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Topography guides refractive surgery decision-making

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Kendall E. Donaldson

SAN DIEGO — Anterior elevation, posterior elevation, pachymetry, underlying pathology and long-term effect on patients are five key elements that Kendall E. Donaldson, MD, MS, integrates into her topographic assessment when planning refractive surgery.

First, the astigmatism value and shape as seen on the anterior corneal curvature map help inform her decision-making.

“We have to take a look at the difference between the manifest and the topographic astigmatism,” Donaldson said at Refractive Subspecialty Day at the American Society of Cataract and Refractive Surgery annual meeting.

Regarding posterior elevation, Donaldson said that even when the anterior surface is “very normal,” the posterior surface may have completely different astigmatism.

The quality of a scan, that is, the inability to accurately image the ocular surface, can be a sign of underlying pathology. “The things we are looking for in these patients undergoing elective corneal surgery are ocular surface disease, keratoconus and anterior basement membrane disease,” Donaldson said. “We are picking up a lot of these patients during our LASIK evaluations.”

When found, ocular surface disease can be treated and then the patient can be re-evaluated.

Finally, how the elective surgery will affect the patient needs to be considered. Resultant corneal thickness and K values, the effect of flattening on quality of vision, as well as the effect the surgery might have on underlying pathology need consideration, she said. – by Patricia Nale, ELS

Reference: Donaldson KE. Corneal topography: What to look for and how it influences my decision making. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.

Disclosure: Donaldson reports financial relationships with Alcon, Allergan, Johnson & Johnson, SUN, Shire, Bausch + Lomb, Kala Pharmaceuticals, EyeVance, Lumenis and Zeiss Meditec.