Case 2 - Refractive

Stockton LASIK Eye Surgery Specialist – Dr. Ash
Refractive Surgery Case Study

37 year old male seeks laser refractive procedure.

OD Plano -2.50 x 085 --> 20/15
OS +0.25 -3.00 x 095 --> 20/15

OD +0.75 -2.50 x 090 --> 20/15
OS +1.00 -3.00 x 095 --> 20/15

Ultrasound Pachymetry:
OD 603 sd 3.9
OD 608 sd 11.9

Here is a case of a young patient that has high astigmatism that is different that most folks his age. Most folks have astigmatism in the vertical axis; his is in the horizontal axis. Where as keratoconic patients have their astigmatism in the vertical axis, pellucid patients have it in the horizontal axis. Pellucid patients also don't have much central thinning, so does our ultrasound pachy miss the point?

Given the above information, what would you do?
a) No Surgery
b) PRK
c) Blade LASIK
d) FemtoSecond LASIK

Well, given that I have a Visante omni, I did a Global Pachymetry Map. The Visante omni's Holladay reports are noted below.

In the case above, when reviewing the topo's I like to look the placido image to confirm quality and centration. In the Visante omni (not presented here) I do review the accuracy of surface matching on the global pachymetry scans. All seem to be of good quality. The Holladay report here combines the topographic data from the ATLAS topographer with the pachymetric data from the Visante omni to create the posterior elevation data in the bottom right image.

The right eye seems to have a perfectly normal map with a mild posterior depression into AC rather than any protrusion forward. In the Left eye there is a mild colorful map, but there is again a central depression into the AC and maybe a mild forward protrusion in a horizontal position. This all seems to me a noise rather than any pathology. My fears about pellucid marginal degenration are fairly alleviated.

I have chosed to proceed with iLASIK. What are your thoughts? Email me at

Dr. Ash is a talented ophthalmologist who has been recognized as a leading Stockton and Modesto LASIK eye surgery expert. In addition, he specializes in cataract surgery and has helped numerous cataracts Stockton / Modesto patients achieve youthful vision while reducing their dependence on glasses.

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