Does Astigmatism Get Worse with Age?

Many infants are born with moderate corneal astigmatism that tends to decrease naturally during the first one to two years of life. By school age, astigmatism usually stabilizes, though it can still change as the eyes grow. Children with higher levels of astigmatism that do not resolve on their own may need glasses to prevent amblyopia and support healthy visual development. Regular pediatric eye exams are important for detecting changes early.

For most people, astigmatism remains relatively stable during young adulthood. Corneal curvature changes slowly, and any shifts in prescription tend to be minor. However, certain conditions like keratoconus, which causes progressive thinning and steepening of the cornea, can produce rapidly increasing astigmatism during this period. If your prescription is changing frequently in your 20s or 30s, our eye doctors may recommend additional testing to rule out corneal irregularities.

In your 40s and 50s, astigmatism often begins to shift more noticeably. Research shows that with-the-rule astigmatism, where the steeper corneal curve runs vertically, gradually transitions toward against-the-rule astigmatism, where the steeper curve runs horizontally. This transition happens because the horizontal meridian of the cornea tends to steepen with age while the vertical meridian flattens. At the same time, changes within the crystalline lens can alter lenticular astigmatism, adding another layer of change to your overall prescription.

After age 60, the shift toward against-the-rule astigmatism typically continues and may accelerate. Studies have found that total astigmatism increases in magnitude for many older adults, meaning your glasses or contact lens prescription may need more frequent updates. Cataract development also plays a role during this period, as the aging lens can introduce or worsen lenticular astigmatism. Once cataracts are removed, your surgeon can address residual astigmatism using specialized intraocular lenses or other techniques.

In some cases, yes. Because the cornea naturally shifts from with-the-rule to against-the-rule astigmatism over time, and the crystalline lens compensates in different ways, some people find that their overall astigmatism temporarily decreases during certain periods of life. However, this is not guaranteed, and most adults experience a gradual increase in astigmatism after age 50. Our eye doctors monitor these changes at each exam to keep your prescription current. You can learn more about whether astigmatism can improve without treatment.

Adults with stable astigmatism should have a comprehensive eye exam at least every one to two years. If you are over 60, have a rapidly changing prescription, or have additional eye conditions, annual exams are recommended. Children with astigmatism may need more frequent monitoring to ensure their vision is developing properly and their correction remains adequate.

There is no strong evidence that screen time or prolonged near work directly increases astigmatism. These activities can contribute to eye strain and dry eye symptoms, which may make existing blurry vision feel worse, but they do not reshape the cornea. Practicing good visual habits, including taking regular breaks and maintaining appropriate screen distance, helps reduce discomfort.

Genetics plays a significant role in determining corneal shape, and astigmatism does tend to run in families. If one or both parents have astigmatism, their children are more likely to develop it as well. However, environmental and developmental factors also influence corneal curvature, so having a family history does not guarantee a specific level of astigmatism.

No. Wearing or not wearing corrective lenses does not change the shape of your cornea or lens. Glasses and contacts correct how light enters your eye but do not alter the underlying anatomy. However, going without correction when you need it can cause eye strain, headaches, and difficulty with daily tasks, so wearing your prescribed correction is recommended for comfort and safety.

LASIK can effectively correct astigmatism at the time of surgery, and the corneal reshaping is permanent. However, because the eye continues to change with age, some patients may develop new astigmatism years after surgery due to natural corneal and lens changes. This does not mean the original surgery failed. If needed, an enhancement procedure or updated glasses can address any new changes that develop over time.