Younger age may be a significant risk factor for ectasia in patients without other risk factors. J Refract Surg. Your chances for improved vision are based, in part, on how good your vision was before surgery. Mayo Clinic is a not-for-profit organization. Despite the utility of the PTA metric, Dr. Miller predicted that it will eventually decline in importance, as U.S. ophthalmologists migrate toward procedures that preserve more of the corneas structural integrity. LASIK is an excellent procedure for most patients with myopia and astigmatism. Typically, well say that we want to leave a 250-m residual stromal bed and then the patient will be safe. Clin Ophthalmol. It takes about two to three months after your surgery before your eye heals and your vision stabilizes. 2012;6:1801-1813. The microkeratome (or femtosecond laser) is used to create a hinged corneal flap. Clear. Femtosecond lasers tend to create more precise and uniform flap thickness, and settings of 100-120 m are typically used. A few eyes do not develop ectasia despite having PTA values greater than 40 percent, Dr. Miller said. Critical variable. However, side effects unique to the femtosecond laser, such as transient light sensitivity syndrome, have been reported with first generations of femtosecond lasers. If possible, they should be evaluated at one of our offices before the day of surgery. Proper pre-operative screening is essential. reported on 1,992 LASIK cases with no identified risk factors, in which ectasia developed in a single patient (0.05 percent). It also identifies the thinnest point in the cornea, both by value and location. INTERMEDIATE VISION AFTER PRESBYOPIA CORRECTION. LASIK removes about 12-14 microns per diopter of vision for correction. WebAt Flaum Eye Institute Refractive Surgery Center, your corneal thickness will be measured first by the Orbscan IIz Corneal Analysis System. These usually clear up after a few weeks or months, and very few people consider them to be a long-term problem. This means that after the flap has been made and the prescription is applied, you should have that much left. The axial map placido disc-based topography pattern classification using in this score system consists of: Includes round, oval, or symmetric bowtie patterns. [8] The pachymetric map can useful in detecting incipient keratoconus. Simultaneous topography- guided PRK followed by corneal collagen cross-linking for keratoconus. National Eye Institute. Randleman JB, Woodward M, Lynn MJ, Stulting RD. How the Thickness of Your Cornea Affects Getting LASIK, 6 Benefits of LASIK for Frequent Travelers, How to Select a Los Angeles LASIK Eye Surgery Center. In the Randleman et al score system, the most common risk factors, in order of significance include: Abnormal topography compromises of keratoconus, pellucid marginal corneal degeneration, or forme fruste keratoconus with an I-S value of 1.4 or more[9] and is the most significant factor with highest relative risk. Some surgeons believe corneal thickness less than 500 microns is an independent risk factor for ectasia. LASIK surgeons in Los Angeles correct this issue by removing excess tissue and reshaping the cornea to better reflect light. Optom Vision Sci 2008; 85:E1172 E1178. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Refractive surgical options for hyperopia can be either cornea- or lens-based surgeries. A PRK corneal thickness calculator is an excellent tool to estimate how much laser vision correction you will need in order to achieve stable eyeglass prescription and ensure you receive the best possible outcome from surgery. Refraction should be stable within 0.5 D for 1 year or more before LASIK surgery. Many of the patients in the study who developed ectasia would have been considered at low risk if other measurements (notably RSB or CCT) had provided the sole guidance, said principal investigator Marcony R. Santhiago, MD, PhD. These patients have a high rate of conversion to PRK. You'll be able to see after surgery, but your vision won't be clear right away. Folding back the flap allows your doctor to access the part of your cornea to be reshaped. LASIK removes about 160 microns of tissue to create the corneal flap. No direct measurement of corneal strength. [27][28], PK or deep anterior lamellar keratoplasty are the last resort for visual rehabilitation in patients with post-LASIK ectasia.