LASIK vs ASA Case Studies

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Presentation transcript:

LASIK vs ASA Case Studies Alan C. Parent, M.D., F.A.C.S.

When I Recommend ASA 1. Pachymetry < 475 2. Residual bed < 275 microns 3. Post float/Ant float suspicious 4. Irregular topography 5. Corneal dystrophies

Elevation Map (normal) K Readings Anterior Elevation Map Corneal Pachs Posterior Elevation

Red Flags Posterior “float” greater than +20 (central 5mm zone) Anterior “bump” greater than +15 (central 5mm zone) Inferior corneal steepening Asymmetric astigmatism (Difference SI > then 1.5 diopters central 3mm) Decentered corneal apex

Other things to consider 1. Patient’s risk tolerance 2. Presence of ocular surface disease 3. High Myopia 4. Recovery time 5. Pain tolerance

Case #1 33 yo female OD -7.25-.75 x 165 20/20 OS –7.50-1.00x 30 20/20 Pachs 478 OD 477 OS Normal health Told “not a candidate for surgery”

Elevation OD

Elevation OS

Case #1 Candidate?

Patient received ASA OU Gentle w 20% ETOH 3 month post op: OD plano 20/20 OS plano -.25 x 80 20/20

Case #2 31 yo female OD -350-125x7 20/20 OS -150-100 x 155 20/20 Pachs 540/550 Normal health/eyes

Elevation OD

Elevation OS

Case #2 Surgery? If so , what procedure?

Ideal LASIK Candidate Correct age Correct refraction Good imaging Healthy eyes Reasonable expectations

Case #3 22yo male OD -800-350 x 179 20/30+ OS -775 -125 x001 20/20 Pachs 540-550 Normal exam

Elevation OD

Elevation OS

Candidate??

Topography

No Soup for You !!

Case #4 25yo FM OD -6.00 sph 20/20 OS -6.50 sph 20/20 Pachs 535-547 Hx, pt notes herself, mother and sister all have “had problems with contact lenses”.

Slit lamp Diagnosis?

Elevation OD

Elevation OS

Case #7 Candidate??

ASA Refractive and therapeutic Reduce risk of complications

Case #5 35 yo M OD-575-.25x83 20/20 OS -575-.25x125 20/20 Pachs 559 OD 561 OS Normal hx/SLE/fundus OU

Pentacam OD POST FLOAT

Pentacam OS

Candidate?

ASA with ectasia discussion NO LASIK

Thank You