Screening for corneal topographic abnormalities before refractive surgery.

PURPOSE: The purpose of this prospective study is to evaluate the corneal topography of patients who sought an opinion regarding refractive surgery for the correction of myopia.
METHODS: Both eyes of 53 patients were evaluated with a topographic modeling system. Forty-two patients wore contact lenses (84 eyes: 36 rigid contact lenses and 48 soft contact lenses). Ten patients (20 eyes) wore glasses alone and one patient (2 eyes) wore neither glasses nor contact lenses for correction of myopia.
RESULTS: Thirty-five (33%) of 106 eyes were found to have abnormal corneal topography. Of the 42 patients (84 eyes) who wore contact lenses, 32 eyes (38%) had irregular astigmatism, loss of radial symmetry, or absence of the normal progressive flattening from the center to the periphery of the cornea, consistent with contact lens-induced corneal warpage. Alterations were more frequent and severe in rigid contact lens wearers. Three patients (5.7%) received a diagnosis of definite keratoconus, a higher incidence than has been reported in the general population. Topographic abnormalities in most, if not all, of the eyes would not have been detected by visual inspection of the photokeratoscopic images alone.
CONCLUSIONS: Appropriate preoperative detection and management of corneal topographic abnormalities are essential steps in every refractive surgical procedure. The overall efficacy and safety of procedures such as radial keratotomy and photorefractive keratectomy likely will be improved once the unpredictable variables of contact lens-induced warpage and occult ectatic disease are eliminated by topographic screening before surgery. Patients with keratoconus may be over-represented in the refractive surgery population due to self-selection.