Irregular astigmatism after corneal refractive surgery an overview of the state of the Art

ABSTRACT

Irregular astigmatism is a challenging problem for the refractive surgeon. The aim of this paper is to describe the authors' experience and a present a literature review of the latest advances in the diagnosis and management of this difficult complication. We present a compilation of the different alternatives to treat irregular astigmatism secondary to corneal refractive surgery, as well as an innovative method to quantify the degree of irregular astigmatism, taking into account the clinical symptoms and the corneal aberrometric data. The outcome of the different choices to treat irregular astigmatism are presented, from contact lens fitting to the most recent ablative techniques based on corneal wavefront. Although irregular astigmatism is still one of the worst complications of refractive surgery, the better knowledge of the causes, the enhanced diagnostic devices and the improvement of the refractive surgical techniques have given the refractive surgeon a wide set of alternatives to improve the patients visual performance, and to avoid unwanted litigations.