Imaging Studies

Corneal topography

Corneal topography provides surgeons with effortlessly understood color-coded maps of corneal curvature in addition to quantitative indexes of irregular astigmatism that correlate with potential visual acuity.^{[38, 39]}

Modern instrumentation produces a video keratograph, which generally is in the form of a color-coded contour map.

Different manufacturers use different methods (eg, Placido, 40 scanned slits, combination Placido and 40 scanned slits, phase modified laser holography, raster stereography).

The use of video keratography in preoperative and postoperative evaluations of all refractive surgery patients is valuable.

Dual Scheimpflug analyzers

Scheimpflug imaging differs from conventional techniques in that the object plane, lens plane, and image plane all intersect in a straight line.

This type of imaging allows assessment of anterior and posterior corneal topography, anterior chamber depth, as well as anterior and posterior topography of the lens.^[40]

Pachymetry

The pachymeter (optical, ultrasonic) is used to measure corneal thickness.

Accurate determination of corneal thickness preoperatively allows the surgeon to set the depth of incision to two thirds of the measured result.

Orbscan II by Orbtek uses both 40 scan slits and Placido methods to provide anterior and posterior corneal curvature in addition to data on corneal thickness.

Other Tests

Other tests include the following:

Wavefront aberrometry
Keratometry
Placido ring reflections
Refraction (manifest, automated, cycloplegic)

Histologic Findings

Several authors have performed and reported histologic analysis of treated tissue. The excimer laser ablation of the cornea results in a very smooth ablated surface, no damage to adjacent tissue, and an abrupt transition to the untreated tissue.^[35]An estimated 0.25 µm of corneal tissue is removed with each pulse of the laser. Furthermore, with electron microscopy, an extremely narrow zone of damage may be demonstrated next to the treated area.

Treatment & Management

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Media Gallery

Food and Drug Administration (FDA)-approved lasers for photorefractive keratectomy (PRK). Adapted from US Food and Drug Administration - Center for Devices and Radiological Health - LASIK Eye Surgery.
Food and Drug Administration (FDA)-approved lasers for photorefractive keratectomy (PRK). Adapted from US Food and Drug Administration - Center for Devices and Radiological Health - LASIK Eye Surgery.
Food and Drug Administration (FDA)-approved lasers for laser in situ keratomileusis (LASIK) with or without astigmatism. Adapted from US Food and Drug Administration - Center for Devices and Radiological Health - LASIK Eye Surgery.
Food and Drug Administration (FDA)-approved lasers for laser in situ keratomileusis (LASIK) with or without astigmatism. Adapted from US Food and Drug Administration - Center for Devices and Radiological Health - LASIK Eye Surgery.
Food and Drug Administration (FDA)-approved lasers for laser in situ keratomileusis (LASIK) with or without astigmatism. Adapted from US Food and Drug Administration - Center for Devices and Radiological Health - LASIK Eye Surgery.
Food and Drug Administration (FDA)-approved lasers for laser in situ keratomileusis (LASIK) with or without astigmatism. Adapted from US Food and Drug Administration - Center for Devices and Radiological Health - LASIK Eye Surgery.
Astigmatic ablation profile. Image courtesy of Manolette Roque, MD, Ophthalmic Consultants Philippines Co, EYE REPUBLIC Ophthalmology Clinic.
Myopic ablation profile. Image courtesy of Manolette Roque, MD, Ophthalmic Consultants Philippines Co, EYE REPUBLIC Ophthalmology Clinic.
Hyperopic ablation profile. Image courtesy of Manolette Roque, MD, Ophthalmic Consultants Philippines Co, EYE REPUBLIC Ophthalmology Clinic.
Technolas 217z excimer laser. Digital photo published with permission from Bausch & Lomb Surgical Philippines.
Orbscan IIz. Digital photo published with permission from Bausch & Lomb Surgical Philippines.
ZyWave wavefront aberrometer. Digital photo published with permission from Bausch & Lomb Surgical Philippines.
ZyWave wavefront aberrometer user interface. Digital photo published with permission from Bausch & Lomb Surgical Philippines.
Fixation with ZyWave wavefront aberrometer. Digital photo published with permission from Bausch & Lomb Surgical Philippines.

of 14

Author

Manolette R Roque, MD, MBA, FPAO Section Chief, Cataract and Refractive Surgery, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief, Ocular Immunology and Uveitis, International Eye Institute, St Luke's Medical Center Global City

Manolette R Roque, MD, MBA, FPAO is a member of the following medical societies: American Academy of Ophthalmology, American Uveitis Society, European Society of Cataract and Refractive Surgery, International Ocular Inflammation Society, Philippine Academy of Ophthalmology, Philippine College of Surgeons, Philippine Medical Association, Philippine Ocular Inflammation Society, Philippine Society of Cataract and Refractive Surgery, University of the Philippines Medical Alumni Society

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD, DPBO, FPAO Senior Partner, Roque Eye Clinic; Chief of Service, Pediatric Ophthalmology and Strabismus Section, Department of Ophthalmology, Asian Hospital and Medical Center; Active Consultant Staff, International Eye Institute, St Luke's Medical Center Global City

Barbara L Roque, MD, DPBO, FPAO is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, Philippine Society of Pediatric Ophthalmology and Strabismus, International Strabismological Association, Philippine Society of Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

Roberto Pineda, II, MD Director, Refractive Surgery Service, Massachusetts Eye and Ear Infirmary; Associate Professor of Ophthalmology, Harvard Medical School

Roberto Pineda, II, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Received consulting fee from Amgen for review panel membership; Received consulting fee from Genzyme?Sanofi for review panel membership; Received consulting fee from Novartis for consulting; Received consulting fee from Beaver-Visitec for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

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

Disclosure: Nothing to disclose.

Chief Editor

Douglas R Lazzaro, MD, FAAO, FACS Chairman, Professor of Ophthalmology, The Richard C Troutman, MD, Distinguished Chair in Ophthalmology and Ophthalmic Microsurgery, Department of Ophthalmology, State University of New York Downstate Medical Center; Chief of Ophthalmology, Director of Cornea, Director of Surgical Training, Kings County Hospital Center

Douglas R Lazzaro, MD, FAAO, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, Association of University Professors of Ophthalmology, Brooklyn Ophthalmological Society, Cornea Society, New York Society for Clinical Ophthalmology, Ophthalmic Laser Surgical Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Association for Research in Vision and Ophthalmology

Disclosure: Received grant/research funds from Alcon Labs for independent contractor; Received grant/research funds from Abbott Medical Optics for independent contractor; Received ownership interest from Acufocus for consulting; Received ownership interest from WaveTec for consulting; Received grant/research funds from Topcon for independent contractor; Received grant/research funds from Avedro for independent contractor; Received grant/research funds from ReVitalVision for independent contractor.

Ruben Limbonsiong, MD

Ruben Limbonsiong, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.