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TOP STORIES 1/24/2006
Committee seeks understanding of post-LASIK keratectasia

Helen K. Wu, MD, said physicians need a better understanding of keratectasia.


WAILEA, Hawaii — The extent of knowledge about post-LASIK keratectasia is currently unclear, and a better understanding must be established through an evidence-based approach, according to a speaker here.

At Hawaiian Eye 2006, Helen K. Wu, MD, described recent efforts by an ad hoc committee seeking to address this gray area. She and other prominent refractive surgeons are members of the committee, which is headed by Perry Binder, MD, and Richard L. Lindstrom, MD.

The committee began its work, she said, after the now infamous case in which a New York jury awarded $7.25 million — the largest award to date — to a LASIK patient who claims he suffered severe vision damage from the surgery.

“[Following that verdict] it became clear that there was an extreme difference in opinion regarding the extent of knowledge about keratectasia, specifically about what the established risk factors are and when they became the standard of care,” Dr. Wu said.

She said she and her fellow committee members will seek to establish what is known about iatrogenic corneal ectasia – the incidence of which is unknown – and to create a registry of cases induced by LASIK or PRK, “in an attempt to provide an evidence-based approach.”

The group recently published a consensus opinion to summarize current knowledge about corneal ectasia. The paper was published simultaneously in the November/December issue of the Journal of Refractive Surgery and the November issue of the Journal of Cataract and Refractive Surgery.

Committee members also plan to address the matter at upcoming meetings, including a Hot Topics symposium at the American Society of Cataract and Refractive Surgery meeting in March, Dr. Wu said.

While cornea ectasia is rare, there are several known risk factors for its occurrence after LASIK, including high myopia, deep ablation, an unexpectedly thick flap, low residual stromal bed thickness and abnormal corneal topography, Dr. Wu said. Cases can also develop in the absence of surgery or any risk factors, although these are much less frequent.