Randleman Criteria for Ectasia Risk

How it's scored

Each risk factor earns 0–4 points, and the total sets the risk category. Your patient's values are highlighted.

Points	4	3	2	1	0
Topography	Abnormal	Inferior steepening / SRAX	—	Asymmetric bowtie	Normal / symmetric bowtie
RSB (µm)	< 240	240–259	260–279	280–299	≥ 300
Age (years)	—	18–21	22–25	26–29	≥ 30
CCT (µm)	< 450	450–480	481–510	—	> 510
MRSE (D)	< −14	−12 to −14	−10 to −11.99	−8 to −9.99	> −8

Risk categories

Low risk (0–2 points): Low likelihood of corneal ectasia. LASIK may proceed with standard precautions.
Moderate risk (3 points): Intermediate likelihood of corneal ectasia. Additional evaluation and alternative surgical options should be considered.
High risk (4+ points): Significant likelihood of corneal ectasia. LASIK is generally not recommended.

RSB is calculated as CCT − flap − ablation depth (Munnerlyn: |SE| × optical zone² ÷ 3) unless you enter a measured value. The score was derived from patients 18 and older, and it does not include percent tissue altered (PTA): ectasia can occur in eyes with low scores, so also check PTA with the Munnerlyn calculator.

Randleman JB, et al. Risk assessment for ectasia after corneal refractive surgery. Ophthalmology. 2008;115:37–50. For clinical decision support only; verify results and use clinical judgment.

Randleman Criteria for Ectasia Risk

Risk Factors

Patient (for printout)

Randleman Risk Score

How it's scored

Risk categories