[29]. Pay Bill. Mayo Clinic does not endorse companies or products. The surgeon and patient should decide whether LASIK is indicated based on a full preoperative evaluation and consideration of goals and alternatives, including spectacles, contact lens, and phakic intraocular lens implantation. The amount of your prescription is also a key component with corneal thickness. In Randleman JB, Dawson DG, Grossniklaus HE, McCarey BE, Edelhauser HF. Comanagement, . Corneal thickness is important because it can mask an accurate reading of eye pressure, causing doctors to treat you for a condition that may not really exist or to treat you unnecessarily when are normal. Lifshitz T, Levy J, Klemperer I, Levinger S. Late bilateral keratectasia after LASIK in a low myopic patient. The goal of WFG LASIK is to achieve a more optically perfect ablation based on all of the optical aberrations measured using a wavefront aberrometer, not just spherical and cylindrical refractive errors. Dry eyes. Researchers discovered that corneal thickness can vary slightly in the population. WebCan be used in post-LASIK eyes, if corneal topographies available; Pre-installed on: central corneal thickness D diopter(s) DF design factor Chamon W, Rocha KM. Visit our LASIK page for more information. 2010;21:255-8. Despite the early reported cases of ectasia for extreme myopia (more than 12 D), post-LASIK ectasia has been reported in numerous patients with low myopia With normal vision, an image is sharply focused onto the surface of the retina. In 2014, Moshirfar et al. Before surgery, your doctor will discuss the risks and benefits of LASIK surgery, what to expect before and after surgery, and any questions you may have. Refract Corneal Surg 1989;5: 400 8. Do I think this is going to be a big metric 10 years from now? Sugar A, Rapuano C.J., Culbertson W. W., Huang D.,Varley G. A., Agapitos P.J, de Luise V.P., Koch D.D. Am J Ophthalmol. In 2006, Klein et al. Doctors generally use wavefront-guided technology to evaluate your eye in detail before LASIK surgery. Beyond PTA. LASIK surgery may be an option for the correction of one of these vision problems: If you're considering LASIK surgery, you probably already wear glasses or contact lenses. The reason that this procedure has become so popular is that it is a long-term solution that actually corrects corneal aberrations, rather than just compensating for them. What does the tomography look like? To ensure preservation of at least 250 m of residual bed thickness after laser retreatment, preoperative OCT or intraoperative ultrasound pachymetry could be performed. The metric consists of an equation that calculates the proportion of the cornea that will be impacted by LASIK. Ectasia increases reciprocally relative to RSB thickness and a RSB of < 300 microns has been correlated with increased risk of ectasia[13]. The association is more robust than all the variables isolated, and I use the formula with my patients every day, said Dr. Santhiago, at the Federal University of Rio de Janeiro. Results will be sent to you without interpretation. However, the numerical cutoff values are significantly lower, depending on the individual eyes risk profile, he said.4. The Ectasia Risk Score System designed by Randleman and colleagues[8], is a controversial screening tool carefully developed by an evidence-based review of a large series of LASIK ectasia cases. Accessed Aug. 15, 2019. Ophthalmology. Treatment strategies for corneal ectasia. If possible, they should be evaluated at one of our Its not a direct measurement. Meanwhile, he and other researchers are helping to validate diagnostic technology to directly measure corneal strength. Other risk factors include eye rubbing, family history of keratoconus, refractive instability, BCVA less than 20/20 preoperatively, and male gender and should be considered especially in borderline cases. The cornea is marked to aid in postoperative flap alignment. Financial disclosure: No related interests. Your eye doctor might also ask you to wear a shield over your eye at night until your eye heals. Geggel HS, Talley AR. This is an application that allows the ophthalmology surgeon to perform multiple IOL (Intraocular lens) Power, and Toric (Astigmatic) calculations. LASIK Indications for the Correction of Myopia and Astigmatism, Outcomes of LASIK for Myopia and Astigmatism. Corneal thickness can influence the actual reading of the amount of pressure in the eye. Immediately after surgery, your eye might itch, feel gritty, burn and be watery. The normal cornea is about 540 microns thick (a little more than half a millimeter), measured in the center. LASIK (laser in situ keratomileusis) is a surgical procedure designed to correct refractive errors. Doctors may not recommend laser refractive surgery for you if you have certain conditions, including: LASIK surgery is usually not advisable if you: If you're considering LASIK surgery, talk to your doctor about your questions and concerns. The flap usually heals without stitches. Kymionis GD, Kontadakis