Significance of corneal topography in predicting patient complaints after photorefractive keratectomy

To evaluate the sensitivity and specificity of postoperative corneal topography to predict potential patient complaints after photorefractive keratectomy (PRK). Doheny Eye Institute, Los Angeles, California, USA. Postoperative tangential corneal topographic maps, in 0.5 and 1.0 diopter (D) relative scales, were obtained from patients (n = 34) at least 4 months after PRK. Topographies of complaining (n = 18) and noncomplaining patients (n = 16) were analyzed by 6 masked examiners with 2 different experience levels in PRK (experts, n = 2; beginners, n = 4), who assigned the topographies to 1 of the 2 groups. Topographies of complainers (sensitivity) and noncomplainers (specificity)were correctly classified in 53.2% overall and in 44.0% and 63.5% ( P = .06) in complainers and noncomplainers, respectively. Experienced examiners were not significantly more accurate than inexperienced examiners (46.3% and 56.6%, respectively; P = .09). Images of 1.0 D scales received significantly more correct responses than those of 0.5 D scales (56.4% and 50.0% respectively; P = .03). The reproducibility between images for the same patient in both scales was significantly better for the experienced examiners than the inexperienced examiners (κ coefficient 0.73 and 0.51, respectively; P = .05). Subjective analysis of postoperative corneal topography alone is notsufficient to predict potential patient complaints after PRK. Topographic findings should be interpreted only in the context of a complete clinical examination.