ABSTRACT
Techniques for refractive surgery have made tremendous strides since the pioneering work of Jose Barraquer and the introduction of radial keratotomy in the late 1970s (1). Traditional outcome measures for the efficacy of specific refractive surgeries are primarily uncorrected and best-corrected visual acuities and cycloplegic and manifest refractions. Corneal topography analysis has not been considered a primary outcome measure for clinical trials in the United States-this despite the fact that corneal topography is now the standard of care for preoperative screening of refractive surgical candidates and analysis of postoperative results and is a mainstay of anterior segment practice. Direct analysis by corneal topography has clearly shown the causes of visual loss after eventful refractive surgery. The best examples include the formation of central islands and peninsulas after surface ablation with the excimer laser (2) and induced generalized irregular astigmatism after automated lamellar keratectomy (3). In this chapter, the topographic characteristics of the presbyope and the current modalities for the correction of hyperopia are reviewed.
