Eyeworld

DECEMBER 2022 | EYEWORLD | 61 R Contact Hura: ah@maloneyshamie.com Reinstein: dzr@londonvisionclinic.com Shamie: ns@maloneyshamie.com Trattler: wtrattler@gmail.com necessarily some underlying weakness in the cornea. (2) Epithelial hyperplasia in the central area of a previous myopic ablation that appears normal on topography could explain why a patient has experienced a regression in their myopic refractive error. (3) Epithelial maps may suggest subclinical EBMD if there is mild irregu- lar astigmatism on topography and the exam is unremarkable. (4) Unremarkable topography in the postoperative period after refractive surgery in a patient now with unsatisfactory vision who has variable epithelial mapping may suggest that healing is still taking place. Neda Shamie, MD, who said she performs epithelial mapping to detect keratoconus, doesn't think epithelial mapping is considered the standard of care among refractive surgeons yet either. "I think that tomography and topography are the two critical diagnostic tools with epithe- lial mapping supplementing the information," she said. "It's possible with improvements in technology and further understanding of the results we get that it could potentially move up the ladder of importance. In screening refrac- tive surgical patients, especially as we're trying to screen for conditions that would not yet be overtly evident, the more information we have, the more confidence we can have in recom- mending surgery. After all, my job as a refrac- tive surgeon is not just to perform expertly done surgery but to determine safety long term for our patients. To me, risk assessment is the more challenging part of my job as a refractive surgeon." If a practice is not using this functionality or doesn't have a device that performs epithe- lial mapping yet, Dr. Trattler said a refractive surgeon should discern whether they want to incorporate a technology like this that is going to potentially allow more patients to qualify for corneal refractive surgery who might have otherwise been excluded. "Are surgeons willing to acquire epithelial mapping to rule potential patients in for corneal refractive surgery? If surgeons rule patients out because they do not have epithelial mapping available, it's not the end of the world, but obviously for patients interested in refractive surgery, it would be great to have epithelial thickness mapping available to identify the ana- tomical cause for inferior corneal steepening on topography," Dr. Trattler said. Relevant disclosures Hura: Carl Zeiss Meditec Reinstein: ArcScan, CSO Italia, Carl Zeiss Meditec Shamie: None Trattler: ArcScan, Carl Zeiss Meditec, Oculus A patient who presented for corneal refractive surgery was found to have inferior steepening on topography. Epithelial mapping revealed epithelial hyperplasia, suggesting that the cause of inferior steepening was related to an epithelial irregularity rather than early keratoconus. Source: Jessica Heckman, OD, and Ralph Chu, MD

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