EW
CORNEA
22
July 2011
patient from surgery by itself, but
480 microns is statistically less likely
to be a normal cornea. The reason
age
is a factor is because topographic
changes occur over time. A 22-
year-old with subtle corneal abnor-
malities is more likely to have a
worsening topographic appearance
over
time than a 44-year-old with
the same topographic pattern. In ad-
dition, there is clear scientific evi-
dence from the two different publi-
cations discussed here that proves
young age is a predictor of ecta-
sia."
1,3
In Dr. Randleman's opinion,
clinicians still need to refine and de-
fine what constitutes "slight topo-
graphic abnormality" before
dictating who has it and who does
not. "What we need to measure is
corneal
biomechanical integrity," he
said. "Right now, we're looking at
indirect measures of that function."
It should be noted that in Dr.
Binder's article, age alone did not
predict ectasia. "There may be an ex-
planation for these differences relat-
ing to our inability to detect young
eyes that are genetically predisposed
to ectasia and/or if a patient is
young,
the eye may not have had
time to manifest the abnormality
topographically or mechanically,"
Dr. Binder said.
Both Drs. Randleman and
Stulting said ophthalmologists may
never have a specific topography
that can definitively rule someone
in or out for developing ectasia.
Other research may get physicians
closer than they currently are. For
refractive surgery, however, they
think it is prudent to err on the side
of caution and exclude a few more
patients rather than include them if
they're on the cusp.
EW
References
1. Randleman JB, Woodward M, Lynn MJ,
Stulting RD. Risk assessment for ectasia after
corneal refractive surgery. Ophthalmology.
2008:115(1):37-50. Epub 2007 Jul 12.
2. Binder PS, Trattler WB. Evaluation of a risk
factor scoring system for corneal ectasia after
LASIK in eyes with normal topography. J
Refract Surg. 2010:26(4):241-250.
3. Randleman JB, Trattler WB, Stulting RD.
Validation of the Ectasia Risk Score System for
preoperative laser in situ keratomileusis
screening. Am J Ophthalmol.
2008;145(5):813-818.
Editors' note: Drs. Binder and Trattler
have financial intersts with AMO. Drs.
Randleman and Stulting have no finan-
cial interests related to their comments.
Contact information
Binder: 858-922-8699, garrett23@aol.com
Randleman: 404-778-2264,
jrandle@emory.edu
Stulting: 770-255-3330,
dstulting@woolfsoneye.com
Trattler: 305-598-2020, wtrattler@gmail.com
Ectasia continued from page 21
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