title: Topographic detection of photorefractive keratectomy.
abstract: OBJECTIVE
  This study aimed to evaluate the sensitivity and specificity of subjective review of corneal topography to detect patients who have undergone photorefractive keratectomy (PRK).
  
  
  METHODS
  Topographic maps from 3 different devices were obtained from 19 patients with postoperative PRK and 9 control subjects with emmetropia and 10 control subjects with myopia. Each image was printed in an absolute and relative scale (total of 228 maps) and graded for overall shape and pattern. Fifteen masked reviewers independently rated each map as either postoperative PRK or not.
  
  
  RESULTS
  The overall sensitivity (ability to detect PRK) and specificity rates (ability to exclude control subjects) by reviewers were 65% and 93%, respectively. Sensitivity was influenced independently by the scale (relative, 68%; absolute, 62%; P < 0.01), experience of reviewer (experienced, 77%; inexperienced, 53%; P < 0.001), and device (Alcon, 67 +/- 29.9; Eyesys, 75 +/- 29.4%; and Tomey, 54 +/- 31.7%; P < 0.001). Low levels of preoperative myopia were consistently more difficult to detect than higher levels (low myopia -1.50 to -2.99 diopters [D] sensitivity: 53 +/- 34.5%; medium level -3.00 to -4.49 D: 67 +/- 28.9%; and high level -4.50 to -6.00 D: 77 +/- 21.1%; P < 0.0001). Differences in specificity between experienced and inexperienced reviewers were obtained when maps had a homogeneous topographic pattern (97 +/- 5.6% and 85 +/- 13.7%, respectively; P < 0.05). Several control topography patterns (e.g., homogeneous, focal, and keyhole) were disproportionately more difficult to correctly identify on the Eyesys device.
  
  
  CONCLUSIONS
  Topographic experience is a significant factor influencing the correct identification of PRK. Techniques also can be used to enhance detection, such as the use of different devices and scales. However, if subjective review of topography is used as the only method of detection, many patients with PRK will not be identified properly. In addition, the most prevalent preoperative myopic category in the general population (myopia < -3.00 D) also is the most difficult to detect after treatment. This reduces the usefulness of topography as a screening tool. Other techniques are needed to improve the detection of patients with postoperative PRK.
authors.affiliation: Department of Ophthalmology and Clinical Investigation, Naval Medical Center, San Diego, California 92134-5000, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Schallhorn
authors.forename: J L
authors.initials: JL
authors.lastname: Reid
authors.forename: S E
authors.initials: SE
authors.lastname: Kaupp
authors.forename: C L
authors.initials: CL
authors.lastname: Blanton
authors.forename: L
authors.initials: L
authors.lastname: Zoback
authors.forename: H
authors.initials: H
authors.lastname: Goforth
authors.forename: C W
authors.initials: CW
authors.lastname: Flowers
authors.forename: P J
authors.initials: PJ
authors.lastname: McDonnell
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D019781:Corneal Topography / Q000379:methods*; D004311:Double-Blind Method; D006801:Humans; D054018:Lasers, Excimer; D009216:Myopia / Q000175:diagnosis* / Q000601:surgery; D015588:Observer Variation; D018903:Photorefractive Keratectomy; D011184:Postoperative Period; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity