Eyeworld

FEB 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/78719

Contents of this Issue

Navigation

Page 94 of 111

September 2011 EW MEETING REPORTER 95 Screening and treating ectasia was a recurrent topic among speak- ers. William B. Trattler, M.D., refractive, corneal, and cataract specialist, Center for Excellence in Eye Care, Miami, began the ectasia conversation by pointing out the subjective nature of topography readings in his keynote address, "Advanced Diagnostics for Pre-oper- ative Evaluation of the Refractive Surgery Candidate." "How effective are we at inter- preting corneal maps?" he asked. "What it really boils down to is if a corneal map is normal or abnormal in your eyes. You're trying to screen patients and select the right candi- dates. You don't want to operate on someone who will develop ectasia, but you also have to be careful not to rule everyone out. Interpretation of maps is a challenge." If a case doesn't look quite nor- mal, he advised surgeons to thor- oughly evaluate both eyes and even flip a topography reading over so the steep part of the eye is inferior. Dr. Trattler also stressed that thick- ness doesn't mean the cornea is strong or stiff. Although an abnormal topogra- phy is an important pre-op clue, pa- tients with normal topographies can develop ectasia as well. "Ectasia is a risk of laser vision correction," said retired Navy Capt. Steve C. Schallhorn, M.D., former director, Cornea Service & Refractive Surgery, Naval Medical Center, San Diego; and professor of ophthalmol- ogy, University of California, San Francisco. "Sometimes there are no apparent risk factors." Dr. Schallhorn reported his ob- servations from a laser vision correc- tion analysis involving 204,284 patients, 58 of whom developed ec- tasia. Ectasia affected more males than females, and patients were slightly younger on average than the cohort, he said. "The average age of the entire cohort was 38 years old, whereas the average age of the ectasia patient was 31," he said. "Ectasia tends to happen in younger patients, but we also have seen ectasia occur in pa- tients over the age of 50. Older age is no guarantee [a patient is] not going to develop ectasia, but it is associ- ated with younger patients." Dr. Schallhorn called cornea shape the "most significant risk fac- tor" for ectasia. Anterior curvature seems to be the most predictive fac- tor. Ectasia mostly occurred in my- opes, but there were some cases of ectasia in hyperopes as well. On av- erage, 24 months passed between treatment and ectasia diagnosis. Although determining which patients will develop ectasia can be maddening, there is good news. The continued on page 96

Articles in this issue

Archives of this issue

view archives of Eyeworld - FEB 2012