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Irregular Astigmatism

Wang Vision 3D Cataract and LASIK Center, Nashville, Tennessee

Dr. Wang's textbook on astigmatism, irregular astigmatism, astigmatism treatment, LASIK complications, PRK complications, RK complications, blurred vision, night glare, double vision, premium IOL complications after cataract surgery, LASIK surgeon, Nashville, Tennessee (TN)

Irregular Astigmatism, by Dr Ming Wang, Nashville Tennessee laser cataract and LASIK Surgeon

Since the advent of keratorefractive surgery and its rising popularity, irregular astigmatism has become an increasingly important issue for ophthalmologists and optometrists. Despite the success of LASIK and PRK, there are more and more patients experiencing visual quality problems due to the non-physiological modification of the corneal structure. Among these complications, irregular astigmatism is perhaps the most difficult to treat.

The first of its kind, Irregular Astigmatism: Diagnosis and Treatment synthesizes our knowledge and understanding of irregular astigmatism and addresses state-of-the-art technology in management and treatment. Dr. Ming Wang, assisted by Dr. Tracy Swartz, has led a team of internationally known experts in the field to produce this innovative, comprehensive, and logically presented text, which includes more than 300 illustrations to supplement the information provided.

Inside you will find:

  • History and optics of regular and irregular astigmatisms
  • Useful criteria for diagnosis and classification
  • Current state-of-the-art technologies for treatment
  • Suggestions for future direction in treatment technology

Every physician who performs keratorefractive surgery understands that in reducing a patient’s refractive error, there is a possibility of creating irreversible effects on visual quality. Irregular Astigmatism: Diagnosis and Treatment is intended to help prevent and reduce the iatrogenic creation of irregular astigmatism, as well as provide effective treatment when postoperative complications do arise.

Complications discussed include:

  • Decentered treatment
  • Small optical zone
  • Central island
  • Oblate cornea
  • Destablized cornea

In addition, this text systematically separates two distinctly different etiological groups of irregular astigmatism—that of a structurally stable cornea and that of a structurally unstable weak cornea—and comprehensively presents all treatment modalities for each.

Treatment technologies addressed include:

  • UV corneal cross-linking
  • Intacs intracorneal rings
  • Penetrating and lamellar keratoplasties
  • C-CAP
  • Custom wavefront- and topography-driven treatments
  • Lens surgery and toric IOL
  • Conductive keratoplasty

With the maturation of keratorefractive technology in recent years, effective treatment for iatrogenic irregular astigmatism is quickly developing. Irregular Astigmatism: Diagnosis and Treatment provides everything refractive surgeons, ophthalmologists, and optometrists need to know about this important topic.


