Your Tips for a Successful Cylinder Reduction! (Guide-ish prompt)

(Disclaimer: This post has been inspired by the latest Shortsighted podcast episode with Greg. It won’t contain spoilers (:laughing:) but I highly recommend it!!)
(Disclaimer 2: this is not another “how to reduce” thread. Just hopefully a support thread for people whose reductions are taking time.)

So I have started to think that clearing up residual astigmatism is one of the easiest things to procrastinate on. Or rather, it is all too easy to “reduce too quickly” before the cylinder needs are completely gone. In my case, my full dioptre of astigmatism is a virtual non-issue in my -1.25D (with no cylinder). That is, I can read the 20/20 line, I guess well enough in artificial lighting. And I can barely notice any distortion outside during the day. It seems, then, reasonable to want to stop targeting it. Why would anyone wait to make another spherical reduction when they are seeing 20/20 in their norms? One could probably keep improving the myopia, without specifically improving the astigmatism. People with low cyl/sph ratio might actually get away with that. Or not. I’m not an eye guru.

But then in a lot of cases, making successive spherical reductions before the astigmatism is completely gone, one might find themself stuck in this situation of mine, where I see almost too well in my norms, but removing them, oh boy do I notice the astigmatism. And it’s incredibly frustrating in the last dioptre because stuff is clear enough to read across the street without glasses, and ghost images can make the difference between “barely readable” and “illegible”.

So if you have -.75D or more of stubborn astigmatism, there might come a time where it is the only obstacle to not needing glasses anymore. So I would think it is a reason to be more intentional about getting rid of it as soon as conveniently possible.

A lengthy introduction, I know.

I would love to know if you guys have experiences to share about how long cylinder reductions have taken, if they have been successful, favourite tips to speed them up, etc.

Below is my a priori suppositions for how this might work. Please feel free to add or correct anything that looks suspicious.

What makes astigmatism worse?

(that is, what specific set of bad habits can cause the eye to worsen at the level of one axis instead of uniformly becoming more myopic. The point is to become aware of possible lifestyle habits that are impeding improvement.)

From what I’ve gathered, one or several of these might be the culprit (keyword being might. I would love being corrected as, like Jon Snow, I know nothing.):

  • Wearing cylinder correction on the wrong axis or beyond one’s needs.
  • Looking for extended periods of time at a target that is not in the centre of vision. (example: computer screen is on the side instead of right in front of the user, reading or using the phone while lying sideways, etc.)
  • Habits of looking in a certain direction by moving the eyes without moving the head.

When is a cylinder reduction considered successful?

If you see well in good lighting, it might not be enough. I am not sure if it is a form of (clinical) blur adaptation or if light just hides the weirdest aberrations, but be sure to check your vision at night.

  • Are the moon, neon lights and digital clocks in darkness free of all distortion and/or ghosting in your normalised?
  • Same point as the above, but in your next normalised. That is, did the increased spherical challenge reveal residual cylindrical challenge?

If so, it seems reasonable to me to consider the astigmatism gone. An optometrist’s confirmation is not necessary, but desirable.

I’ve been at it for months and it does not seem to go away, what to do?

  • The challenge might be too big. Consider going up by introducing back some cylinder or by adding a little bit of spherical correction.
  • You might not be getting enough stimulus. If there is not enough challenge during the day, try to use more regularly neon lights (or the moon) at night for active focus.
  • If you have a fair amount of myopia left, consider maybe rescheduling your cylinder reduction and add in a few successful spherical reductions before the next attempt.

I hope this can be helpful, but again, input highly encouraged! :smile:

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I think this is an excellent initiative, and I would like to see it expanded, not specifically as a ‘give me the steps’ guide, but as an easily accessible source of our collective experience on astigmatism and astigmatism reduction. It can be very discouraging to wade through many posts, far into the history of the forum, to find some information one is looking for. I have no idea how one would ensure that it remains the first thread one would find when using the search function.

It would be nice to see it distinguish low astigmatism from high astigmatism, equal astigmatism from a big diopter gap in astigmatism, a high sphere to cylinder ratio from a low one. I think such differentiation could be useful so that members can go straight to the section that interests them. These could also give links to any of Jake’s videos that cover the specific situation (if any). Each separate section could then also include suggestions on how to phase the cylinder reductions in that specific situation, and here we could use the input from people such as Kent who started out with a complex situation and seems to have tackled it pretty well. Theory is all very well, but practical experience is more useful… It could become something like the Rough Guide on Astigmatism, but I would hope that it would remain accessible to forum members and not dissapear behind a pay wall.

