EyeWorld Asia-Pacific June 2021 Issue

REFRACTIVE EWAP JUNE 2021 39 C orneal ectasia after laser vision correction was first reported in 1998 by Theo Seiler, MD, PhD, 1 and since then, preop screening and treatment parameters have improved to help avoid such a complication. The incidence of post-LASIK ectasia (as it is commonly referred to though ectasia can occur with other refractive and corneal procedures) is not officially known. Research from the early 2000s puts it at 0.2–0.6%. 2,3,4 A retrospective review in 2018 of 30,167 eyes that had LASIK (16,732 patients) from 2007–2015 with follow-up between 2 and 8 years saw an ectasia incidence of 0.033% over this timeframe. 5 “Over the 20+ years of experience since [the first LASIK cases], we’ve gained a lot of knowledge about both the corneal anatomy and the impact of LASIK on the cornea,” said Evan Schoenberg, MD. “Unfortunately, some of that knowledge is from experience because some patients have developed ectasia. Along the way we’ve also developed better diagnostic devices. I think the playing field has changed a lot since the early days of LASIK, and it’s a combination of better diagnostics and better awareness.” Maria Jose Cosentino, MD, had a similar viewpoint on the reason for decreasing post-refractive surgery ectasia incidence. “Nowadays the incidence of corneal ectasia after LASIK is decreasing due to, on one hand, the existence of risk-calculation indices (the new and updated traditional ones) and on the other hand, the new alternatives for the refractive treatment of moderate and high myopias that prevent the weakening of the cornea,” she said. Dr. Schoenberg said he thinks the biggest change to further reducing ectasia risk has been awareness of the risk factors for corneal ectasia and the development of scoring systems for those risk factors. “I like the Randleman ectasia score. I don’t think it says everything about the risk for ectasia, but it nicely summarizes some of the basic factors that we look at,” he said, noting the variables of the Randleman score: topographic pattern, predicted residual stromal Technology, screening improvements decrease already low refractive surgery ectasia risk This article originally appeared in the March 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Cosentino: majose.cosentino@icloud.com Schoenberg: evan.schoenberg@gaeyepartners.com by Liz Hillman Editorial Co-Director Common appearance of ectasia: Tomographies from each eye of a 39-year-old who had myopic LASIK in 2009 with progressive vision loss over the past 4 years. Source: Evan Schoenberg, MD