To view this page ensure that Adobe Flash Player version 11.1.0 or greater is installed.
Expert Interview Corneal and External Eye Disease
The Importance of Diagnosing Ectatic
An Expert Interview with Renato Ambrósio Jr
Instituto de Othos Renato Ambrósio and Refracta-RIO, Rio de Janeiro, Brazil
Renato Ambrósio Jr
Professor Ambrósio is the Founder and Scientific Coordinator of The Rio de Janeiro Corneal Tomography and Biomechanics Study
Group. He is an Affiliated Professor of Ophthalmology of the Federal University of São Paulo, an Associate Professor of Ophthalmology
of Pontifícia Universidade Católica do Rio de Janeiro, and has recently been qualified as Adjunct Professor of Ophthalmology of the
Federal University of the State of Rio de Janeiro (UniRIO). He is the Director of Cornea and Refractive Surgery at the Instituto de Olhos
Renato Ambrósio, Visare-RIO Refracta Personal Laser. Professor Ambrósio attended medical school at the Fundação TE Souza Marques
(Rio de Janeiro, Brazil). He served residency in ophthalmology and had a cornea fellowship at the Instituto de Oftalmologia Tadeu
Cvintal (São Paulo, Brazil) from 1997–2000, and a further fellowship in cornea and refractive surgery at the University of Washington
(Seattle, WA, US) from 2000–2002 with Professor Steven E Wilson, MD (Professor and Chair). Dr Ambrósio received his PhD in science,
(concentration medicine-ophthalmology), in 2004, from the University of São Paulo, Brazil.
Keywords Corneal ectatic disease, imaging technologies,
Scheimpflug tomography, Pentacam, Corvis
Disclosure: Renato Ambrósio Jr is a consultant for
Oculus, Alcon, Zeiss, Allergan and Mediphacos. This is an
expert interview and as such has not undergone the
journal’s standard peer review process.
Acknowledgments: Medical writing assistance was
provided by Katrina Mountfort at Touch Medical Media.
Authorship: All named authors meet the International
Committee of Medical Journal Editors (ICMJE) criteria
for authorship of this manuscript, take responsibility
for the integrity of the work as a whole, and have
given final approval to the version to be published.
Open Access: This article is published under the
Creative Commons Attribution Noncommercial License,
which permits any non-commercial use, distribution,
adaptation and reproduction provided the original
author(s) and source are given appropriate credit.
Received: 30 November 2017
Published Online: 21 December 2017
Citation: European Ophthalmic Review, 2017;11(2):83–4
Corresponding Author: Renato Ambrósio Jr, MD, PhD,
Instituto de Olhos Renato Ambrósio, Rua Conde de
Bonfim 211 / 712 - 20520 - 050, Rio de Janeiro, Brasil.
Support: No external funding was received in the
development and publication of this article.
TOU CH MED ICA L MEDIA
E ctatic corneal disease (ECD) or corneal ectasia is a group of progressive eye disorders
characterised by thinning and bulging of the cornea, and can result in moderate to severe
impairment of vision. Recent advances in corneal imaging systems allow for the detection
of mild or subclinical stages of the disease, which is fundamental in the face of novel strategies for
minimising progressive ectasia after laser vision correction procedures, such as LASIK and SMILE. 1,2
At the European Society of Cataract and Refractive Surgeons (ESCRS) Annual Meeting, in Lisbon,
in October 2017, Renato Ambrósio Jr, Medical Director of the Instituto de Otho and Refracta-RIO,
Rio de Janeiro, Brazil, discussed the importance of diagnosing ECD and how advances in corneal
imaging technologies can enhance diagnosis.
Q: Why is ectasia so important?
There has been a great growth in interest in keratoconus and ECD. I consider ectasia to be not only
a disease, but a true novel specialty in ophthalmology. We have a lot of patients and tremendous
progression in technology to improve diagnosis, prognosis and treatment.
Q: What are the major challenges of diagnosing ECD, and how
have advances in corneal imaging technologies enhanced the
diagnosis of ECD?
Our challenge has evolved from the detection of very mild cases of the disease towards the
characterisation of the inherent susceptibility for ectasia progression. We have the technology to
characterise the front surface of the eye or topography. We also have tomography that provides
3D reconstruction, segmented tomography that provides epithelial mapping, and corneal
biomechanics. Other important information is the optical properties or the wavefront of the eye.
I am sure that in the future we will have more molecular biology tests. It is important that we
are conscious that these technologies generate a tremendous amount of information and we
should learn how to use these data to make good clinical decisions to better help our patients.
The integration of data with artificial intelligence has gained momentum, such as technology
that was developed with Scheimpflug tomography, and biomechanical data from Pentacam ®
(Oculus, and Corvis ® (Oculus, Wetzlar, Germany). 3 Note the examples of Figures 1 and 2, of a
case with very mild keratoconus that presented with a relatively low Kmax of 44.9 D in the right
eye, and even milder or fruste disease in the left eye. This patient had no history of contact lens
use, had distance corrected visual acuity of 20/20 but complained about the quality of vision.
In fact, he presented as a refractive candidate and such diagnositic sensitivity is fundamental
to screen such cases with higher risk for ectasia progression. Also, screening for ectasia risk