March consultation #5

and some 20 degrees rotated, cylinder change. Figure 2 may be interpreted as a slight decentration superiorly, an estimate of up to 0.5 mm superior decentration, but this is difficult to confirm from sagittal curvature without preoperative topography. Preoperative topographies and local curvature maps would be helpful and perhaps particularly relevant for the 1-year measured refraction. In my opinion, the overcorrection might be due to overplanning. My recommendation for correction is anterior segment optical coherence tomography and detailed diagnostic evaluations. But one could check whether a simple +1.50 D reaches good VA, as well as comparing the CDVA and quality of vision for +2.25 D 0. 25D × 8 with +2.50 D 1.25 D × 140. Placing a rigid gas-permeable contact lens in the left eye to see if quality of vision improves can help determine if corneal wavefront-guided (CWFG) ablation is required. If CWFG ablation is required, the residual hyperopia can be treated either with CWFG or aberration-free ablation after determining a refraction closer to that predicted by topography. An optical zone of 6.7 mm should be used with CWFG ablation, and a 6.3 mm with aberration-free ablation. Likely relift would be the most reasonable technique. If CWFG ablation is required, then transepithelial photorefractive keratectomy can be also considered, despite the hyperopic refraction.