Microscopic irregular astigmatism is when cornea curvature has many small irregularities like flat steep which all come together Causing two principle meridian which are not perpendicular(for cylinder power correction we rely on principle meridian) Normal regular astigmatism is different which can be easily solved with cylindrical power and lasik We need to do confocal microscopy and pentacam for microscopic irregular astigmatism before going for refractive correction I.e lasik or prk We might have to start rigid gas permeable or hard toric contact lens in this case