Abstract
Purpose :
To determine how the addition of corneal epithelial thickness maps impacts patient screening for refractive surgery candidacy.
Methods :
A retrospective evaluation of 100 consecutive patients who were screened for refractive surgery candidacy was conducted. For each patient, screening based on Scheimpflug tomography, clinical data, and patient history was done and a decision on eligibility for corneal refractive surgery, and choice of surgery, was made by two masked reviewers. The reviewers were then shown the patient’s epithelial thickness maps derived from OCT. The percentage of screenings that changed after evaluating the epithelial thickness maps, with regards to candidacy for surgery, surgery of choice, and ranking of surgical procedures from most favorable to least favorable, was determined.
Results :
Candidacy for corneal refractive surgery changed in 17% of patients after evaluation of the epithelial thickness maps, with 41.18% of the changes resulting in screening out patients, and 58.82% screening in patients. In the subset of patients that remained eligible candidates for surgery, the surgery of choice changed in 20.83% of cases after evaluating the epithelial thickness maps. In that same subset, the ranking of surgical procedures, from most favorable to least favorable, changed in 36.11% of cases, with 13.89% of patients losing eligibility, and 11.11% gaining eligibility, for one or more surgical procedure. In the subset of patients in which eligibility for surgery, surgery of choice, and ranking of surgical procedures from most to least favorable did not change, the epithelial thickness maps increased the reviewers’ confidence in their decision in 49.12% of cases, decreased their confidence in 17.54% of cases, and had no impact on their level of confidence in 33.33% of cases.
Conclusions :
Epithelial thickness mapping derived from OCT imaging of the cornea alters candidacy for corneal refractive surgery, as well as choice of surgery, in a substantial percentage of patients, and is thus a valuable tool for screening evaluations. Overall, the use of epithelial thickness maps results in screening in a slightly larger percentage of patients for corneal refractive surgery.
This is a 2021 ARVO Annual Meeting abstract.