Laser refractive procedures such as laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) are considered some of the most ground-breaking inventions in elective eye surgery.
As a post-PRK patient and OD who manages pre- and postop visits for a large OD/MD practice specializing in refractive surgery, I have seen firsthand the benefits of being able to wake up on any given day and just see.
I have found that the best way to combat postoperative dry eye is to know about it pre-operatively. Many patients seek refractive surgery due to the inability to tolerate contact lenses, and it is thought that the prevalence of patients already suffering from dry eye symptoms prior to refractive surgery ranges from 38 percent to 75 percent of patients.1
Taking the time to explain to each patient exactly why it is necessary that their corneas be “primed and prepped” before surgery is an important step in the pre-op process. Forgoing aggressive treatment of dry eye disease (DED) and ocular surface irregularities may cause surgery to be delayed, or worse, the end results may not be as precise as they could have been.
Although there is no way to predict post-refractive dryness for an individual patient, pre-existing dry eye disease is a known risk factor for ocular surface problems after refractive surgery.2
Postoperatively, up to 95 percent of patients experience symptoms of dry eye at some point over the first three months after surgery, which often improves with time.2
The quicker optometric physicians can identify the cause of a patient’s subjective complaints, the faster patient satisfaction can be improved and the need for surgical enhancements minimized.
Before referring a patient for surgery or a refractive enhancement, ask: Has everything been done in order to solve the all ocular surface concerns?
To help triage a post-refractive surgery patient who is seeing well—but who may be symptomatic with “blur,” “glare,” or “halos”—assess the following before referring for an enhancement.
1. Cohen E, Spierer O. Dry Eye Post-Laser-Assisted In Situ Keratomileusis: Major Review and Latest Updates. J Ophthalmol. 2018 Jan 28;2018:4903831.
2. Yu EY, Leung A, Rao S, Lam DS. Effect of laser in situ keratomileusis on tear stability. Ophthalmology. 2000 Dec;107(12):2131-5.
3. Solomon R, Donnenfeld ED, Perry HD. The effects of LASIK on the ocular surface. Ocul Surf. 2004 Jan;2(1):34-44.
4. Edwards JD, Burka JM, Bower KS. Effect of brimonidine tartrate 0.15% on night-vision difficulty and contrast testing after refractive surgery. 2008 Sep;34(9):1538-41.