GA, Kounis GA, et al. Reported rates of post-LASIK ectasia in eyes without identified risk factors have declined in recent years: 1 Klein SR et al. Adding PTA [to your preoperative protocol] will increase the chances that you will identify the patients with normal topography who have high risk for ectasia., For example, Dr. Santhiagos study found that PTA and younger age were the top two factors associated with ectasia development in seemingly normal corneas. Ophthalmology 2003; 110:267275. Following the excimer laser, the flap is replaced. A suction ring is placed on the eye to achieve fixation. Accessed Aug. 16, 2019. ICL power calculation is performed through the online calculator provided by the modified vertex formula provided by STAAR surgical. Corneal thickness, degree of myopia and RSB are related and RSB thickness is the most significant predictor of ectasia among them. Translate: Search. This totals 196 to 202 microns of corneal tissue. WebCorneal Thickness Calculator For laser vision correction candidates LASIK Fee Collection For the pre and post-op care you provide Helpful ICD-10-CM Resource Quick reference to eye codes Lifetime Achievement Award Dr. Stanfield honored with Lifetime Achievement Award. The ablation depth for myopic LASIK on the VISX laser is between 12-14 microns, depending on the optical zone. Laser refractive surgery. Your doctor will discuss whether you're a candidate for the procedure or other similar procedures. He or she will see how your eye is healing and check for any complications. J Refract Surg 1995;11:3719. Low residual stromal bed (RSB) thickness, Histopathology and Immunohistochemical characteristics, Binder PS, Lindstrom RL, Stulting RD, et al. Ferrara P, Torquetti L. Clinical outcomes after implantation of a new intrastromal corneal ring with a 210-degree arc length. The flap allows access to the deeper layers of your eye. After LASIK or PRK, the power of the anterior corneal surface can then be added to that of the posterior corneal surface (which is assumed to be unchanged), as expressed by the formula Portland, Tualatin, Yakima, Spokane,Bellevue, Bellingham, When corneal thickness is unknown, this calculator defaults to the average corneal thickness of 540 microns. Dr. Miller said that he is generally in agreement with the PTA concept because it can enable surgeons to recognize corneas in which the usual minimum values for RSB and CCT values would not suffice. Serious adverse complications leading to significant permanent visual loss occur rarely. Furthermore, the identification of central corneal thickness as an independent indicator of glaucoma risk by the Ocular Hypertensive Treatment Study (OHTS) has PTA is an additional significant risk factor for post-LASIK ectasia and may be considered in addition to residual stromal bed when determining the safety of an excimer laser treatment. [16] A PTA of 40% is an indicator of a higher risk for ectasia. WebThese systems measure the corneal thickness at different points of the cornea. Figure 2. [CDATA[*/var l=new Array();var output = '';l[0]='>';l[1]='a';l[2]='/';l[3]='<';l[4]=' 109';l[5]=' 111';l[6]=' 99';l[7]=' 46';l[8]=' 105';l[9]=' 108';l[10]=' 99';l[11]=' 112';l[12]=' 64';l[13]=' 108';l[14]=' 101';l[15]=' 98';l[16]=' 109';l[17]=' 105';l[18]=' 103';l[19]=' 46';l[20]=' 110';l[21]=' 105';l[22]=' 108';l[23]=' 114';l[24]=' 97';l[25]=' 109';l[26]='>';l[27]='\"';l[28]=' 109';l[29]=' 111';l[30]=' 99';l[31]=' 46';l[32]=' 105';l[33]=' 108';l[34]=' 99';l[35]=' 112';l[36]=' 64';l[37]=' 108';l[38]=' 101';l[39]=' 98';l[40]=' 109';l[41]=' 105';l[42]=' 103';l[43]=' 46';l[44]=' 110';l[45]=' 105';l[46]=' 108';l[47]=' 114';l[48]=' 97';l[49]=' 109';l[50]=':';l[51]='o';l[52]='t';l[53]='l';l[54]='i';l[55]='a';l[56]='m';l[57]='\"';l[58]='=';l[59]='f';l[60]='e';l[61]='r';l[62]='h';l[63]='a ';l[64]='<';for (var i = l.length-1; i >= 0; i=i-1){ if (l[i].substring(0, 1) == ' ') output += "&#"+unescape(l[i].substring(1))+";"; else output += unescape(l[i]);}document.getElementById('eeEncEmail_aOqrpfADDW').innerHTML = output;/*]]>*/, Copyright 2023 Pacific Your eye surgeon uses a small blade or cutting laser to cut a small hinged flap away from the front of your eye. Analysis of quantitative cohesive tensile strength in normal human corneas: implications for refractive surgery. You may have difficulty seeing at night after surgery, which usually lasts a few days to a few weeks. After its development, the excimer (excited dimer) laser was used to reshape the cornea in a technique called photorefractive keratectomy (PRK). Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. We wont be making flaps in the future. 