Significance of corneal topography in predicting patient complaints after photorefractive keratectomy

Purpose: To evaluate the sensitivity and specificity of postoperative corne al topography to predict potential patient complaints after photorefractive keratectomy (PRK). Setting: Doheny Eye institute, Los Angeles, California, USA. Methods: 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 exp erience levels in PRK (experts, n = 2; beginners, n = 4), who assigned the topographies to 1 of the 2 groups. Results: Topographies of complainers (sensitivity) and noncomplainers (spec ificity) were correctly classified in 53.2% overall and in 44.0% and 63.5% (P = .06) in complainers and noncomplainers, respectively Experienced exami ners were not significantly more accurate than inexperienced examiners (46. 3% and 56.6%, respectively; P = .09). Images of 1.0 D scales received signi ficantly 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 pa tient in both scales was significantly better for the experienced examiners than the inexperienced examiners (kappa coefficient 0.73 and 0.51, respect ively; P = .05). Conclusions: Subjective analysis of postoperative corneal topography alone is not sufficient to predict potential patient complaints after PRK. Topogr aphic findings should be interpreted only in the context of a complete clin ical examination.