What causes sudden astigmatism?

[Bubbles19822002]

Hi there, I had my last eye test around 6 months ago.  My left eye was -2.75 and had no astigmatism.  6 months later and I noticed one morning that my vision seemed noticeably blurry in one eye.  When I went to the opticians I could read no further than the second line with my left eye with glasses on.
The test results for my left eye were now -4.00, and astigmatism is -1.50. Axis 47.5  Optician has referred me for an investigation as to whether I could have keratoconus. Is this what happens with it? I am 35.  I have previously been referred for the other eye as the same thing happened but after corneal topography they decided that I didn't have it.  Any thoughts?

[John C Hagan III, MD, FACS, FAAO]

Astigmatism means aspheric  so the cornea is no longer round. If your cornea toprography is normal and you don't have K conus then 'its just one of those things"  like a growth spurt in a child. Or cornea changes shape over our lifetime usually developing plus cylinder astigmatism at 180 degrees

[Bubbles19822002]

Thank you.  Is the axis of 47.5 of any significance?  As  you say it usually develops at 180 degrees?

[John C Hagan III, MD, FACS, FAAO]

No not of any significance. Axis varies between 0 and 180 degree. No clinical significance.

[Bubbles19822002]

Thanks for your help.  Appreciate it.  Have a good evening.

[John C Hagan III, MD, FACS, FAAO]

You to

[Bubbles19822002]

It is almost three months since I wrote last and I am still waiting to be seen but I have noticed that the vision in my left eye has got significantly worse again.  Bearing in mind I got a new lens for it around two months ago and at first it was my stronger eye with spectacles on, now I am struggling to see again.  Things are blurry.  Does this sound like kerataconus - can it progress this quickly or do I need to go back to optician to see if he can hurry me being seen with a specialist?

[JohnHaganMD]

I can’t tell what the problem is. Certainly you need to see the specialist ASAP.  How you fight your way through your health care system varies from country to country.

[Bubbles19822002]

Thank you so much for getting back to me.  I have spoken to my doctor who recommends that I see an optician tomorrow and ask for an urgent referral as my eyesight has deteriorated so much, so quickly. I am also having pain when I move my head behind my eye.  I will let you know when I get answers.  Thank you again and have a good evening.

[JohnHaganMD]

Best of luck

[Bubbles19822002]

I've been back today and she said that my astigmatism has doubled again and I now need a new lens for my spectacles again.  She says she would now give the diagnosis of Kerataconus as she can also see a scissor reflex in my eye.  My eyesight can now no longer be fully corrected with glasses and she said I can pay privately for special contact lenses to be made for my eye, if I don't want to wait for NHS. What are your thoughts on this?  She has also written another letter to the hospital.  

[John C Hagan III, MD, FACS, FAAO]

I have no ideal your financial status or the costs of going private.  You need to be under the care of an Eye MD ophthalmologist that specializes in cornea disease. There is a new treatment for K-conus called cornea cross-linking that drips riboflavin on cornea then exposes it to a special light. It make the cornea stronger and less likely to bow out in a cone shaped.  Try and find one that does that procedure. Otherwise you are looking at wearing hard contacts the rest of your life.

[Bubbles19822002]

Thank you so much for this info.  I have telephoned the hospital and they have told me that there is another three months to wait before I am seen.  Is this an acceptable time to wait given how fast I am deteriorating or should I as you say look in to private.  Can't afford it really but will have to look in to all options.

[John C Hagan III, MD, FACS, FAAO]

If you do have K-conus 3 months is not that long of a wait especially if you can't afford to go private.

[Bubbles19822002]

Thank you so much for your input.  I will wait then.  

I must say I think you are fantastic!  What a wonderful person dedicating so much time to helping people.   Thanks once again! :)

[John C Hagan III, MD, FACS, FAAO]

You are welcome.  Happy to help

[Bubbles19822002]

I paid privately in the end as my vision was deteriorating so much and the specialist said that I have cataracts in both my eyes - a mixture of congenital dot cataract and nuclear sclerotic cataract.  He done a corneal topography scan and said although there is some steepening it is not enough for him to be able to diagnose keratoconus or possible pellucid marginal degeneration at the moment, he wants to watch and see what happens.    I will see him for a follow-up in 6 months and he said depending on my vision he thinks it likely that I will probably need cataract surgery in about 12-18 months.  Should my usual optician have been able to see the cataracts? I am puzzled.  Thanks for your help.

[John C Hagan III, MD, FACS, FAAO]

I don't know where you live.  In the USA  a non-medical health eye professional is an 'optometrist" and a Eye MD is an 'optometrist"  I think someplace maybe UK they call Eye MD optician  (In the states an optician is someone that makes glasses with no medical skills at all. In any case both an optometrist and an ophthalmologist should be able to see a cataract.

[Bubbles19822002]

Thank you.  One last question, if I have a conjenital dot cataract does that mean that I was born with it? If my reading is correct, I think sometimes they don't become apparent until the 2nd to 4th decades of life.  Is it usual to have a mixture of types of cataracts? I guess I am quite young to have them too at 36? Thanks so much.

[John C Hagan III, MD, FACS, FAAO]

Last answer. "Congenital" means present at birth. If not present at birth it's not 'congenital"   Most people that have cataract surgery have more than one type. The most common types are: nuclear, cortical and posterior-subcapsular.