
The American Academy of Ophthalmology recommends that children have a comprehensive eye exam before starting school, and annually thereafter if myopia is present or risk factors exist.
The following interventions have solid clinical evidence for slowing myopia progression. Efficacy figures below are drawn from a 2023 systematic review of 12 randomized controlled trials (PMC10076805) and the IMI 2025 Interventions report (PMC12448128), which note that axial elongation reduction is a more reliable outcome measure than percentage progression rates.
| Intervention | How It Works | Reported Efficacy | Typical Age Range | Notes |
|---|---|---|---|---|
| Low-dose atropine (0.01%-0.05%) | Nightly eye drops that slow axial elongation | 27%-67% reduction in progression depending on concentration | 6-14 years | Higher doses more effective; 0.01% shows rebound on discontinuation |
| Orthokeratology (Ortho-K) | Rigid gas-permeable lenses worn overnight; reshape cornea temporarily | Median 0.30 mm reduction in axial elongation over 2 years | 8-16 years | Requires nightly wear; risk of microbial keratitis if hygiene lapsed |
| Peripheral defocus spectacle lenses (MiYOSMART, Stellest, HAL) | Lens design creates peripheral defocus to slow eye growth | 67%-87% reduction in progression (DIMS/HAL studies) | 6-18 years | Non-invasive; compliance depends on consistent full-time wear |
| MiSight contact lenses | Soft daily disposables with defocus zones | 59% reduction in myopia progression; 52% reduction in axial elongation | 8-15 years | Daily disposables improve hygiene compliance |
| Outdoor time | Natural light exposure; mechanism not fully established | Protective for onset; effect on progression less quantified | All children | At least 1-2 hours/day recommended; no adverse effects |
For a detailed guide on intervention options, evidence levels, and age-specific considerations, see our article on myopia control.
Accurate measuring PD in children is part of fitting their first pair of glasses correctly, and precision matters as much as in adults. For information on contact lens options for older children and teens, see contact lenses for children.
Living with Myopia and Astigmatism
A common scenario in optical practice: A patient returns two weeks after collecting new glasses, complaining that the prescription “feels wrong” and walls appear to lean. Their sphere hasn’t changed, but the axis shifted 15 degrees from the previous prescription. The lenses check out correctly on the lensometer. The issue is adaptation: the brain is recalibrating to the new cylinder orientation. Experienced opticians recognize this pattern and can distinguish it from a genuine fitting error by comparing the new prescription to the previous one and confirming the optical center alignment. When in doubt, verifying PD and axis placement takes five minutes and prevents an unnecessary remake.
A few practical considerations for day-to-day life:
Night driving: Astigmatism is particularly disruptive at night. The irregular focal pattern creates starbursts and halos around headlights and streetlights. Wearing the correct prescription, including anti-reflective coating, significantly reduces this effect. If night glare is a concern even with corrected lenses, mention it at your next eye exam.
Screen use: Both conditions can contribute to eye strain during extended screen use. The 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds) remains practical advice. With astigmatism, fonts at certain sizes or orientations may cause more effort than expected. Adjusting screen brightness and contrast helps.
Lens care and frame adjustment: Glasses for astigmatism must sit consistently on the face. If frames slip down the nose or sit at an angle, the cylinder correction rotates out of its intended axis, reducing effectiveness. Regular frame adjustments matter more for high-cylinder prescriptions. For general guidance, see our eyewear care guide.
Blue light and screen glasses: Blue light glasses are sometimes marketed for digital eye strain. The evidence for reducing eye strain is limited, but anti-reflective coatings provide documented benefit for glare reduction. See our breakdown of blue light glasses for a balanced review.
When to See an Eye Care Professional
Myopia and astigmatism progress gradually. The following symptoms are not typical of these conditions and warrant prompt evaluation.
Seek urgent care (same day or ER) if you notice:
- Sudden vision loss in one or both eyes, even briefly
- New flashes of light in one eye, especially in a dark room
- A sudden increase in floaters (moving spots or threads in your vision)
- A dark curtain or shadow blocking part of your visual field
- Sudden double vision
- Severe eye pain with redness
These may indicate retinal detachment, vascular occlusion, or other ophthalmic emergencies where timing directly affects the outcome.
Routine exam schedule:
- Children: first comprehensive exam before school age; annually if myopia is present or progressing
- Adults (no complaints): every 1-2 years
- Adults with high myopia (-6.00 D or greater): annually, with focused evaluation of the retinal periphery
An ophthalmologist performs dilated fundus exams to assess retinal health, which is particularly important for high myopes. Routine visual acuity testing can track changes between comprehensive exams.
Frequently Asked Questions
Does astigmatism get worse over time?
In most adults, astigmatism is relatively stable. It may fluctuate slightly during childhood as the eye grows, and can change after corneal injury or surgery. Keratoconus, a condition where the cornea progressively thins and steepens, causes worsening irregular astigmatism and requires specialized monitoring and treatment. Routine eye exams every one to two years are sufficient to detect any meaningful changes.
Can LASIK fix both myopia and astigmatism?
Yes. LASIK and PRK both treat myopia and astigmatism simultaneously by reshaping the cornea with a laser. The procedure corrects the sphere (myopia) and the cylinder (astigmatism) in a single treatment. Candidacy depends on corneal thickness, prescription stability, and overall eye health, and is assessed during a preoperative evaluation with an ophthalmologist.
Do I need special frames if I have a high astigmatism prescription?
Not a special frame type, but frame selection matters. High cylinder prescriptions produce lenses that are thicker along one axis and thinner along another. Smaller, rounder frames minimize edge thickness and the optical distortion that comes with it. Your optician can calculate the expected lens thickness for any frame you are considering using your prescription and the frame dimensions. A lens thickness calculator can give you an estimate before you order.
Why do my glasses feel strange if I have astigmatism?
New glasses with a cylinder correction, or a change in the axis of correction, often cause a brief adaptation period. The brain must learn to process the new focal information. Floors and walls may appear slightly tilted or curved for the first few days. This usually resolves within one to two weeks. If significant distortion persists beyond two weeks, ask your optician to verify the optical center alignment and axis placement, as an error in frame fitting can mimic an adaptation problem.
Is astigmatism the same as lazy eye?
No. Lazy eye (amblyopia) is a developmental condition where the brain suppresses input from one eye, reducing visual acuity that cannot be fully corrected with lenses alone. Astigmatism is a refractive error caused by corneal shape. However, uncorrected astigmatism in one eye during childhood can contribute to the development of amblyopia if the brain learns to prefer the other eye. This is one reason early diagnosis and correction in children matters.
Can I wear regular contact lenses if I have astigmatism?
Standard spherical contact lenses do not correct astigmatism reliably because they can rotate on the eye, shifting the correction away from the intended axis. Toric contact lenses are specifically designed to stay oriented correctly on the cornea, providing stable cylinder correction. They are available in daily, bi-weekly, and monthly formats and can correct myopia and astigmatism simultaneously.
How does having both conditions affect my prescription?
A prescription for myopic astigmatism will show a negative sphere value (correcting the myopia) plus cylinder and axis values (correcting the astigmatism). Both are corrected by a single lens. The combined prescription is no more complex to fill than either condition alone, though high values in both sphere and cylinder can affect lens thickness and frame selection.
The Content Above Is Educational, Not Medical Advice
This article explains myopia and astigmatism based on published clinical data and is intended for patients and eyecare professionals seeking a reference overview. It does not replace a comprehensive eye examination. If you have concerns about your vision or a diagnosis, consult a licensed optometrist or ophthalmologist.
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