The effect of astigmatism axis on visual acuity



To evaluate the effect of astigmatism axis on uncorrected distance visual acuity (UDVA) in emmetropic eyes that underwent laser refractive surgery.


This retrospective study included patients who underwent laser in situ keratomileusis or photorefractive keratectomy between January 2000 and December 2015 at the Care-Vision Laser Centers, Tel Aviv, Israel. Eyes with a 3-month postoperative spherical equivalent between -0.5 D and 0.5 D were included in this study. Eyes with ocular comorbidities and planned ametropia were excluded. Study eyes were divided into 3 groups according to the steep astigmatic axis: with the rule (WTR) (60-120), oblique (31-59 or 121-149), and against the rule (ATR) (0-30 or 150-180). The UDVA of these 3 groups was compared. The oblique group was divided into oblique ATR and oblique WTR, which were compared with each other.


A total of 17,416 consecutive eyes of 8,708 patients were studied. The WTR eyes (n = 10,651) had significantly better UDVA (logMAR 0.01 ± 0.08) than the oblique (n = 3,141, logMAR 0.02 ± 0.09) and ATR eyes (n = 3,624, logMAR 0.02 ± 0.10) (p<0.001). The oblique WTR group had significantly better UDVA than the oblique ATR group (p<0.001). The UDVA of the oblique and ATR groups was similar. Stepwise multiple regression analysis showed that the group accounted for 15% of the UDVA variance (p = 0.04).


The astigmatic axis has a small but significant effect on UDVA in emmetropic eyes; WTR was better than oblique and ATR astigmatism. Therefore, when correcting astigmatism, it may be preferable to err towards WTR astigmatism.

Eur J Ophthalmol 2017; 27(3): 308 - 311




Michael Mimouni, Achia Nemet, Russell Pokroy, Tzahi Sela, Gur Munzer, Igor Kaiserman

Article History


Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.

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  • Department of Ophthalmology, Rambam Health Care Campus, Haifa - Israel
  • Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba - Israel
  • Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Israel
  • Care-Vision Laser Centers, Tel Aviv - Israel
  • Michael Mimouni and Achia Nemet contributed equally to this work.

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