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    Corneal tomography: Beyond but not in lieu of topography


    “The unoperated eye would be considered a good candidate for LASIK based on findings from standard screening methods, which included a normal front surface topography and central corneal thickness of 542 µm,” Dr. Ambrósio said.

    Similarly, tomography and biomechanical information identified subclinical keratoconus in eyes of identical twins, of which only one sibling had developed clinical keratoconus in one eye.15 One twin presented with VAE and subclinical (fruste) keratoconus in the fellow eye, and the sibling presented with bilateral fruste disease.

    A case involving a 16-year-old male with progressive loss of distance corrected visual acuity illustrated that while tomography can rule out keratoconus, additional anterior segment data was needed to establish the cause of the vision loss, which was a subluxed lens.13

    “Interestingly, the patient was being considered for corneal crosslinking based on loss of visual acuity and abnormalities seen on topography (Figure 2).  No evidence of ectasia was found on tomography (Figure 3), however, and the correct diagnosis was possible using the Scheimpflug images (Figure 4),” Dr. Ambrósio said.

    “Older technologies may be replaced, but this is not the case for Placido topography because the data it provides for the evaluation of the ocular surface and the tear film is still very relevant for clinical decisions. There is a need to be conscious about what we are trying to detect or measure.”

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