Safety Guidelines and Preoperative Assessment for Refractive Surgery: Challenges in High Myopia and Corneal Risk Factors

侯鈞賀 Chiun-Ho HouTaiwan Speaker Safety Guidelines and Preoperative Assessment for Refractive Surgery: Challenges in High Myopia and Corneal Risk FactorsRefractive surgery has evolved substantially over the past decade, offering increasingly precise and predictable outcomes. Yet, ensuring patient safety—particularly in individuals with high myopia or underlying corneal risk factors—remains a core responsibility in clinical decision-making. This presentation provides an updated, evidence-based overview of safety guidelines and preoperative assessment strategies essential for optimizing refractive surgery outcomes. We will begin by reviewing current standards for evaluating refractive stability, corneal biomechanics, epithelial thickness mapping, and posterior elevation indices. Special emphasis will be placed on the identification of subclinical keratoconus and forme-fruste ectasia, conditions that significantly elevate the risk of postoperative corneal ectasia. Practical screening algorithms—including integration of tomography, biomechanical testing, and individualized risk calculators—will be discussed to support accurate risk stratification. High myopia presents unique challenges, including thinner corneas, greater ablation depth requirements, and a potentially higher susceptibility to biomechanical decompensation. The talk will highlight recent data on surgical candidacy thresholds, residual stromal bed safety margins, and considerations for choosing between LASIK, PRK, SMILE, or phakic IOL implantation in this population. Case-based examples will illustrate real-world pitfalls and decision-making nuances encountered in screening high-risk patients. Finally, updated consensus recommendations and emerging technologies for improving preoperative detection and enhancing surgical safety will be summarized. By reinforcing rigorous assessment protocols and individualized risk evaluation, this presentation aims to support ophthalmologists in delivering safer, more predictable refractive surgery outcomes for patients with high myopia and complex corneal profiles.