Does Astigmatism Get Worse Over Time?
Understanding Astigmatism and How It Affects Vision
Astigmatism occurs when the cornea or the internal lens of the eye has an irregular curvature. Instead of being shaped like a basketball with equal curves in every direction, the eye is shaped more like a football, with one meridian curving more steeply than the other. This uneven shape causes light to focus on multiple points rather than a single spot on the retina, resulting in blurred or distorted vision at all distances. According to the National Eye Institute and YouGov (2026), approximately 75 percent of adults in the United States need some form of vision correction, making refractive errors like astigmatism one of the most widespread eye health concerns.
Corneal astigmatism originates from the shape of the cornea, the clear front surface of the eye. Lenticular astigmatism comes from the curvature of the crystalline lens inside the eye. Most people have some combination of both, and each type can change independently over the years. Understanding which type you have helps our optometrist predict how your prescription may shift and which treatment options will work best for you.
During a comprehensive eye exam, astigmatism is measured in diopters and described by its axis, which indicates the angle of the steepest curvature. A measurement under 1.00 diopter is considered mild, 1.00 to 2.00 diopters is moderate, and anything above 2.00 diopters is significant. These numbers form the foundation of your glasses or contact lens prescription and serve as a baseline for tracking changes over time.
How Astigmatism Changes Throughout Life
Many children are born with some degree of astigmatism. In many cases, mild astigmatism in infants and toddlers decreases on its own during the first few years of life as the eye grows and the cornea becomes more symmetrical. However, if astigmatism persists or increases beyond age five or six, it is less likely to resolve without correction. Monitoring astigmatism in children is important because uncorrected astigmatism during critical visual development years can lead to amblyopia, sometimes called lazy eye.
For most people between their late teens and early forties, astigmatism tends to remain relatively stable. Small fluctuations of 0.25 to 0.50 diopters are common from one exam to the next and are generally not a cause for concern. However, a rapid or significant increase in astigmatism during this period may warrant further evaluation to rule out conditions like keratoconus, a progressive thinning and bulging of the cornea.
Studies consistently show that astigmatism tends to shift in a predictable way as you move through your forties, fifties, and beyond. The cornea gradually changes from having more curvature along the vertical meridian (called with-the-rule astigmatism) to having more curvature along the horizontal meridian (called against-the-rule astigmatism). This shift can cause noticeable changes in your prescription even if your overall amount of astigmatism does not increase dramatically. These changes are a normal part of aging and can be managed effectively with updated corrective lenses. You can learn more about how aging specifically affects this condition on our page about astigmatism and age.
As the crystalline lens inside the eye ages and develops cataracts, the lens itself can change shape in ways that either add to or partially offset your corneal astigmatism. You may notice your astigmatism prescription changing more frequently in the years leading up to cataract surgery. After cataract removal and lens implantation, astigmatism can be directly addressed with toric intraocular lenses or other surgical techniques.
Factors That Can Cause Astigmatism to Worsen
Keratoconus is the most significant eye condition associated with worsening astigmatism. In keratoconus, the cornea progressively thins and takes on a cone-like shape, producing irregular astigmatism that is difficult to correct with standard glasses. This condition typically begins in the teenage years or early twenties and can progress at varying rates. If your astigmatism is increasing rapidly, our eye doctor will evaluate you for early signs of keratoconus using corneal mapping technology.
Chronic, vigorous eye rubbing has been linked to corneal changes that can worsen astigmatism. The repetitive mechanical pressure on the cornea can thin the tissue and alter its curvature over time. This is one reason why our optometrist advises you to avoid rubbing your eyes, especially if you have allergies or dry eye, and to treat the underlying cause of irritation instead.
Surgical incisions on the cornea, whether from previous eye procedures or injury repair, can change the corneal shape and introduce or increase astigmatism. Even small incisions made during cataract surgery can produce minor shifts in astigmatism. Corneal scarring from infections or trauma can also create irregular astigmatism that may be more challenging to correct with glasses alone.
Certain eyelid conditions, such as a chalazion (a firm bump on the eyelid caused by a blocked oil gland) or chronic eyelid swelling, can press against the cornea and temporarily or permanently alter its curvature. Treating the eyelid condition typically allows the cornea to return to its prior shape, though long-standing pressure may leave residual changes.
Correcting and Managing Astigmatism at Every Stage
Glasses remain the simplest and most widely used way to correct astigmatism. Cylindrical lens power built into your prescription compensates for the uneven curvature of the eye. When your astigmatism shifts, updating your prescription is straightforward and does not require any recovery time.
Toric contact lenses are specifically designed to correct astigmatism. They have different powers in different zones of the lens and are weighted to stay properly oriented on the eye. Modern toric lenses are available in daily disposable, biweekly, and monthly replacement options. For higher or irregular astigmatism, specialty toric or scleral lenses may provide sharper, more stable vision than standard soft lenses.
If you want to reduce your dependence on glasses or contacts, laser vision correction procedures such as LASIK and PRK can reshape the cornea to correct astigmatism. These procedures are most appropriate when astigmatism has been stable for at least one to two years. Our eye doctor will review your corneal thickness, prescription stability, and overall eye health to determine if refractive surgery is a good fit for you.
The most effective way to stay ahead of changing astigmatism is to keep up with regular comprehensive eye exams. The American Optometric Association recommends exams every one to two years for adults at low risk and annually for those with risk factors (AOA Clinical Practice Guideline, 2023). Children, those with known corneal conditions, and anyone noticing vision changes should be seen more frequently. Routine exams allow our optometrist to track even small shifts and update your correction before they affect your daily life.
Take the Next Step for Your Vision
Astigmatism may change over the years, but with proper monitoring and the right correction, it does not have to hold you back from clear, comfortable vision. Regular exams give our optometrist the information needed to catch shifts early and adjust your prescription before they affect how you see day to day.
Whether you are due for a routine exam or have noticed a change in your vision, we are here to help you see your best. Contact us to schedule a comprehensive eye exam and get a clear picture of where your astigmatism stands today.
Frequently Asked Questions
In young children, mild astigmatism sometimes decreases as the eye grows and the cornea matures. In adults, astigmatism rarely resolves on its own, though the axis may shift in ways that feel like an improvement for some activities. You can read more about whether astigmatism can get better on its own for a deeper look at this topic.
Most adults with stable astigmatism should have a comprehensive eye exam every one to two years. If you notice increasing blur, eye strain, or headaches between visits, schedule an exam sooner. Those with progressive conditions like keratoconus may need exams every six to twelve months.
There is no strong evidence that screen time or prolonged near work causes astigmatism to increase. However, these activities can make the symptoms of uncorrected astigmatism feel more noticeable because they demand sustained visual focus. Wearing your prescribed correction while using screens can reduce eye strain and fatigue.
Genetics play a significant role in determining whether someone develops astigmatism. If one or both parents have astigmatism, their children are more likely to have it as well. However, the degree and progression of astigmatism are also influenced by environmental factors and individual eye anatomy.
Wearing an outdated or incorrect prescription does not cause the physical shape of the eye to change. However, it can lead to symptoms such as headaches, eye strain, and difficulty concentrating, which you may interpret as worsening astigmatism. The best approach is to keep your prescription current so your eyes are working as efficiently as possible.
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