Dr. J. Bradley Randleman discusses a new risk-score model for assessing post-LASIK ectasia risk in an interview with refractive editor Dr. David Goldman. Five risk factors were identified: 1.) topographic abnormalities, 2.) low residual stromal bed thickness, 3.) young age, 4.) low preoperative corneal thickness, and 5.) myopia. Dr. Randleman then comments on thin-flap, or SBK, in the context of the tensile strength of the various layers of the cornea. In treating ectasia patients, gas permeable contact lenses alone have shown promise. Trials evaluating corneal cross-linking with riboflavin and UVA are underway at ten sites in the US including Emory. Dr. Randleman reviews some of the preliminary results. Combining various ectasia treatments CCR, intracorneal ring segments, and even PRK on top of the flap is discussed. Achieving spectacle independence is possible in many cases.