At a recent meeting of the Council on Refractive Technology, Dr. Michael Twa discussed the most significant risk of Lasik, kerectasia.
Kerectasia was a little-known corneal disease, most often an inherited tendency which as one ages into their twenties and thirties leads to poor vision by a progressive worsening of the shape of the cornea, becoming thinner and malformed. It was a disease only rarely seen by cornea specialists.
We now know that with the blossoming of lasik some of these genetically predisposed patients can be made worse if they undergo Lasik. Lasik became very popular from about 1997-2004 with significant kerectasia patients made worse, speeding up the natural worsening that would normally only occur with age.
Since the average Lasik surgeon never saw kerectasia before, they were not aware that Lasik could speed up the genetic process, therefore a surprising number of Lasik people developed kerectasia, not right away but within 24 months.
The Lasik community did not become aware of this effect until about 2003. This has lead many surgeons to abandon Lasik and select PRK for patients.
The most important way of preventing Lasik patients from developing kerectasia is to identify those with a genetic tendency for kerectasia. Instruments in the 1990’s and early 2000’s simply were not sophisticated enough to identify all potential cases before surgery.
Editor’s note: Current instruments are able to identify abnormal corneas most of the time, but the surgeon must use his/her experience and judgment to interpret these tests.