Eyeworld

SEPTEMBER 2022 | EYEWORLD | 51 R by Liz Hillman Editorial Co-Director About the physicians Kathryn Hatch, MD Assistant Professor of Ophthalmology Harvard Medical School Boston, Massachusetts Gregory Parkhurst, MD Parkhurst NuVision LASIK Eye Surgery San Antonio, Texas W ith advanced screening param- eters and improved surgical techniques and technologies, the follow-up for refractive surgery—whether it be corneal or lenticular-based refractive correction—has become routine and, in most cases, fairly un- eventful. But EyeWorld caught up with Kathryn Hatch, MD, and Gregory Parkhurst, MD, for a refresher and some important things to remem- ber in the short- and long-term follow-up with post-refractive patients. In general, Dr. Parkhurst said, regardless of the refractive surgery performed, in the early postop period, the surgeon is looking at un- aided vision at the target that was selected for the treatment. He added that most refractive surgery patients are myopic and being corrected for distance vision. In presbyopia patients who have received refractive surgery, Dr. Parkhurst said distance, intermediate, and near is evalu- ated. Patients in all cases are also counseled to make sure they are compliant with appropriate postop instructions (prophylactic antibiotic drop and steroid use, artificial tears, wearing shields/ googles, etc.). Dr. Parkhurst said long-term, annual follow- up of post-refractive patients is important to monitor the success of their refractive surgery but also because previously myopic eyes are more at risk for other ocular comorbidities unre- lated to the refractive surgery. "Just because we're able to correct a refrac- tive error in the cornea of a myope, we're not making their otherwise myopic eye anatomically non-myopic," he said. "We know that myopes are at risk for other unrelated ocular pathology; specifically, we know that high myopes have greater risk for retinal issues including reti- nal tears, retinal detachments, and glaucoma is more prevalent in high myopes as well as cataracts. Additionally, highly myopic eyes have risks for other comorbidities, and those things need to be monitored for even if they've had their refractive error treated." Corneal refractive surgery As with any surgery, Dr. Hatch said corneal refractive surgery (LASIK, SMILE, and PRK) has an acute healing phase early on, and long-term follow-up is advised to monitor for stability. If a patient experiences issues such as dry eye, vi- sual changes, or a need for a second procedure such as an enhancement, they should be mon- itored and treated, if necessary. Dr. Parkhurst noted the importance with corneal procedures to look for DLK at the interface and treat it if observed. Dr. Hatch said she sees patients at postop day 1 and, if they look good, patients will come back at postop week 1. From there, she'll see them at 6–8 weeks and once or twice again in the first year. With PRK patients, she'll see them also at postop day 4 to remove the bandage contact lens and postop week 2 for a pressure check because they're on a longer course of steroids. On an annual or biannual basis, Dr. Hatch said she likes to see patients to check on their general eye health (sooner if the patient experi- ences changes in vision), including topography measurements. "As a general practice, I think it's good for all patients after keratorefractive surgery to not only have baseline topography but serial follow- up scans such that if they were to develop a change, you'd know," Dr. Hatch said. "I think that's often what is lacking when I get a referral for patients with ectasia. I don't typically have prior topographies." In general, Dr. Hatch said if a post-refrac- tive surgery patient develops ectasia, they are presenting to her once they've had vision chang- es, and from there she recommends collagen crosslinking right away. "This is different from keratoconus," she said. "I imagine if they were followed on a regu- lar basis, we would see it on the topography be- fore they had vision changes. A lot of refractive surgery patients don't follow up. They're doing well and don't get eye exams. … Part of it is education for patients. They should be told they need to have an eye exam once a year or every other year. We'd probably find these rare cases of ectasia sooner than the way they're coming with full blown vision changes." Dr. Hatch said that post-refractive surgery ectasia has become rare due to current preop screening procedures. Refractive surgery follow-up continued on page 52 BACK TO BASICS

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