J Bradley Randleman, MD
Surgical correction of ametropias and the identiﬁcation and management of corneal ecta- sias are separate but tightly intertwined issues of major signiﬁcance. Corneal morphologic imaging (topography and tomography) is critical to identify corneal ectatic disorders such as keratoconus and to appropriately screen patients to determine suitabil- ity for corneal refractive surgery. A variety of devices and strategies have been used with varying degrees of success, but discrepancy exists in terms of the rel- ative importance of various screening technologies and variables to identify the earliest manifestations of keratoconus.
Placido-based corneal topography, Scheimpﬂug imaging, and anterior segment optical coherence tomography, especially epithelial thickness varia- tions, all play a signiﬁcant role in identifying kerato- conic eyes in earlier stages. Despite multiple available technologies, there remains a gap in iden- tifying ectatic corneal disease at its earliest manifes- tation, and there remains signiﬁcant controversy and discrepancy in the literature about the relative value of different evaluations in distinguishing keratoco- nus suspect eyes from normal populations.The latest research shows that combining technologies pro- vides better discriminating capability than using any device in isolation.
Early identiﬁcation of corneal ectasias using current technology is critical, but current tests in the clinic are morphological, not biomechanical, and therefore do not allow a deﬁnitive diagnosis at the earliest stages, resulting in some patients incorrectly receiv- ing refractive surgery while others lose vision before cross-linking treatment is initiated. Thus, the need for accurate identiﬁcation of subclinical ectasia has never been greater. The next step in corneal imaging will address direct biomechanical measurements in an accurate, reproducible way. Brief Curriculum Vitae:
J. Bradley Randleman, MD, is Professor of Ophthal- mology at the Keck School of Medicine of USC and Director of the Cornea & Refractive Surgery Service at the USC Roski Eye Institute in Los Angeles, Cali- fornia. A widely respected cornea specialist, his areas of expertise include: corneal and intraocular refractive surgical procedures including LASIK and premium laser-assisted cataract and IOL surgery, complicated cataract surgery, and the management of corneal ectatic disorders. His primary research focuses on identiﬁcation and management of corneal ectatic diseases including keratoconus and postoper- ative ectasia after LASIK, and the avoidance, diag- nosis, and management of refractive surgical complications.
Dr Randleman received his BA degree from Colum- bia College at Columbia University in New York City, his M.D. degree from Texas Tech University School of Medicine in Lubbock, Texas, where he was elected to the Alpha Omega Alpha medical honour society in his junior year, followed by his Ophthalmology residency at Emory University in Atlanta, Georgia. Dr Randleman joined the Emory faculty and served as Assistant Residency Director for two years while also completing a fellowship in Cornea/External Disease, and Refractive Surgery at Emory University. He served as Director of the Emory Corneal Fellowship program until taking over as Director of the Cornea Service in 2010, and was named the Hughes Professor of Ophthalmology in 2016.
Dr Randleman has been awarded the Claus Dohl- man Fellow Award, the inaugural Binkhorst Young Ophthalmologist Award from the American Society of Cataract and Refractive Surgery, the Kritzinger Memorial Award, Founder’s Award, and the Inau- gural Recognition Award from the International Society of Refractive Surgery, and the Secretariat Award, Achievement Award, and Senior Achieve- ment Award from the American Academy of Ophthalmology.
Dr Randleman has served as Editor-in-Chief for the Journal of Refractive Surgery since 2011. He has authored more than 120 peer-reviewed publications in leading ophthalmology journals in addition to
30 book chapters on refractive surgery evaluation, corneal cross-linking, and management of complica- tions with IOLs, and has authored four textbooks, Collagen Cross-Linking and Corneal Cross-Linking 2nd Edition, which he co-edited on Farhad Hafezi, MD, PhD, Refractive Surgery: An Interactive Case-Based Approach, and Intraocular Lens Surgery: Selection, Compli- cations, and Complex Cases.
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