Eamon N. Dreisbach , 2025-04-26 13:30:00
April 26, 2025
1 min read
Key takeaways:
- Topography-guided laser vision correction offers several benefits for patients with irregular astigmatism.
- The procedure is not dependent on pupil size and can be measured reproducibly.
LOS ANGELES — Topography-guided laser vision correction offers several benefits: It is not dependent on pupil size, can be measured reproducibly and is not influenced by vitreous opacities, according to a speaker.
During Refractive Day at the American Society of Cataract and Refractive Surgery meeting, Karl G. Stonecipher, MD, offered an overview of and general advice for topography-guided excimer laser ablation in patients with irregular astigmatism.
Image: Eamon N. Dreisbach
Topography-guided laser vision correction offers an alternative to correct higher-order refractive errors, he said. Top candidates include patients with asymmetric astigmatism, corneal decentrations, central islands, post-penetrating keratoplasty corneal scarring or previous corneal cross-linking.
There are multiple protocols available for topography-guided laser vision correction, he said.
“For the most part, you find one, stick to it, nomogram it as best as you can and then work through the process,” he said.
Stonecipher’s preferred method for topography-guided excimer ablation is to use –4 D with the WaveLight laser (Alcon) to remove 60 µm of epithelium and “then go on and divide that up and make a topographic treatment after that.”
Small aperture lenses should also be considered.
“People have lens changes, so go do a cataract procedure to put in an IC-8, or an Apthera, lens (Bausch + Lomb),” he said. In post-LASIK patients, “if you’re going to remove the epithelium, try and find the surgeon that did the initial surgery.”
If customized treatment is necessary, the epithelium can be removed with alcohol, or a transepithelial approach can be used.
Contact lens trials can be beneficial in patients with irregular corneas, Stonecipher said, using astigmatic lenses.
“Try and see what the patients need, what they like and what they can wear, and you will be surprised at how that helps you with outcomes,” he said.
Sources/Disclosures
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Stonecipher KG. Treating irregular astigmatism with topography guided excimer ablation. Presented at: American Society of Cataract and Refractive Surgery meeting; April 25-28, 2025; Los Angeles.
Disclosures:
Stonecipher reports having financial disclosures for Alcon, Allergan/AbbVie, Alphaeon, Attia Vision, Bausch Health, Blink Energy, CSI, Dompe, Espansione, Eyevance Pharmaceuticals, EyePoint Pharmaceuticals, Johnson & Johnson, Presbia, Rayner, STAAR Surgical, Surface and Tarsus.