4. The ideal approach to preventing post-LASIK ectasia would be to directly measure the structural integrity of the preoperative cornea, which PTA does not do, Dr. Waring said. (JavaScript must be enabled to view this email address), Corneal Cross-linking Comanagement Resources, Patient Education Video Library for use in Your Pactice, Direct Messaging with PCLI Details and addresses. For every diopter corrected, around 12 to 14 microns are removed. Certain health conditions can increase the risks associated with LASIK surgery or make the outcome less predictable. This page has been accessed 149,374 times. This helps conserve corneal tissue. Some surgeons consider off-label treatments combining ICRSs with corneal crosslinking, and others even consider perfoming additional customized excimer laser ablation. Ophthalmology 2008;115:1249 1261. DETECT THE HIDDEN DANGER OFTHYROID EYE DISEASE (TED), 2022 Horizon Therapeutics plc DA-UNBR-US-01273 12/22, Easy Calculation Evaluates Post-LASIK Ectasia Risk, Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Dr. Richard Mills' Opinions, 2002 to 2016, International Society of Refractive Surgery. microkeratome. Same numerator, different outcomes. 2014 Jul;158(1):87-95.e1. Corneal thickness map Shape Cone-like Superior-inferior difference (m) <30 >30 Thinnest location difference between both eyes (m) <30 >30 Talk with your doctor about any vision changes. The corneal flap is typically about 160 microns thick For every one diopter of prescription power, 12 to 14 microns of corneal tissue are removed For example, if you have 3 diopters of refractive error, 160 microns would be used for the corneal flap and 36 to 42 microns would be removed. Corneal ectasia after excimer laser keratorefractive surgery: histopathology, ultrastructure, and pathophysiology. 2022 Excel Laser Vision Institute. LASIK. To help patients suffering with progressive ectasia, Copy the URL to use this on your website, exam room PCs or tablets, View surgery calendars for each of our offices Corneal flap thickness was set at 120 m (all flap pedicles were located in the upper portion of the eyes), excimer laser cutting energy at the corneal stromal bed at 1.0 J, femtosecond laser scanning line distance at 8 m, spot pitch at 8 m, and flap edge cutting energy at 1.3 J. Well, not really. However, in comparison to conventional LASIK, WFG surgery did not result in improved outcomes. Mild to moderate keratoconus can be treated with eyeglasses or contact lenses. Laser In Situ Keratomileusis for Myopia and Astigmatism: Safety and Efficacy. When glasses or contacts become too troublesome and inconvenient, many people turn to laser eye surgery. The procedure allows the surgeon Therefore, before recommending LASIK, your LASIK surgeon will first perform an exam that includes a corneal pachymetry test to measure the thickness of the cornea. Laser Epithelial Keratomileusis (LASEK). Then depending on your prescription you may still be a LASIK candidate, however PRK may still be the safer option to make sure you have enough residual corneal bed left over after the procedure. We dont want to oversimplify. Ectasia is the nightmare scenario in refractive surgery, said Kevin M. Miller, MD, at the Jules Stein Eye Institute in Los Angeles. In the past, risk factors have been largely considered independently and with equal weight. WebObjective. Contact the Excel Laser Vision Institute to learn whether you qualify for LASIK eye surgery and get started on the journey to clear, independent vision. J Cataract Refract Surg 2005; 31:20352038. https://www.fda.gov/medical-devices/lasik/what-should-i-expect-during-and-after-surgery#top. A suction ring placed on your eye just before cutting the corneal flap may cause a feeling of pressure, and your vision may dim a little. Despite its advantages, PTA does have certain drawbacks. WebThe average normal corneal thickness is 540-700 microns, from center to periphery, with the greatest thickness nasally and superiorly. reported eight cases (1.8 percent), out of 450 LASIK procedures. WebThe metric consists of an equation that calculates the proportion of the cornea that will be impacted by LASIK. But if a patient has two borderline findingssay a PTA of 30 percent and an age of 18he or she would likely not be a suitable LASIK candidate. Randleman JB, Banning CS, Stulting RD. After reshaping the cornea, the surgeon lays the flap back into place. The Ectasia Risk Score System is a cumulative score system. Marcony R Santhiago. It is documented that cross-linking may stop the progression of ectasia. Dr. Moosa of Excel Laser Vision Institute has performed tens of thousands of LASIK eye surgeries and is considered one of the leading laser eye experts in Southern California. Accessed Aug. 16, 2019. WebThe most common reason PRK is recommended over LASIK is when corneal thickness is not adequate to safely make a LASIK flap. However, thicker flaps alone were insufficient to create ectasia unless coupled with greater ablation depthsand thus high PTA values. 