As I did EM cold turkey, after having failed to get used to wearing glasses again, I can add very little from personal experience with cylinder reduction in lenses, but would be very willing to language edit any contributions that might need it.

A big job, I know, but Laurens guided the Rough Guide to fruition and I am sure it can be done.

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Definitely a thread I’d love to be involved in, I’m an odd case of “never wore glasses” and have basically resisted them all the way till now, when I got into this and learned stuff I realized I’m dealing with astigmatism as well and since my myopia stayed low (around -1 both eyes) my astigmatism has a relatively high ratio compared to the myopia, left eye seems to be about 0.75 and right is between 0.25 and 0.5, I’m not 100% sure if that’s correct and they might be even higher but those sound about right.

I find in my case that the astigmatism gets in the way of active focus especially later during the day when there’s less light, normally outdoors I can clear up signs I can’t read at all to a point where they’re almost perfect but at night I might struggle clearing up more than just a little, I think the astigmatism has very slowly reduced in the past few weeks but as I’m still fairly new to this I can’t say anything with absolute certainty, one thing I do know however is that mine is most likely caused by bad scanning habits as you mentioned, I don’t want to babble on about this in every thread so the detailed explanation is in my 20/20 gains thread. In short I noticed I mostly look up and down but rotate my head left and right, had bad posture habits that can possibly explain why the left eye has more astigmatism and I’m guilty of using my phone lying to my side too, though I stopped doing that since I started EM.

As far as strategies go I’ve been sparingly using the concentric circle images and try to clear them up, I can clear them up to some degree, sometimes the blurred parts become less grey or stay grey but become sharper, sometimes it becomes a sharp circle all around but with a ghost image in the astigmatism direction (almost horizontal blur in my case), I also started implementing Elliot B. Forrest’s scanning therapy and interestingly with that when I do it behind the window late at night I can see instantly that the lights in the distance become a lot less distorted, the starburst effect lessens quite a bit for the first few seconds after the “exercise” and then it slowly goes back, but not quite all the way, if I go back in a while it looks the same as before so the short term improvement doesn’t last and I haven’t done it long enough yet to know if it is gonna have profound long term effects, though that’s about what I expect since active focus behaves similarly, non-permanent short term effects that slowly become permanent over time.

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:+1: for the guide(-ish prompt)

The more podcasts I listen to, the more convinced I am that the angle of lights is also important.
There was a guy who lived in the basement with windows high on the wall and he identified a link to his astigmatism. There are others who always get the lights from a certain direction, e.g. sitting next to the window, good natural lights coming from the left. Office lights and sitting at the same desk for years are the same. Someone else commented on wearing lenses for norms and using plus glasses for close-up, and developing the habit of looking above the glasses (like grandma / grandpa looks up from reading) and doing it for a few months resulting in cyl added to the prescription. What is important about these that it can happen with good lights, too.

When very little of it returns with the next sph reduction. At least, some residual astigmatism always appeared for me with the drops in the last diopter. (Even if I never wore corrections for astigmatism)
You can of course step back with cyl. But if it is from “no cyl” state, I’d say it is worth experimenting with stepping back with SPH only, even if that wasn’t a correction you used before. But after all, it is a part of the eye that needs that extra correction, like equalising within the eye. The lower the cyl is, the more it varies in axis if you go to different optos within a short time. Vs. with high cyl value it is more obvious what the axis is.

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I have double vision but doctor said that y don’t have astigmatism, wt to do now

I’m still struggling to get my CYL drops to stick, so I don’t have much to add to your excellent guide. I would however point out that measuring centimeters can be quite tricky when there’s both SPH and CYL blur involved. @Dlskidmore’s Stenopaeic slit method is what I’ve been using to keep track of vision changes.

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Very much my experience, and most of my left eye measurements are guestimates.

I am blessed and fortunate to have somehow gotten to nearly 6 diopters of Myopia (down to low 3’s now) without inducing significant astigmatism. My right eye is astigmatic-free (maybe a touch of higher-order astigmatism, but no base cylinder), and my left eye is 0.25D astigmatic (and has been for decades). I only wore glasses for a year or two back in the late 90’s with correction for that astigmatism, the rest of my glasses-wearing have been pure spherical correction.