About the Editors
Contributing Authors

Chapter 1: Introduction: A Brief History of Astigmatism
R. Dax Hawkins, MD
Chapter 2: Ocular Components of Regular and Irregular Astigmatism
Doug Horner, OD, PhD and Larry Thibos, PhD
Chapter 3: Corneal Biomechanics
Sandeep Kakaria, MD; Tracy Schroeder Swartz, OD, MS, FAAO;
and Ming Wang, MD, PhD
Chapter 4: Evaluation of Irregular Astigmatism With Artemis VHF
Digital Ultrasound Scanning
Dan Z. Reinstein, MD, MA(Cantab), FRCSC, DABO, FRCOphth;
Timothy J. Archer, MA(Oxon), DipCompSci(Cantab);
and Ronald H. Silverman, PhD
Chapter 5: Clinical Evaluation of Regular and Irregular Astigmatism
Dhivya Ashok Kumar, MD; Soosan Jacob, MS, FRCS, DNB, MNAMS;
Athiya Agarwal, MD, DO; and Amar Agarwal, MS, FRCS, FRCOphth
Chapter 6: Keratoconus and Pellucid Marginal Degeneration: Etiology and
Clinical Presentations of Irregular Astigmatism
Judy I. Ou, MD and Christopher N. Ta, MD
Chapter 7: Nonectatic Corneal Problems Causing Irregular Astigmatism
Tracy Schroeder Swartz, OD, MS, FAAO; Michael Duplessie, MD;
Wuqaas Munir, MD; Jeremy Kieval, MD; and Ming Wang, MD, PhD
Chapter 8: Etiology and Clinical Presentations of Irregular Astigmatism After Keratorefractive Surgery
J. Bradley Randleman, MD
Chapter 9: Etiology and Clinical Presentation of Irregular Astigmatism
in Other Surgical Settings
Wuqaas M. Munir, MD and Jeremy Kieval, MD
Chapter 10: Nonsurgical Treatment for Irregular Astigmatism: Contact Lens Options
Heidi Wagner, OD, MPH and Stephen P. Byrnes, OD
Chapter 11: Principles of Surgical Treatment for Irregular Astigmatism: An Overview
Jorge L. Alió, MD, PhD
Chapter 12: Indications for Penetrating Keratoplasty for Irregular Astigmatism
Scott G. Hauswirth, OD; David R. Hardten, MD, FACS;
and Elizabeth A. Davis, MD
Chapter 13: INTACS Implantation
Tracy Schroeder Swartz, OD, MS, FAAO; Brian S. Boxer Wachler, MD;
and Ming Wang, MD, PhD
Chapter 14: Lamellar Keratoplasty
Michael Duplessie, MD
Chapter 15: Corneal Cross-Linking With Riboflavin and Ultraviolet Irradiation
in Unstable Corneas With Progressive Irregular Astigmatism
Mirko R. Jankov II, MD, PhD and Ronald R. Krueger, MD, MSE
Chapter 16: Treating Stable Corneas: Wavefront-Guided Treatment for Irregular Astigmatism
Regina Sun, MD; David R. Hardten, MD; Richard L. Lindstrom, MD; and
Elizabeth A. Davis, MD
Chapter 17: Photorefractive Keratectomy for the Correction of Corneal Irregular Astigmatism
Lee T. Nordan, MD and Lawrence Chao, MD
Chapter 18: Phototherapeutic Keratectomy for Irregular Astigmatism With and Without Modulators
Eric C. Amesbury, MD, FACS and Richard A. Eiferman, MD, FACS
Chapter 19: Treating Stable Corneas: Combined Consideration of Wavefront and
Topography-Guided Treatment
Noel Alpins, FRANZCO, FRCOphth, FACS and
George Stamatelatos, BScOptom
Chapter 20: Irregular Astigmatism: WaveLight Allegretto Wave Topography-Guided
Customized Ablation Treatment
Mirko R. Jankov II, MD, PhD and Aleksandar Stojanovic, MD
Chapter 21: Irregular Astigmatism: LaserSight Ellipsoid Model and Topography-Driven
Aspheric Treatment
David D. Liu, PhD; David Santiago, OD; Liangcheng Wu, MD;
Bing Liu, MD; Li Zhen, MD; Zhengjun Fan, MD; Junhua Xiao, MD;
Tracy Schroeder Swartz, OD, MS, FAAO; and Ming Wang, MD, PhD
Chapter 22: Treatment of Irregular Astigmatism: Developing an Ideal Corneal Surface
With the iVIS Suite
Aleksandar Stojanovic , MD and Mirko R. Jankov II, MD, PhD
Chapter 23: Topography-Guided Ablation With the Carl Zeiss Meditec MEL80 and
CRS Master
Dan Z. Reinstein, MD, MA(Cantab), FRCSC, DABO, FRCOphth; Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); and Marine Gobbe, MST(Optom), PhD
Chapter 24: Irregular Astigmatism: Custom-Contoured Ablation Pattern Treatment
Weldon W. Haw, MD and Edward E. Manche, MD
Chapter 25: Correcting Irregular Astigmatism After LASIK
John P. Berdahl, MD; Anthony N. Kuo, MD; Terry Kim, MD;
and Roy S. Rubinfeld, MD
Chapter 26: Management of Astigmatism During Lens-Based Surgery
Elizabeth Yeu, MD and Jonathan B. Rubenstein, MD
Chapter 27: Conductive Keratoplasty Treatment for Astigmatism
Soosan Jacob, MS, FRCS, DNB, MNAMS; Dhivya Ashok Kumar, MD;
Athiya Agarwal, MD, DO; and Amar Agarwal, MS, FRCS, FRCOphth
Chapter 28: Principles of Surgical Treatment of Irregular Astigmatism in Unstable Corneas
Arun Gulani, MD
Chapter 29: Asymmetrical Surgical Treatment Using Vector Planning
Noel Alpins, FRANZCO, FRCOphth, FACS and George Stamatelatos, BScOptom
Chapter 30: Optimal Treatment of the Normal Cornea: Topographically-Guided
LASIK for Myopia Using the NIDEK Customized Aspheric Treatment Zone
George Waring, MD, FACS, FRCOphth; Paul J. Dougherty, MD;
Barbara Fant; Arturo Chayet, MD; Jeffery Fischer, MD; and
Harkaran S. Bains
Chapter 31: Future Direction: Technological Development and Treating the Problem at Its Source
Ming Wang, MD, PhD


“Ming Wang’s new textbook, Irregular Astigmatism: Diagnosis and Treatment, provides a comprehensive guide for the management of induced aberrations following refractive surgery. This reference text belongs in the library of anyone who treats or manages refractive surgery patients.”

—-Dr. John A. Vukich, Dean Medical Center, Madison, WI .

“Irregular astigmatism remains a significant challenge in the daily practice of the corneal/refractive surgeon. In the book Irregular Astigmatism: Diagnosis and Treatment, Editor Ming Wang has compiled a comprehensive offering regarding the current state of our knowledge in this challenging area. The book is comprehensive and well written, deserving the attention of all active clinicians.”

—Dr. Richard L. Lindstrom, Minnesota Eye Consultants, P.A., Bloomington, MN .

“It is our moral obligation as physicians to help those who have irregular astigmatism after LASIK, PKP, PRK, RK, corneal injury, or corneal infection. Dr. Wang’s book is a big step in the right direction toward treating these patients.”

—-Dr. Marguerite McDonald, Ophthalmic Consultants of Long Island, Lynbrook, NY .

“Dr. Wang and his co-authors propose solutions for a problem that plagues all refractice surgeons: the management of the patient with an irregular cornea that is present either before surgery or as a result of excimer laser surgery.”

—--Dr. George O. Waring III, In View, Atlanta, GA .

“Irregular astigmatism is likely the most important yet most misunderstood condition in corneal refractive surgery. Congratulations to Dr. Wang for writing this book about such a crucial topic.”

—--- Dr. Stephen Slade, The Laser Center, Houston, TX .

“The book is well organized and comprehensive, covering all aspects of the diagnosis and management of astigmatism…Irregular Astigmatism can be one of the most frustrating conditions in an anterior segment surgeon’s practice and compiling all aspects of this problem in a single text is a worthy objective, clearly met by the authors..The author is clearly an authority on the subject…This book will be a tremendous addition to the library of all anterior and refractive surgeons as a reliable and readable source of information on this challenging subject.”

—Stephen E. Orlin, MD (Scheie Eye Institute), Doody Enterprises, Inc.

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