HISTORY OF ASTIGMATISM

William Whewell (1794-1866), professor of mathematics and physiology, defined the

term astigmatism in 1817. The word astigmatism is etymologically derived from the
Greek “a” sin and “stigma” period.
The first reference and prescription of astigmatism was made in 1800 by the
Englishman Thomas Young (1773-1829) in his work On the Mechanism of the Eye .
Young built his own optometer to observe his own eye, verifying that the image of a
line crossed at different distances if he placed the instrument in the vertical or horizontal
plane, and that the vertical rays coming from an object were focused on the retina at 10
inches from the cornea and the horizontal ones at 7 inches. He considered this to be due
to an obliquity of the uvea or a tilt of the lens. .
The main person responsible for self-diagnosed Young's astigmatism was the lens since
it was an astigmatism against the rule and the difference in measurements between the
horizontal (5.62 D) and vertical (3.94 D) meridians at a focal length of 23 inches,
represented a reverse astigmatism of 1.68 diopters.
AND. G. Fisher (1754-1831), in 1805 , demonstrated the anomaly to his students using
two series of parallel lines crossed at a right angle. In his writing included in his
subsequent thesis by his disciple Gerson, his knowledge and appreciation of the concept
of focal lines is implicit. In the same way, it is possible to attribute the first testimony in
which the cornea is designated as the cause of astigmatism. Years later, in 1818, he
established the hypothesis that the corneal curvature resembles that of an ellipsoid and
that in some eyes this aberration is so evident that it can be demonstrated only by
measuring and comparing with a caliper of vertical and horizontal meridians.
Gerson Hartog (Hirsch) (1788-1843), despite writing the first detailed physiological
study of the anomaly, possibly turned his interest toward vision problems. In 1810 , he
indicated that he could see and count a bundle of fine horizontal lines at a distance of
15-18 inches and the vertical lines only at 6-8 inches. The horizontal section of my
cornea forms a flatter arc than the vertical one, so the rays incident on the vertical
meridian of my cornea have their focal point on my retina and the rays incident on the
horizontal have a focal point behind my retina. The horizontal line image will look
sharp but elongated, the vertical line will look thick because the image consists of a
series of overlapping lines. Gerson performed corneal measurements on autopsy eyes
using the Pourfour du Petit method, finding for the first time that in the cornea the
vertical radius is smaller than the horizontal radius. Already in 1808, the astigmatism
detection test used a rectangular card and series of horizontal and vertical lines.
In 1812 , GPL Sachs , in his work, described hyperopic astigmatism, indicating,
together with absolute hyperopia, his cornea has a lower dioptric power in the horizontal
meridian, seeing at any distance the fine blurred vertical lines and the sharp horizontal
ones.
In 1818 , David Brewster (1781-1868) described the subjective optical effects of
astigmatism, although he attributed its cause to the tear secretion that lubricates the
cornea due to several causes:
  Being in a state of rest due to its own gravity.
 Fluid alteration during blinking.
 Its quality attraction towards the inferior fornix that constitutes its horizontal
reservoir.
The downward movement of the tear fluid crosses and blurs the horizontal lines, while
when it coincides with the vertical lines, it has little effect on their focus. In 1837 , he
accepted the role of the cornea or the lens in the production of astigmatism, and to
differentiate it, he suggested examining the reflected image of a candle on it, which
allows us to appreciate whether it is circular (the cause is the lens) or oval.
In 1825 , the Englishman George Biddell Airy performed the first astigmatism
correction, ignoring Young's work. He noticed that his left eye was useless when
looking at a nearby object, assuming the problem was lack of use, he tried to use it more
by occluding his right eye, without success. He observed that by tilting the lens of his
glasses obliquely or looking at the object at a point near the edge, he could perceive it
more clearly.
In the examination of his left eye, Airy observed that the image formed by a bright point
such as a light bulb or a star was not circular but elliptical "with its major axis forming
an angle of 35º with the vertical and its greatest extremity inclined to the right." . By
drawing on a paper a black cross that could easily determine that at a certain distance
from the eye one line was observed perfectly sharp while the other was barely visible
and by bringing the paper closer to the eye, the sharp line disappeared and the other was
clearly visible. defined.
He noticed that at 6 inches (15.8 cm) (1 inch = 2.54 cm) a point appeared as a well-
defined line, inclined approximately 35º from the vertical and at 3 1/2 inches (8.89 cm)
a sharp line, forming a right angle with the first and of the same length.
After these determinations, it was concluded that this condition could be corrected by
making a lens in which parallel incident rays produced divergence in a plane from a
distance of 3 1/2 inches and in the perpendicular plane from 6 inches. To make the
sphero-cylindrical lens, a glass with a refractive index of 1.53 and a radius of curvature
of 3.18 inches and 4.45 inches was used, for the spherical and cylindrical surfaces
respectively, equivalent to a dioptric power of 6. .25 D and 4.62 D approximately.
Airy's astigmatism data in inches would mean a value of between 4-4.5 diopters.
Once his diagnosis was confirmed, he commissioned the creation of a cylindrical lens
that was manufactured in 1824 by an artisan instrument maker from Ipswich called
Fuller. In 1846 , the optician Simms manufactured regularly shaped sphero-
cylindrical lenses for spectacles with different powers. These first crystals were cut in a
round shape to be inserted into circular mounts in a way that allowed them to rotate
until the appropriate axis was found.
In 1827 , John Isaac Hawkins (1772-1855) detected astigmatism in his own eye,
highlighted the usefulness of the optometer to individually explore vision and, together
with Hersche , went ahead to point out the cornea as the cause of the defect. To detect
astigmatism, he suggests using a music book (precedent of the modern "fan and block"
test). He advises covering one eye, moving the book horizontally from front to back
until you see the lines in focus, and measuring the distance with a ruler and then rotating
the vertical text and performing the same operation.
Hawkins' contribution to astigmatism did not receive the deserved recognition,
however, for several reasons. Firstly, it was dedicated to the detection and correction of
astigmatism, while Hawkins' study only marginally discussed it along with other aspects
of ocular optics in which it was indisputable (for example, trifocal lenses). Secondly, the
originality of both works Hawkins was explicitly and directly influenced and inspired
by the literature of the time while paradoxically Airy ignored the initial studies and
previously published works, including those of Young, thus managing to discover his
own astigmatism independently and design a sphero-cylindrical lens to correct the
visual defect.
In 1829 , Henry Coddington published the first mathematical equations applied to
astigmatism in A Treatise on the Reflection and Refraction of Light.

