APR 2013

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

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April 2013 Dry continued from page 53 two techniques and the effects on dry eye. "Contrary to the conventional wisdom, we did not find any difference between PRK and LASIK," he said. Dr. Manche said people tend to believe that PRK causes fewer induced dry eyes, but his study did not yield these results, and over a 12month period, PRK and LASIK were essentially equivalent.1 Difference between a microkeratome and a femtosecond laser? punctal plugs. "By using punctal plugs, you can raise the tear film ahead of time." If a patient already has dry eyes, he will put in punctal plugs beforehand; he sometimes uses them after the procedure as well. He said treatment is very important, as well as bringing the patient back for repeat testing of topography, refraction, and wavefront. EW References Dr. Thompson said that between the microkeratome and femtosecond laser, he prefers the femtosecond laser because the microkeratome tends to cut deeper peripherally and thinner centrally, which can cause more dry eye. "We find that the thinner the flap, the less dry eye there is," Dr. Donnenfeld said. "We feel that the femtosecond laser provides a superior flap with less dry eye," he said about his practice in particular. Dr. Manche said he has done a study comparing the use of the microkeratome and the femtosecond laser.2 The cut for the femtosecond laser has the same thickness throughout, while the microkeratome has a meniscus-based flap, which is thicker in the periphery and thinner centrally. Dr. Manche said many believe the microkeratome induces more dry eye because of the possibility of severing some of the deeper nerves in the peripheral cornea. "We did not find that there was any significant difference between those two." Extra precautions for treating dry eye patients In terms of extra precautions for patients with pre-existing dry eye, Dr. Trattler said he often likes to use 1. Murakami Y, Manche EE. Prospective, randomized comparison of self-reported postoperative dry eye and visual fluctuation in LASIK and photorefractive keratectomy. Ophthalmology. 2012;119(11):2220-2224. 2. Golas L, Manche EE. Dry eye after laser in situ keratomileusis with femtosecond laser and mechnical keratome. J Cataract Refract Surg. 2011 Aug:37(8):1476-1480. Editors' note: Dr. Trattler has financial interests with Allergan (Irvine, Calif.), TearScience (Morrisville, N.C.), and Bausch + Lomb (Rochester, N.Y.). Dr. Donnenfeld has financial interests with AcuFocus (Irvine, Calif.), Abbott Medical Optics (Santa Ana, Calif.), Alcon (Fort Worth, Texas), Allergan, Bausch + Lomb, Physician Recommended Nutriceuticals (Plymouth Meeting, Pa.), and TearLab (San Diego). Dr. Manche has financial interests with Calhoun Vision (Pasadena, Calif), Refresh Innovations (Stanford, Calif.), Seros Medical (Palo Alto, Calif.), and Veralas (Mountain View, Calif.). Dr. Thompson has no financial interests related to the article. Contact information Donnenfeld: ericdonnenfeld@gmail.com Manche: edward.manche@stanford.edu Thompson: vance.thompson@vancethompsonvision.com Trattler: wtrattler@gmail.com On any of your mobile devices

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