LASIK Astigmatism Workup

  • Author: David R Hardten, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 15, 2012
 

Laboratory Studies

For any patient undergoing surgical correction of astigmatism, the patient’s general health is important. No routine laboratory workup is typically done, but the status of any concurrent systemic disease should be known.

Diabetes mellitus, in particular, is an example of one systemic disorder that can cause wide fluctuations in the refractive status of the eye. Prior to surgical treatment, diabetes should be well controlled, and relatively stable refractions should be performed over several visits.

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Imaging Studies

The most important imaging studies for astigmatism correction are corneal topography and tomography.[38, 39, 30, 40] These imaging studies are essential in understanding the shape and curvatures of the cornea, and they can be of tremendous help in establishing a diagnosis and in deciding management.

Corneal thickness using ultrasonic pachymetry may also be useful.

In patients who have had prior surgery, such as cataract surgery, phakic intraocular lens implantation, or keratoplasty, the corneal endothelium can be monitored using specular microscopy.

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Contributor Information and Disclosures
Author

David R Hardten, MD  Phillips Eye Institute; Adjunct Clinical Associate Professor, Director of Refractive Surgery at Minnesota Eye Consultants, Pennsylvania College of Optometry; Clinical Associate Professor, Department of Ophthalmology, University of Minnesota Medical School, Minnesota Veterans Affairs Medical Center

David R Hardten, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery

Disclosure: Abbott, Allergan, ESI, TLCV Consulting fee Consulting; Allergan, Calhoun, Glaucos, ISTA, JAEB, Omeros, Ophthec Grant/research funds Other; Abbott, Allergan, ISTA, Oculus Honoraria Speaking and teaching

Coauthor(s)

Ahmad M Fahmy, OD  Staff Optometrist, Minnesota Eye Consultants, Adjunct Clinical Professor, Illinois College of Optometry

Ahmad M Fahmy, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association

Disclosure: Nothing to disclose.

Scott G Hauswirth, OD  Consulting Staff, Department of Optometry, Minnesota Eye Consultants

Scott G Hauswirth, OD is a member of the following medical societies: International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel S Durrie, MD  Director, Department of Ophthalmology, Division of Refractive Surgery, University of Kansas Medical Center

Daniel S Durrie, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology

Disclosure: Alcon Labs Grant/research funds Independent contractor; Abbott Medical Optics Grant/research funds Independent contractor; Acufocus Ownership interest Consulting; WaveTec Ownership interest Consulting; Topcon Grant/research funds Independent contractor; Avedro Grant/research funds Independent contractor; ReVitalVision Independent contractor

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Louis E Probst  MD, Medical Director, TLC Laser Eye Centers

Louis E Probst is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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Typical astigmatic keratectomy incisions.
Wedge resection.
Corneal marker indicating optical zone diameter and degrees of arc.
LASIK for myopic with-the-rule astigmatism.
LASIK for myopic against-the-rule astigmatism.
LASIK for hyperopic with-the-rule astigmatism.
LASIK for hyperopic against-the-rule astigmatism.
Corneal topography of a central island.
Corneal topographies of decentered myopic ablations.
A properly aligned reticle. Note the position over the center of the pupil.
Infectious keratitis following LASIK. Note hyperemia, which typically does not occur in cases of diffuse lamellar keratitis.
Epithelial ingrowth following LASIK surgery.
Diffuse lamellar keratitis - Stage 1.
Diffuse lamellar keratitis - Stage 2.
Diffuse lamellar keratitis - Stage 3. Note central clumping of interface cells.
Diffuse lamellar keratitis - Stage 4. Note "cracked" appearance in central cornea following stromal melt.
 
 
 
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