Case 4 - Guess

Modesto / Stockton / Tracy Cataracts & LASIK Surgeon – Dr. Ash
Case Presentation

46 year old white male presented for evaluation of his eyes. Medical history includes significant obesity and diabetes mellitus (5 years). Wants to know if his left eye (OS) is normal.

Uncorrected Visual Acuity: OS 20/30

MRx: OS Plano -1.00 x 075 --> 20/20>

Since the patient was in my office, I performed a Visante omni imaging of his eyes. Here is the left eye information below.

In the Holladay report above the "X" in the middle of the orange spots reads 8.51 microns of protrusion anterior to the best fit ellipsoid. the Area of blue just above it can be seen in the image below.

The "X" in the middle of the blue on the posterior elevation map in the bottom right read -6.03 microns below the best fit ellipsoid. So if you were to consider the difference between these 2 spots of the high and low, you have 14.5 micron difference (protrusion anteriorly).

He is 46 years old, with flat K's of 41.00 and 41.63, and a pachymap central pachy of 550's.

What would your answer be to him about his cornea in the left eye? Can he have LASIK?


Below is an enhanced anterior segment image of his other eye, the right eye (OD).

Here is also the topography:

This is a great educational case. You have a misleading relatively "normal" left eye with a grossly abnormal (keratoconic) right eye. He is scheduled for a corneal transplant surgery. The differences in the posterior elevation map points show a 14.5 micron forward protrusion and give the clue that the left eye is not as normal as we think. Are there other patient that have "normal" corneas that we miss? Visante omni clearly showed us that this was not the case!


Over the years, Dr. Ash has treated numerous individuals seeking LASIK in Stockton / Modesto. In order to deliver the best possible results for all patients, he uses state-of-the-art evaluation and surgical technologies. This approach allows Dr. Ash to realize vision correction dreams of all of his LASIK and cataracts Modesto / Stockton patients.

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