ARE THERE SPECIAL CONSIDERATIONS IN THE EVALUATION AND TREATMENT OF PATIENTS WITH HIGH ASTIGMATISM SEEKING LASER VISION CORRECTION?

When evaluating a patient for refractive surgery, the refraction and corneal topography are clearly important parts of the work-up. One factor that may be identified during this evaluation is high astigmatism (more than 2.0 diopters [D]). In the assessment of high astigmatism, one must take into account the degree, symmetry, and regularity of the astigmatism. High astigmatism, when asymmetric, irregular, or associated with decreased pachymetry, suggests an ectatic process that may worsen with refractive surgery. When high astigmatism is detected, closer evaluation of symmetry indices, pachymetry, pachymetric progression, and even corneal biomechanics, if available, is highly recommended to prevent postoperative ectasia.