2014;40(6):918-928. You may detect a distinct odor as the laser removes your corneal tissue. U.S. Food and Drug Administration. If the flap created during the LASIK procedure is irregular, incomplete, or buttonholed, laser treatment cannot safely be performed in the same session. The Optical Zone will depend on the pupil size and the type of laser. But with nearsightedness (myopia), farsightedness (hyperopia) or astigmatism, the light is bent incorrectly, resulting in blurred vision. One-year follow-up of corneal confocal microscopy after corneal cross-linking in patients with post laser in situ keratosmileusis ectasia and keratoconus. Some surgeons also believe that the stromal bed should be at least half of the original corneal thickness. After measuring the thickness of your cornea, LASIK specialists will need to do some mathematical reasoning in order to determine if you are a safe candidate for the procedure. Am J Ophthalmol. RSB thickness is especially important after LASIK because both stress-strain analysis[11] and tensile strength analysis[12] indicate greater strength in the anterior 40% relative to posterior 60% of stroma and LASIK reduces anterior corneal structural integrity. Thus, percent tissue altered is derived from (FT + AD) CCT. Since the LASIK method requires a corneal flap to be made, patients must have a cornea that is within a certain range of thickness. Glasses or contact lenses can correct vision, but reshaping the cornea itself also will provide the necessary refraction. J Refract Surg2008; 24:S726S729. 5 The disadvantage of this method is the lack of pre-operative information (i.e., prior to LASIK treatment). Refractive stabilization for myopes take up to 3 months depending on the amount of treatment performed. Residual refractive error can be corrected after stabilization, typically by relifting the flap and ablating the stromal bed in a retreatment procedure (also called an enhancement). Alain Saad, Damien Gatinel. The answer pertains to corneal thickness. Here are some of the qualifications and facts that LASIK specialists consider: After measuring the thickness of your cornea, LASIK specialists will need to do some mathematical reasoning in order to determine if you are a safe candidate for the procedure. In some people with keratoconus, the cornea becomes scarred with advanced disease or wearing contact lenses becomes difficult. In 2012, Spadea et al. [1]Ectatic changes can occur as early as 1 week[2] or can be delayed for years after LASIK. Your corneas may thicken by as much as 10 microns on each side by giving them a break from contact lenses. Flap thicknesses can deviate significantly from the nominal setting and routine measurement can help the surgeon evaluate the range of actual thickness obtained. A combined look at risk. Critical variable. PTA correlated more strongly with ectasia incidence than did the previously known risk factors, including patient age, residual stromal bed (RSB) thickness, the Ectasia Risk Scoring System (ERSS), and CCT, the researchers found. Imperfect prescriptions are caused by irregularities in the cornea which can be perceived as nearsightedness, astigmatism, or farsightedness. Dr. Stanfield honored with Lifetime Achievement Award.Read more , Our mission is to provide the best possible comanagement services to the profession of Optometry. Clin Ophthalmol. FT=flap thickness, AD=ablation depth CCT=preoperative central corneal thickness. This will likely be a long-term treatment, especially if your cornea becomes stable with time or from cross-linking. 2009;147:774-8, 778.e1. 5th ed. With each pulse of the laser beam, a tiny amount of corneal tissue is removed. Femtosecond laser aided LASIK has been shown to provide better predictability of refractive outcomes and lower enhancement rates than LASIK performed using a WebOur Coastal Vision LASIK consultants are available to help you determine your LASIK options. J Cataract Refract Surg 2000;26: 96777. The typical pedestal thickness for PRK and LASIK is approximately 5 m, but this value may vary depending on the specific medical excimer laser device and even the profile type. When youre ready, call (888) 501- 4496 to schedule a free consultation. Thus, if both those factors were marginal in a prospective LASIK patient, caution might be in order, Dr. Waring advised. The surgeon also confirms that the correct treatment data are entered into the laser computer. https://www.aao.org/eye-health/treatments/lasik-2, https://eyewiki.org/w/index.php?title=LASIK_for_Myopia_and_Astigmatism:_Safety_and_Efficacy&oldid=88234. PTA is a better metric in a case like this., The anterior corneas role. