A 28-year-old software engineer with −5.5 D myopia and −0.75 D astigmatism is being evaluated for LASIK. Corneal topography shows a mild inferior steepening and the thinnest point is 498 μm. The Ectasia Risk Score (ERS) is elevated. What is the MOST appropriate recommendation?
- A Proceed with standard LASIK as the refraction is within the safe range
- B Avoid LASIK; consider surface ablation (PRK) with mitomycin C ✓
- C Proceed with LASIK using a thicker residual stromal bed target
- D Perform corneal cross-linking (CXL) alone
Explanation
An elevated Ectasia Risk Score with inferior steepening on topography raises concern for subclinical keratoconus or forme fruste keratoconus, which is a relative contraindication to LASIK due to the risk of post-LASIK ectasia from hinge creation and flap cutting weakening the already compromised corneal biomechanics. Surface ablation (PRK with mitomycin C to prevent haze) preserves more anterior stromal integrity and is safer in such cases. Simply targeting a thicker residual bed with LASIK does not fully mitigate the biomechanical risk. CXL alone does not correct the refractive error.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.