Being the perfectionist I am :slight_smile: I’d love to get rid of my left eye astigmatism and make it match my right. So far, with almost 2D of baseline no-AF myopia reduction, the left eye remains stubbornly at 0.25D. Definitely livable, but why not go for zero?

Are there any approaches to eliminate that last bit of astigmatism?

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If there are, I would love to know of them. But as I have a feeling that my right eye retains a bit of astigmatism to balance out the higher astigmatism (mirror image oblique) in the left eye, it might actually be best to let sleeping dogs lie.

I’m sorry for my recent lack of activity, I am really grateful for everyone’s contributions!

That is a good point, which makes me think that perhaps the wiki format might be more appropriate as I would be reluctant to fill in the cases I have not had personal experience with. This has been mostly my thoughts about a common case of people being functional without cylinder correction but deciding that they would probably keep that little bit of astigmatism forever. And that does not make sense to me, if the astigmatism is lens/habit-induced, then it should be possible to reverse it unless we are doing something wrong. So hopefully, a few good practices and a lot of patience might help solving that.

I would be very interested in knowing how you do it specifically! Do you scan in any specific direction? What do you look at while trying to clear up the distortion?

That is interesting, and quite scary to be honest. If that’s indeed the case, preventing astigmatism might be more difficult than I thought, if one also needs to not be too consistent with their work setting.

The scanning thing is already pretty annoying because few habits are more ingrained than the way we use our eyes. It would take a lot of mindfulness to change that (and it probably wouldn’t hurt if we could get more evidence that it’s beneficial for, you know, additional motivation.)

Very true! I personally use the astigmatism wheel as shown in this excellent post in which I measure my distance to blur to the sharpest axis for the SPH and… Honestly I don’t often bother with the CYL.

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If the general consensus of the astigmatics on the forum is that this would be better covered in the wiki, I am fine with that. I would prefer not to take any initiative there, as I do not feel much at home on the wiki. I belong much more to the printed guide with everything in one place generation.

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My experience is very lacking so please take the following with a grain of salt.

So far, from a mix of what I’ve read and what seems to be helpful for me, my only suggestion is to take the time to tackle it specifically. That is, put yourself in a situation where the only challenge you have is the astigmatic blur and treat it like an equalising step for a few weeks (or months, depending). Having a compound challenge (both sph and cyl) has not stopped me from improving but so far, most of my improvement was spherical so perhaps the brain will take the time to resolve the astigmatism when it is the only thing it has to resolve. Also, you know, mindset. I have no idea how it plays but I feel it helps when you are intentional about reducing the cylinder and not expecting it to go away as a side-effect.

Speaking of which, seeing that you still have quite a bit of myopia, I think you can afford to wait some more before worrying about that tiny bit of astigmatism. After all, if axial length shortening is how this all (at least partly) works, there is a chance that the astigmatism will go away as a side-effect or that the reduction will get easier with time. Or at least that is my theory which I am incapable of personally verifying.

As is mine, but I believe that as long as both eyes work together naturally, things don’t have a high chance of going wrong while trying to improve. Maybe both eyes will improve at the same time, or only the eye with higher astigmatism will. I really am curious to see how your eyesight evolves naturally because sometimes, I feel the biology has a wisdom that it tries to follow in spite of our best efforts to guide it.

Even if we do take it to the wiki eventually, I would prefer coming up first with a decently complete guide in a space that facilitates debates and the exchange of ideas.

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I also think it would be the best approach.

In that case, I would be willing to participate. I suggest we start a new thread called Working Group on Astigmatism Guide. I have started a rough outline of what coud be covered, and how to divide this up. It is in word format, and it would need someone more clued up than myself to put it on the forum in such a way that we do not end up with pages-long posts.

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I scan perpendicular to my axes which are almost vertical, though also almost mirrored, my ghost images go towards the bottom left and right.

I usually go for about 120 movements left and right and try to hold each for a second, I don’t strain by going all the way to either direction as it’ll start hurting after a short while, I’m still not 100% sure if it’ll help in the long run and if it won’t end up making it worse, I suppose I’ll find out.

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I spent a lot of time working at a place with big rooftop windows. I just loved sitting under or near them. But the lights were very good at the other parts of the rooms, too, at least 750 LUX. After a while I noticed that the Snellen was blurrier in the evenings when I was looking at it from sitting position (upwards) than from standing position (straight), but switching the lights on (ceiling) corrected this blur/DV. I’m sure at that point I would have received a 0.5 cyl recommendation at least for that axis from any opto.

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