APR 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/119916

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February 2011 April 2013 EW REFRACTIVE SURGERY 53 Refractive editor's corner of the world Dry eye effects on corneal refractive procedures by Ellen Stodola EyeWorld Staff Writer D ry eye is an often overlooked yet frustrating issue in refractive surgical patients. We know it becomes more prevalent as part of the aging process. Aqueous deficient and evaporative dry eye are common etiologies. It's important to recognize dry eye preop in order to optimize the precorneal tear film (the refracting surface of the eye). Dry eye can affect the accuracy of preop measurements and can complicate postoperative healing. Many contact lens patients that present for LASIK surgery are contact lens intolerant because of their dry eye (which the patient, of course, is not aware of). In this month's "Refractive corner of the world," we asked several experts their thoughts about dry eye and refractive surgery. Kerry Solomon, MD, refractive editor P atients at risk for dry eye or who have a pre-existing condition may require extra consideration before corneal refractive surgery, but this does not completely exclude them from having these procedures. According to experts who spoke to EyeWorld, dry eye needs to be recognized and managed for a patient to have a successful surgery. Can dry eye patients have corneal refractive procedures? William Trattler, MD, Center for Excellence in Eye Care, Miami, said a pre-existing dry eye condition is not automatically a reason for a patient not to have a corneal refractive procedure. "I think it's important that we carefully evaluate that person prior to surgery," Dr. Trattler said. A high percentage of patients who desire a corneal refractive procedure actually have dry eye, he said. "The key thing is to identify it and treat it." Dr. Trattler said if a patient has dry eye ahead of time and it's not addressed, this could lead to the condition worsening or the procedure having poor results. Eric Donnenfeld, MD, clinical professor of ophthalmology, New York University Medical Center, New York, agreed that patients at risk for dry eye or with pre-existing dry eye are not automatically excluded from corneal refractive procedures. "If someone has dry eye but you manage it appropriately preoperatively, you often turn poor candidates into very good candidates for refractive surgery," he said. Dr. Donnenfeld said that dry eye is one of the most common problems seen after corneal refractive surgery, especially LASIK. Edward Manche, MD, director, cornea and refractive surgery, Stanford Eye Laser Center, and professor of ophthalmology, Stanford University School of Medicine, Palo Alto, Calif., said it is different for each patient. "It depends on the severity of the pre-existing dry eye," he said. He said dry eye in some patients would definitely exclude them from having a corneal refractive procedure, while others can be managed and treated so they will be better candidates. can cause issues for patients with pre-existing dry eye. "If they're dry enough that I'm concerned, I'm not comfortable doing either," he said. He's comfortable using either PRK or thin-flap LASIK on someone with dry eye who responds well to therapy, but it depends on each individual patient. Both Drs. Donnenfeld and Trattler said that there is not a major difference between doing PRK or LASIK on patients with dry eyes. For many years, Dr. Trattler said, it was thought that PRK caused fewer dry eyes, but more recent data shows that the risk for dry eye is about the same for both techniques. "Both procedures have the same impact on dry eye," he said. "If you are aggressive and treat it ahead of time and get it under control, dry eye typically is not a major issue postoperatively for patients." Dr. Manche agreed and said he worked on a study that essentially showed no difference between these continued on page 55 Lissamine green conjunctival staining in a patient with dry eye disease PRK or thin-flap LASIK? Vance Thompson, MD, Vance Thompson Vision, Sioux Falls, S.D., said both PRK and thin-flap LASIK Severing of the corneal nerves following LASIK can result in neurotrophic dry eye. Source (all): Eric D. Donnenfeld, MD

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