In 1832 , Krause determined the exact dimensions in shape and size of the human eye,
including the thickness of the cornea and lens and their refractive power.
In 1845 , Jacques Charles Francois Strum (1803-11855), professor of mathematics at
the Polytechnic School of Paris, presented “Memoir on the theory of vision” in which
he proposed a hypothesis with which he attempted to demonstrate the possibility of
seeing at different distances. without accommodation. He establishes certain theoretical
aspects of refraction through asymmetric surfaces but, above all, he describes a
geometric figure, the Strum Conoid that bears his name and which represents the path
of refracted rays through a theoretical lens.
In 1849 , Gabriel Stokes (1819-1903) developed a simple method to determine the
degree of astigmatism presented at a meeting of the British Society for the
Advancement of Science which, given the few references to the subject in the literature
of the time, aroused a notable interest. The conviction that it was a relatively common
ocular optical problem stimulated him to conceive a procedure that would allow
estimation in a device that he called the astigmatic lens Stokes lens. Although the
Stokes lens constitutes the basis of the lenses subsequently designed to estimate the
degree of astigmatism and its system is the principle on which the crossed cylinder
method is based for the refraction examination that Edward Jakson proposed in 1887
starting from the Stokes lens and is called the Jakson cross cylinder.
The importance and prevalence of astigmatism is highlighted by Colonel of Engineers
Goulier, professor of Topography at the Military School of Metz who, in 1852,
presented his observations on astigmatism to the Academy of Sciences. He included in
his reports an illustration consisting of a series of horizontal and vertical lines, grids,
etc. Which he used successfully to detect astigmatism, allowing him to establish the
high frequency of the defect and which constitutes one of the first known tests. The
table was designed to detect not only the horizontal and vertical meridians but also the
oblique ones. His research in which he also pointed out the possibility of its correction
using cylindrical glasses.
The Dutch doctor Franciscus Cornelis Donders, professor at the University of Utrecht,
undoubtedly represents one of the most outstanding ophthalmological figures of the
19th century and with the greatest scientific influence on the modern physiology of
vision. In 1858, he published his work Uber die Refractions and Accomodations
Anomalien in which he described the subjective method of examining refraction,
avoiding the use of ophthalmometry. In 1862, he presented the monograph
Astigmatismus ans cylindrische Glaser in the Netherlands, from which cylindrical
crystals were regularly incorporated into the lens case. In 1864, his classic book on the
Anomalies of Accommodation and Refraction of the Eye was published in English, in
which all the hitherto confusing concepts of refractive errors and particularly
astigmatism, derived from previous works from Young and Airy, were clarified. ,
establishing the way to correct it using cylindrical lenses.

In the same year of 1862, his disciple and friend Hernan Snellen, proposed his famous
publication of Optotypi ad visum determinadum, the most universal and well-known
optotype screen, to which he incorporated the radial disc for the detection of
astigmatism and which is still in force. . It provides the definition and concept of
astigmatism according to the rule and against the rule and proposes surgical treatment.
In 1886, Laval and Roure reported the existence of several cases of corneal and lens
astigmatism. In 1888, the Frenchman Eugene Kalt, professor of ophthalmology at the
Hotel Dieu in Paris, reported the visual improvement of a patient with keratoconus
through the adaptation of a contact lens.
In 1890, Allvar Gullstrand, Swedish ophthalmologist, professor at the University of
Uppsala, applying mathematical methods to the study of optical images and ocular
refraction, established in his thesis Bidrag till astigmatismes teori the basic principles of
astigmatismes teori the basic principles of astigmatism , which he ratified in his
following works between 1900 and 1911, receiving the Nobel Prize in Medicine that
year for it. Studies and develops spherical lenses in order to correct astigmatism due to
oblique incidence. The knowledge of the structure and function of the cornea
contributes significantly, determining, according to the model of the eye, that its total
power is 43 D, the result of the sum of the power
From the anterior surface 49D and the posterior surface -6D. He also established his
theory of intracapsular accommodation complementary to that of von Helmholtz,
perfected the ophthalmoscope and designed the slit lamp.
When observing, corneal astigmatism and total astigmatism do not always coincide,
neither in the dioptric value nor in the inclination of the main meridians. Manuel
Marquez, professor of Ophthalmology in Madrid, began a series of studies with which
he described a variety of astigmatism that called BIASTIGMATISM and which he
communicated at the Naples Congress of 1909. For its correction, it determines, first,
the corneal astigmatism using keratometry and then the remaining astigmatism, either
objectively by schiascopy or by the subjective method of observing the hour circle, after
myopizing the eye, placing a second perpendicular cylinder in the frame. to the
direction in which the radii are perceived as sharper, until they are equal, then adding
spherical crystals until maximum visual acuity is reached. This twin-cylinder
combination could be transposed to a single cylinder, according to tables that, in 1922,
were prepared jointly by Marquez and T. Bustoo.