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Skewed topography

Q:

27 year old woman wants Lasik.

MR

-5.75 +0.50 x 95 20/20

– 5.25+0.50 x 85 20/20

Pachs 574 OD, 599 OS

Topographies attached.

What concerns me is the skewed topography left eye.

Would you recommend:

1. No refractive surgery

2. PRK

3. Lasik

Thanks,

David

Atlanta, GA

A:

Hi David

In general, if the axis of the astigmatism lines on topography/Orbscan/Pentacam up with a patient’s other refractive data, eg MR, AR, wave scans, etc, I don’t call this a skew and just attribute the pattern to the corneal topography accurately reflecting the patient’s astigmatism, which in such cases are primarily corneal in nature, rather than lenticular, for example.

I don’t work in + cylinder notation, but isn’t this the case in your case?

I’m wondering what the group’s consensus is about the use of the word “skew”? Deviating from 90/180? Or deviating from the other refractive data for cyl?

If so, then I wouldn’t be worried about anything, and I would think LASIK wouldn’t be contraindicated. She’s got plenty of tissue, manifests to 20/20, and I assume you can get old eyeglass data to confirm the degree of her astigmatism has been stable

If the Topo axis doesn’t align with her refractive axis, that in itself isn’t necessarily always that worrisome, because couldn’t she just have more lenticular than corneal cyl? But in this case I’d suggest an ASA (LASEK or epiLASEK)

The decision on whether to perform incisional vs non incisional surgery is easier for me, since as you know I’m 100% ASA

Hope you’re doing well. It’s been a long time since I’ve seen you in person–20 years!

I also have a question for you personally if you still have fellows, as I’ve got a problem situation with a current fellow I’d like your guidance on about how to deal with it

Looking forward to catching up!

Yours

Emil William Chynn, MD, FACS, MBA

Harvard/Columbia/Dartmouth/NYU/Emory-trained

No other laser vision correction surgeon in New York….

No other laser vision correction surgeon in New York....

...offers you the opportunity to have a Free Remote Consultation with the surgeon! Ask Dr. Chynn your main question or concern, and will answer, personally, within 2 business days!

Unsure whether you're a good candidate because of a lot of astigmatism? Large pupils? Dry eyes? Maybe you were rejected by LASIK surgeons due to a “thin cornea” or high prescription.

Take advantage of this incredible opportunity to find out if LASEK is an option for you from Dr. Chynn, our famous, cornea fellowship-trained, Columbia & Harvard graduate who’s in MENSA & was the 1st eye surgeon in NY, NJ, CT & PA to get LASIK, & has performed 1,000 PRKs, 5,000 LASIKs, 10,000 LASEKs, and 5,000 epiLASEKs

But please be considerate. Dr. Chynn gets paid $1,000/hour as a consultant for expert networks & expert witness, so please limit yourself to your most pressing question or concern, as he’s doing this for free on a trial basis to help interested patients.

Please include the information below in your email so Dr. Chynn can answer your question specifically.

Age:
Approximate prescription (if known):
Occupation (the more specific the better):
Main barrier or concern:

  • This field is for validation purposes and should be left unchanged.

Tell Dr. Chynn your main barrier so he can help overcome it😉👌

Email us at dr@ParkAvenueLASEK.com
Text us at (212) 691-4221

Contact Dr. Chynn

x

Tell Dr. Chynn your main barrier so he can help overcome it😉👌 Email us at dr@ParkAvenueLASEK.com Text us at (212) 691-4221

No other laser vision correction surgeon in New York….

No other laser vision correction surgeon in New York....

...offers you the opportunity to have a Free Remote Consultation with the surgeon! Ask Dr. Chynn your main question or concern, and will answer, personally, within 2 business days!

Unsure whether you're a good candidate because of a lot of astigmatism? Large pupils? Dry eyes? Maybe you were rejected by LASIK surgeons due to a “thin cornea” or high prescription.

Take advantage of this incredible opportunity to find out if LASEK is an option for you from Dr. Chynn, our famous, cornea fellowship-trained, Columbia & Harvard graduate who’s in MENSA & was the 1st eye surgeon in NY, NJ, CT & PA to get LASIK, & has performed 1,000 PRKs, 5,000 LASIKs, 10,000 LASEKs, and 5,000 epiLASEKs

But please be considerate. Dr. Chynn gets paid $1,000/hour as a consultant for expert networks & expert witness, so please limit yourself to your most pressing question or concern, as he’s doing this for free on a trial basis to help interested patients.

Please include the information below in your email so Dr. Chynn can answer your question specifically.

Age:
Approximate prescription (if known):
Occupation (the more specific the better):
Main barrier or concern:

  • This field is for validation purposes and should be left unchanged.