In elderly patients, refractive error shifts toward which astigmatism pattern?

In elderly patients, refractive error shifts toward which astigmatism pattern?

• A. Against-the-Rule
• B. With-the-Rule
• C. Oblique
• D. No shift

Answer: (A)

As people age, the way the cornea curves tends to change so that the horizontal meridian becomes relatively steeper than the vertical one. This flattening of the vertical meridian with age, along with other age-related changes in the cornea and eyelids, shifts the astigmatism pattern from the younger, typically vertical-steeper (with-the-rule) toward the horizontal-steeper pattern, which is called against-the-rule. In practical terms, elderly patients often end up with astigmatism where the steepest meridian is horizontal, so the refractive error shifts toward against-the-rule.

As people age, the way the cornea curves tends to change so that the horizontal meridian becomes relatively steeper than the vertical one. This flattening of the vertical meridian with age, along with other age-related changes in the cornea and eyelids, shifts the astigmatism pattern from the younger, typically vertical-steeper (with-the-rule) toward the horizontal-steeper pattern, which is called against-the-rule. In practical terms, elderly patients often end up with astigmatism where the steepest meridian is horizontal, so the refractive error shifts toward against-the-rule.