Media Type: Textbook (Hardcover)

Synopsis: Keratoconus is an acquired ectasia of the cornea of unknown etiology leading to progressive myopic irregular astigmatism. Keratoectasia post-laser refractive surgery may represent a causal etiology or the inclusion of patients with form fruste keratoconus. Recent advances in diagnostic equipment including corneal topography, OCT, ocular response analyzer (ORA), and aberrometry have improved our ability to diagnose this condition earlier as well as avoid offering laser refractive surgery to patients with subclinical findings.

This book on keratoconus and keratoectasia, edited by Ming Wang, represents current concepts in diagnosis and treatment for any comprehensive ophthalmologist as well as subspecialist.

Target Audience: Corneal, refractive and general ophthalmologists.

Review: Dr. Ming Wang is a well-recognized international authority on the subject of keratoconus and keratoectasia. He is a uniquely qualified editor in that he brings a background of a PhD in the physical sciences as well as MD, and residency in ophthalmology. His fellowship training included genetics, molecular biology and external diseases. His peer review contributions to the ophthalmic literature in laser surgery and keratoconus are numerous and sustained.

The book is divided into 4 sections comprised of 18 individual chapters. This text would appeal to any ophthalmologist who practices comprehensive ophthalmology as well as corneal or refractive surgery.

In Chapter 2 of the first section, Dr. Dupps and his collaborators present their research in the biomechanical properties of the cornea. This has led to the development of the Ocular Response Analyzer (ORA), a clinical tool which has applications in identifying responses to a pulse pressure to evaluate corneal hysteresis as well as intraocular pressure measurement in keratoconic corneas.

The second section is devoted to defining keratoconus versus post-LASIK keratoectasia as well as legal ramifications of post refractive surgery ectasia.

The third section on diagnostic devices reviews surface topography systems as well as the importance of changes in the posterior corneal surface in post-LASIK ectasia patients. The use of ultrasound with OCT and wavefront aberrometry has further improved the ability to identify patients who are at risk of developing post LASIK ectasia.

The final section on treatment of keratoconus and keratoectasia will appeal to general ophthalmologists who fit contact lenses that still remains the mainstay of treatment. The actual surgical techniques for keratoplasty and excimer laser treatments for keratoconus are authored by surgeons outside of the United States. The information on collagen crosslinking, which should be FDA approved in the near future, has great potential based on current literature in the management of keratoconus and post LASIK ectasia. The ability to combine collagen crosslinking with excimer laser and INTACS will hopefully improved outcomes of therapies and avoid the risks of corneal replacement.

There are very few criticisms of this multi-authored text. Obviously, some of the international authors provide information and techniques not applicable to the US reader. The only criticism of the format of the book is the tables. They are printed with a blue gray background which makes reading data points difficult.

In summary, this text provides a well-written summary of current concepts of the diagnosis and treatment of keratoconus and keratoectasia. New information form cornea biomechanics has applications in other disease states making it valuable to the general ophthalmologist. The ability to use topography as an absolute indicator of keratoconus in early cases still remains elusive but the addition of ancillary tests of ORA, aberrometry, and OCT narrows the gap and increases the ability of the practitioner to offer laser refractive surgery to those patients who will benefit and avoid the complication of post LASIK ectasia.