Case 5 - Refractive

This a case of a 42 year old male that seeks iLASIK procedure.

MRx:    -5.25 -1.00 x 099 OD
            -5.25 -0.75 x 089 OS

Ultrasound Pachymetry 540 OD, 519 OS

Topographies of both eye obtained by ATLAS 995 are seen below:

The topographies are taken after the patient has been out of his soft contact lenses for over a month.  The PathFinder Corneal Analysis is noted as normal in both eyes; however, on the Axial maps of both eyes there is a bit of inferior steepening that is curious.  I performed a Visante Anterior Segment OCT imaging of the eye and a Global Pachymetry Map.  The Visante omni combines the data from the ATLAS above with the Global Pachymap.

The Visante omni of the right eye above generated the Holladay Report as standard printout.  In the small box on the top right corner, one can see the "Pachy Min: 480 [microns]" and in the bottom image of the left eye it is 479 microns.  These number differ from the ultrasound pachymetry above.  That is usually technician error even though Visante tends to reads central pachymetry about 15 microns thinner than most ultrasound pachymeters.

The more concerning area is the Anterior Elevation map in the top right shows a 3.31 micron anterior protrusion and the Posterior Elevation map in the bottom right shows a 9.88 micron anterior protrusion of the posterior corneal surface.  These numbers are mirrored similarly in the Holladay Report of the left eye below.

Despite the fact that he has demonstrated excellent refractive stability, relatively normal to flatter K's and "normal" topographies, I find that Visante omni was able to point out the subtle differences of the K's in both eyes, technician error in the pachymetry data collection, anterior bowing of the posterior corneal surface and lead me to label this patient as a Forme Fruste Keratoconus.

I encouraged him to continue with his glasses and the contact lens use.