Corneal Asphericity and Its Implications for Photorefractive Keratectomy: a Mathematical Model

BACKGROUND: Several clinical trials investigating myopic excimer laser photorefractive keratectomy (PRK) report an initial change in refraction from myopia to hyperopia, followed by a gradual regression toward emmetropia and occasionally to recurrent myopia. We examined the effect of corneal shape on refraction following PRK for myopia using a mathematical model. METHODS: We calculated the volume of corneal tissue removed by PRK for -3.00-diopter (D) and -6.00-D corrections with ablation diameters of 5 mm and 6 mm. For all the operating algorithms, the central region of the cornea was considered spherical. Mathematical models were developed based on calculations of the apical radius of the ablated cornea and the final refraction for a range of corneal asphericities. Baker's equation was used to model corneal asphericity. RESULTS: The smaller both the ablation size and desired correction, the smaller the effect of corneal asphericity on the refractive outcome. While corneal asphericity can influence the immediate refraction after PRK, the maximum effect is unlikely to be greater than +0.75 D. CONCLUSIONS: Corneal asphericity marginally affects the initial outcome of PRK. The effect will probably be offset by the healing response of the cornea.