Keratoconus is generally considered a contraindication for excimer laser refractive surgery, since it is expected that the progression of ectasia is likely to be hastened by the removal of central corneal tissue. Some authors have suggested that the risk is greatly exaggerated and have reported no evident acceleration of ectasia from 6 to 46 months after performing surface photorefractive keratectomy (PRK) on patients with a clinical diagnosis of keratoconus.1 While experience is limited and follow-up brief, these results have prompted others to perform PRK in eyes that might be classified as forme fruste keratoconus; ie, those eyes demonstrating topographic changes suggestive of keratoconus but without notable thinning, ectasia, or scarring. It might be argued that such corneas might share biomechanical properties with those that demonstrate true keratoconus, and so demonstrate an increased tendency toward progression of thinning, myopia, and astigmatism after surgery. Indeed, Kremer et al2 have demonstrated in a study of 8 eyes in 6 patients with mild keratoconus (compound myopic astigmatism and topographic features consistent with keratoconus without notable ectasia, thinning, or scarring) who were followed for more than 3 years after undergoing surface PRK that while most experienced improvement in unaided vision, 1 suffered progression of keratoconus. Conversely, Doyle et al,3 arguing that topographic evidence of inferior corneal steepening in the absence of clinical signs consistent with keratoconus is often artifactitious, performed PRK in 4 such eyes and found the results comparable to those expected in normal eyes with myopic astigmatism.