In this discussion, Dr. Perry Binder cautions that ectasia cannot be predicted based on risk factors, including residual bed thickness and patient age. A risk factor score greater than 3 does not guarantee ectasia will occur, nor does a zero risk factor score guarantee ectasia will not occur.

Post-LASIK ectasia, he argues, can be significantly reduced with improved measurement of corneal biomechanics, improved topographic screening, compulsory intraoperative measurements of all corneas and flaps, and a high-frequency ultrasound or OCT screening. Abnormal topography is the top risk factor for developing post-LASIK ectasia. Suspicion when faced with any topographic findings is essential. If the pachymetry is good, the patient is over 30 years of age, but the topography is abnormal, Dr. Binder recommends surgeons avoid LASIK.