Existing disease leads to worse outcomes
Many cataract and refractive surgery patients have undiagnosed dry eye. The PHACO study found the majority of patients screened for cataract surgery did not complain of dry eye symptoms, yet up to 80% showed conjunctival or corneal staining.1
For physicians, this can present a challenge as cataract surgery can increase the severity of dry eye by about one level and LASIK will increase the severity by two levels.
Postoperative outcomes are also worse in patients with existing dry eye than in patients without.
For LASIK, existing dry eye will impact wavefront and topography readings, leading to residual refractive error.
In cataract surgery, dry eye will lead to inaccurate IOL calculations and axis and magnitude of astigmatism.
The American Academy of Ophthalmology now considers uncontrolled dry eye a contraindication for refractive surgery. It is therefore critical that clinicians evaluate the ocular surface and treat any disease before referring the patient to surgery.
Diagnostic tools include patient-reported symptom questionnaires such as SPEED and tests such as Schirmer’s, phenol red thread, tear break-up time, and ocular surface staining.
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