Eyeworld

I APRIL 2020 | EYEWORLD | 79 Contact Assil: kerry@assileye.com Chu: yrchu@chuvision.com Kugler: lkugler@kuglervision.com Relevant disclosures Assil: None Chu: None Kugler: None Epithelial thickness map of a normal, healthy cornea Epithelial thickness map of an eye with keratoconus; the epithelium has thinned over the area of ectasia Source (all): Jessica Heckman, OD healing process and why it can take some time. "You show patients the maps, and they under- stand that it needs to reach a certain thickness," Dr. Kugler said. One of his patients had a corneal abra- sion after cataract surgery. On the first night, the patient's corneal abrasion caused an area of thinning over the center of the visual axis. The patient's vision in the affected eye was not as strong at that point and had a hyperopic refraction. The patient went from an epithelium that was 10–20 µm thick to 50 µm as seen with epithelial mapping. "As it filled in, her refraction normalized and approached what it was in the left eye, but that didn't happen until it was fully thickened," Dr. Kugler said. A second patient had LASIK and con- junctivitis with a fair amount of inflammation. The patient's epithelium became very thin, and vision went from plano to +1.25 D. "It wasn't until the epithelium had thickened that the refraction turned back to what it was immedi- ately after LASIK, which took about 8 weeks," Dr. Kugler said. The patient was concerned about vision loss, but Dr. Kugler and staff were able to assure her that there was a physiological reason why she had become hyperopic and that she would heal, as she eventually did. As a third example, a patient with a PRK enhancement was thrilled with his vision for 3–4 months but then became myopic. Although his eye looked great on exam, the epithelial thickness mapping showed he had gone from 50 µm to more than 80 µm due to hyperplasia. "Had we not had epithelial mapping, it would have been tempting to do an enhancement," Dr. Kugler said. Instead, they removed the epitheli- um and let it grow back in a controlled fashion. It did eventually grow back to 50 µm, and the patient's vision returned to plano. Case studies Dr. Kugler shared several cases where epithelial thickness mapping helped with treatment plans for patients, and he explained the educational role that mapping has with refractive surgery. Mapping gives patients and surgeons an easy, visual tool to explain what happens during the

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