Update on topography and tomography for refractive surgery

To review and summarize the current literature on recent advances in corneal topography and anterior segment tomography, highlighting emerging technological advances and the integration of artificial intelligence, and their clinical applications in screening, planning, and optimizing outcomes of modern refractive surgery.

A comprehensive review of the recent literature was conducted using the PubMed, Scopus, and Web of Science databases to identify peer-reviewed articles published within the last 18  months that focus on advancements in corneal imaging technologies, including Placido-based topography, Scheimpflug imaging, and swept-source anterior segment optical coherence tomography (SS-ASOCT). Comparative studies, diagnostic accuracy reports, and new indices and software for ectasia risk assessment were analyzed.

Recent innovations in corneal topography and tomography have greatly improved the ability to detect subclinical keratoconus, evaluate corneal biomechanics, and develop personalized surgical plans. The integration of 3D corneal mapping, epithelial thickness profiling, and artificial intelligence-based analysis has increased diagnostic accuracy and safety in refractive procedures. These developments enable earlier detection of at-risk corneas and more accurate prediction of postoperative stability.

Advances in topography and tomography continue to improve the safety and predictability of refractive surgery. The use of multimodal imaging and AI-based diagnostics is transforming preoperative assessment and postoperative care, leading to more personalized and reliable visual outcomes.