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Expert Interview Corneal and External Eye Disease The Importance of Diagnosing Ectatic Corneal Disease 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. E: dr.renatoambrosio@gmail.com 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 83