Refractive surgery: Paris & Cachan
Astigmatism Surgery in Paris & Cachan: LASIK, PRK, SMILE, Toric Implant
Laser correction of astigmatism (LASIK, PRK, SMILE) or toric implant in Paris 13 and Cachan. Dr Tourabaly, ophthalmologist.
Understanding the condition
What is astigmatism?
Astigmatism is a refractive error caused by a non-spherical corneal (or lenticular) curvature. Instead of being perfectly round like a soccer ball, the cornea has two meridians with different curvatures, resembling a rugby ball. This asymmetry means that the image received by the retina is distorted both at a distance and up close.
There are two main forms:
- Regular astigmatism: the two meridians are perpendicular. This is the most common form, correctable with glasses, toric lenses or refractive surgery.
- Irregular astigmatism: the meridians are not perpendicular, often linked to keratoconus, a corneal scar or previous surgery. Correction is more complex, sometimes via rigid lenses or a corneal graft.
Causes and symptoms
Astigmatism is most often congenital and stable over time. It can also be acquired following trauma, a corneal scar or surgery (cataract, graft). The main symptoms are:
- Distorted or blurry vision at varying distances, particularly when making out small details (letters, numbers).
- Confusion of similar letters (O/Q, E/F, 3/8).
- Eye strain, headaches and eye irritation during prolonged tasks (reading, screens).
- Increased glare from artificial light or when driving at night.
Astigmatism is frequently combined with myopia or hyperopia, and is rarely isolated. More than 80% of clinically significant cases of astigmatism are accompanied by another refractive error.
Diagnosis and workup
How is astigmatism diagnosed?
Diagnosis relies on an ophthalmological examination combining several measurements:
- Automated refractometry: first objective measurement of the astigmatism (axis and power).
- Subjective refraction: fine-tuning with the patient to confirm the optimal correction.
- Keratometry: measurement of the corneal curvature radii.
- Corneal topography: precise mapping of curvature variations, essential before any surgery. It also helps screen for keratoconus.
- Corneal tomography (Scheimpflug or OCT): analysis of the anterior and posterior surfaces of the cornea, essential for diagnosing subclinical forms of keratoconus.
Regular or irregular astigmatism: an essential distinction
Corneal topography clarifies the nature of the astigmatism before any surgery. Regular astigmatism, the most common, has two perpendicular meridians and responds well to laser correction (LASIK, PRK) or a toric implant. Irregular astigmatism, where the curvature is disorganized, can reveal keratoconus and contraindicate conventional laser; other approaches are then discussed during the preoperative workup.
Astigmatism can also be isolated or combined with myopia or hyperopia, which guides the correction strategy and the choice of technique.
Options for correcting astigmatism
Glasses and toric lenses
As the first line of correction, sphero-cylindrical glasses correct the majority of cases of astigmatism. Toric contact lenses (soft or rigid) offer an alternative for astigmatism up to about -6 diopters. For irregular astigmatism (keratoconus), rigid gas-permeable lenses often remain the most suitable non-surgical option.
Laser surgery (LASIK, PRK, SMILE)
All three laser techniques correct regular astigmatism, generally up to -5 diopters. The choice depends on corneal thickness, lifestyle and any associated myopia or hyperopia. Excimer laser treatment uses an asymmetric ablation profile driven by aberrometry or topography-guided data for high cylindrical precision.
Toric phakic implant (ICL EVO Toric)
Indicated in cases of high myopia combined with astigmatism up to -6 diopters, or when the cornea does not allow laser surgery. The ICL EVO Toric is custom-made according to the patient’s biometry. Its placement and cylindrical orientation are checked intraoperatively.
Toric cataract implant
When a cataract requires surgery, a toric implant makes it possible to correct the astigmatism at the same time. The latest-generation toric implants correct up to 6 diopters of corneal astigmatism, with positioning controlled by intraoperative guidance. This integrated approach avoids the need for a second procedure and reduces dependence on glasses for distance vision.
Decision tree
Which technique for which profile?
| Profile | Suitable techniques | Preferred |
|---|---|---|
| Low astigmatism (-0.5 to -2 D) with mild myopia | LASIK, SMILE, PRK | LASIK |
| Moderate astigmatism (-2 to -4 D) with high myopia | SMILE, LASIK, ICL Toric | SMILE or ICL Toric depending on the cornea |
| High astigmatism (-4 to -6 D) with high myopia | ICL EVO Toric | Toric phakic implant |
| Astigmatism + early cataract (>55 years) | Cataract surgery with toric implant | Toric cataract implant |
| Irregular astigmatism (keratoconus) | Cross-linking, rings, rigid lenses | Specialized keratoconus management |
Pricing and consultation
Pricing and consultation with Dr Tourabaly
Refractive surgery for astigmatism is not reimbursed by the French health insurance system (except for cataract indications). The fees at Dr Tourabaly’s practice follow the reference schedule, astigmatism being corrected at no extra charge: LASIK €1,500/eye (€3,000 both eyes), PRK €1,250/eye (€2,500 both eyes), SMILE €1,650/eye (€3,300 both eyes), ICL EVO Toric around €3,200/eye (implant included). Where astigmatism is corrected during cataract surgery, the toric implant is subject to a specific quote.
Dr Moïse Tourabaly sees patients for the initial evaluation and preoperative workup at the Cachan practice (94). Laser refractive surgery (LASIK, PRK, SMILE) is performed at the Clinique Laser Victor Hugo (Paris 16); the ICL implant and cataract surgery at the Clinique Sainte-Geneviève (Paris 14). See the refractive surgery pricing page for full details.
Frequently asked questions
Frequently asked questions about astigmatism
See clearly, at every distance
Have your astigmatism evaluated in consultation
Dr Tourabaly: Cachan & Paris 13. Corneal topography, complete workup, personalized technique.
Sources and references
- Vitale S, Ellwein L, Cotch MF et al. Prevalence of refractive error in the United States, 1999-2004. Arch Ophthalmol. 2008;126(8):1111-1119. PMID 18695106.
- Reinstein DZ, Archer TJ, Gobbe M. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye Vis (Lond). 2014;1:3. PMID 26605350.
- Société Française d’Ophtalmologie. SFO report: Refractive surgery.
- Haute Autorité de Santé. Recommendations on cataract surgery and refractive surgery.
This article is for informational purposes. A personalized ophthalmological opinion remains essential for any treatment decision.