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Email me with your comments or questions at . Not everyone can be eligible for LASIK because there are certain factors that can affect the accuracy of the results and the safety of the patient. Eye-tracker and iris registration technology are increasingly used to ensure a well-centered laser treatment. Staring at this light helps you keep your eye fixed while the laser reshapes your cornea. WebFor a flap procedure, such as LASIK or IntraLASIK, the standard of care in the United States is to leave at least 250m behind after subtracting out the flap thickness and ablation depth. Includes the following asymmetric patterns: Includes keratoconus, pellucid marginal corneal degeneration, or forme fruste keratoconus with an I-S value of 1.4 or more.[9]. For instance, he said, You can have patients with thin corneas that are strong, and you can have patients with thick corneas that are weak. The surgeon adds the expected flap thickness (FT) to the planned ablation depth (AD), and then divides the sum by the eyes central corneal thickness (CCT). Early onset keratectasia following laser in situ keratomileusis: case report and literature review. 5. WebThe IOL Calculator is meant to serve as an adjunct tool to assist physicians in selecting the appropriate IOL for a particular patient. During the evaluation, your eye doctor will ask about your medical and surgical history and give you a comprehensive eye examination to evaluate your vision and assess whether you can undergo the procedure safely. Figure 5. Rao SN, Epstein RJ. Keratoconus and corneal ectasia after LASIK [letter]. Maguen E, Maguen B, Regev L, Ljubimov AV. Corneal ectasia induced by laser in situ keratomileusis. The diagnostic criteria are a central corneal thickness (CCT) less than 500 mm, in addition to topographic asymmetry. Autoimmune disorders, such as rheumatoid arthritis, A weakened immune system caused by immunosuppressive medications or HIV, Recent changes in vision due to medications, hormonal changes, pregnancy, breast-feeding or age, Inflammation of the cornea, lid disorders, eye injuries or eye diseases, such as uveitis, herpes simplex affecting the eye area, glaucoma or cataracts, Have an eye disease that causes the cornea to thin and bulge, or if you have a family history of it, Have age-related eye changes that cause vision to be less clear, Participate in contact sports that may be associated with blows to the face. This service is free of charge if patients proceed with surgery. 2 Spadea L et al. More than 8 out of 10 people who've undergone LASIK refractive surgery no longer need to use their glasses or contact lenses for most of their activities. Advertising revenue supports our not-for-profit mission. Patients must have a minimum of 250 microns of corneal thickness after their surgery. All rights reserved. Last summer, a joint Brazilian-U.S. group reported Before surgery the excimer laser, suction ring, microkeratome and blade (or femtosecond laser settings), are checked by the technician and the surgeon. Cataract and Laser Institute. J Refract Surg 2002;18:177184. People with a high degree of nearsightedness or farsightedness along with astigmatism have less predictable results. While surgical complications are rare, good postoperative care is important. Dr. Santhiago is currently investigating the relative contribution of flap thickness and ablation depth within the PTA. Iatrogenic keratectasia after laser in situ keratomileusis for less than -4.0 to -7.0 diopters of myopia. Privacy Policy, Serving Anchorage, Boise, Lewiston, Great Falls, Albuquerque, Avoid going below 300m for primary treatment. A thin cornea may also be an indication of subtle keratoconus, and indicates a need for caution in tissue removal. It does also appear to play a role in eyes with abnormal topography, Dr. Santhiago said. When visiting a LASIK clinic in Los Angeles, patients will receive a comprehensive eye exam in order to determine if they are an ideal candidate for the procedure. An eyelid speculum is placed in the operative eye, which has been anesthetized with drops, and the fellow eye is covered. After a mean follow-up of 6.892.35 years (standard deviation), the safety index was 1.17, the efficacy index was 0.94, J Refract Surg 2009; 22:112. After LASIK surgery, the patient should have a minimum of 250 microns of corneal thickness remaining (flap thickness not included. Curr Opin Ophthalmol. All rights Reserved.
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