51
EW REFRACTIVE SURGERY
April 2015
Contact information
Santhiago: marconysanthiago@hotmail.com
Wilson: WILSONS4@ccf.org
Editors' note: Drs. Santhiago and
Wilson have no financial interests
related to their comments.
eyes with normal preoperative topography. Am
J Ophthalmol. 2014 Jul:158(1):87–95.
Dr. Santhiago thinks the study
demonstrates that PTA should be
considered when screening a refrac-
tive surgery patient.
"We have to take PTA into ac-
count, and if it is higher than 40%,
I would strongly recommend that
you consider the patient high risk,"
he said. Converting such patients to
PRK puts them in the safe zone, as
this removes the flap thickness from
the equation, he said.
For his part, Dr. Wilson views
this as a helpful tool for determining
which patients should be steered to
PRK, and thereby potentially spared
the risk of ectasia.
"A lot of us, if all things are nor-
mal, would like to do LASIK because
the patient's visual recovery is fast-
er," he said. "While PRK is a good
procedure, too, I'm confident that if
it's safe I would rather do the LASIK
procedure." PTA can help to put him
in a position to determine if this can
be safely accomplished. For patients
approaching that 40% number, Dr.
Wilson says that he is much more
likely to go the PRK route.
Dr. Santhiago thinks that mak-
ing the incorporation of PTA values
easier for surgeons will be very im-
portant. He also thinks that spurred
by this, more surgeons will incor-
porate any technique of small-inci-
sion lenticule extraction or surface
ablation for myopia.
"It should also be noted that as
a risk factor, the weakening predict-
ed by a high PTA or any other factor
does not mean ectasia will occur
in all high-risk eyes, but that these
eyes carry increased risk for ectasia.
Given the elective nature of LASIK,
it seems logical that the balance of
risk acceptance should be weighted
toward minimizing risk, especially
when other excellent procedures are
available for refractive correction,"
Dr. Santhiago said, adding that
abnormal corneal topography is still
the most important risk factor for
post-LASIK ectasia. EW
Reference
Santhiago MR, Smadja D, Gomes BF, Mello GR,
Monteiro ML, Wilson SE, Randleman JB.
Association between the percent tissue altered
and post-laser in situ keratomileusis ectasia in
