Case 1 - Refractive

LASIK – Stockton, Modesto, Tracy, Manteca, Modesto
Dr. Ash – Refractive Case Study

40 year old female presents for laser vision correction evaluation.

OD -0.50-4.25x004 --> 20/20
OS Plano-4.50x001 --> 20/25+2

OD Plano-4.50x180 --> 20/25
OS +0.25-5.25x180 --> 20/25-

Ultrasound Pachymetry:
OD 484 sd 2.1
OS 494 sd 7.6


So at this point there are a number of concerns!

1) patient has a fairly thin central cornea on the ultrasound pachymetry.
2) Patient has very high cylinder OU with K's as noted in the TOPO's

But, patient is 40 and has had stable refractive for many years.

What will you consider for this patient?
a) No surgery
b) PRK
c) Blade LASIK
d) Femtosecond LASIK

Do you need more data? See the Holladay reports from the Visante omni below.

In the Holladay reports above you can see that the Anterior Axial Curvature map from the ATLAS is combined with the Global Pachymetry Map from the Visante to produce the Posterior Elevation Map in the bottom right hand. The Map of the right eye above is missing data in the inferior portion.

I personally like to have the full ATLAS report as presented above. I personally like to see the Placido image to make sure of centration and the quality. I also review the images of the Visante pachy scans (not presented here) to make sure of the quality as well. In this case the data for the right eye are fair placido, but a relatively poor pachymetry Visante images. The images were too dark and poor recognition of the corneal surfaces lead to a poor Holladay report. The posterior elevation map is none the less a relatively normal map as the areas of elevation are not in the inferior position (the red spots).

Left eye has good placido image and good Visante image pachymetry scans (not presented here). The Holladay report presented a very regular, normal looking posterior elevation map.

In my opinion the ultra-conservative folks may chose not to do any surgery. The conservative folks may chose to do PRK. I think the Blade LASIK is a poor choice. IntraLase LASIK with 90 micron flap is an option and will still retain a residual stromal bed of at least 300 microns.

What are your thoughts? Email me at

As a highly experienced Modesto / Stockton LASIK eye surgery specialist, Dr. Ash performs every procedure with the utmost attentiveness and dedication. He uses the same approach when operating on Stockton / Modesto cataracts patients. As a result, he is able to consistently deliver highly rewarding vision correction results.

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