Eyeworld

it will improve on its own, but it may improve faster with treatment. LASIK satisfaction overall is ex- tremely high, but there are a few vocal patients who are very un- happy." Dr. Pflugfelder said those pa- tients may be experiencing some- thing beyond dry eye, a type of neuralgia. "The problem with post-LASIK dry eye is a lot of people who are di- agnosed as having dry eye after LASIK really don't have dry eye. If they have irritation symptoms or pain, they may actually have a type of neuralgia due to the way that the nerves seal in the cornea. They be- come hypersensitized and it can drive them crazy," he said. Identifying the patients and treating them before operating can make a good procedure even better, Dr. Pflugfelder said. The same is true with multifocal IOL patients, he added. "On a weekly basis, I see people with pretty bad dry eye after LASIK who probably should never have had the procedure to begin with," he said. "With multifocal IOL pa- tients, a big problem is if they do have dry eye or an unstable tear film and you implant a multifocal IOL, it will divide light rays for distance and near. The light that now comes in the eye and hits the multifocal IOL no longer gives 100% of the light rays for distance or near. Con- trast sensitivity goes down a little crucial," Dr. Pflugfelder said. "The deeper the laser ablation, the more chance patients are going to have dry eye, especially with LASIK be- cause you're already cutting the flap and ablating deeper." Hyperopic LASIK increases the risk. "I've seen some really miserable patients, especially hyperopic LASIK patients, because it's a bigger flap and bigger treatment zone," Dr. Pflugfelder said. "I think those pa- tients are probably better off having refractive lens exchange because there's minimal risk of dry eye, and the quality of their vision would be a lot better." Dr. Trattler agreed about the size of the flaps created during LASIK. "We believe that thinner flaps re- duce the risk of developing dry eye afterward. Also, with a deeper flap, we sever more corneal nerves," he said. "A deeper, wider flap can make bit. In someone with a normal tear film, that's OK, but if the patient has an abnormal tear film, it can de- crease contrast sen- sitivity and scatter light. It can drive some people with a multifocal IOL crazy." Avoid dry eye in surgery Creating smaller flaps during LASIK can help mitigate some of the follow- up dry eye compli- cations, both surgeons said. "Smaller flaps are probably bet- ter because they don't cut as many nerves. The depth of the ablation is Using DEWS Dr. Pflugfelder said he uses the Dry Eye Workshop (DEWS) system to evaluate a framework for treatment. DEWS was published in the April 2007 issue of The Ocular Surface as a follow up to the Delphi panel spon- sored by the National Eye Institute and ophthalmic industry. Dr. Pflugfelder was the chairman of the management and therapy subcom- mittee. DEWS, which expanded on the Delphi criteria, identified dry eye as "a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual dis- turbance, and tear film instability with potential damage to the ocular surface. It is accompanied by in- creased osmolarity of the tear film and inflammation of the ocular sur- face." It classified the etiology of the disease into two categories: aqueous tear deficient and evaporative. "With level 2 or worse, steroids should probably be used for treat- ment, at least short term," Dr. Pflugfelder said. "No one in level 4 should have LASIK. These people might not even be good candidates for IOLs." Although post-op dry eye can be nerve-wracking for patients, Dr. Pflugfelder said it will resolve with time. "Tear function tends to improve over the first 6 months after LASIK," he said. "The natural history is that EW FEATURE 43 February 2011 April 2011 OCULAR SURFACE INTRODUCING (9L]VS\[PVUPU[OL;YLH[TLU[ VM(J\[L,`LSPK*VUKP[PVUZ Ocudox ™ (Doxycycline Hyclate 50 mg) is indicated to reduce the development of drug-resistant bacteria and should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria. Ocudox ™ is contraindicated in persons who have shown hypersensitivity to doxycycline or any of the other tetracyclines. Doxycycline can cause fetal harm when administered to a pregnant woman. The use of drugs of the tetracycline class during tooth development (last half of pregnancy, infancy and childhood to the age of 8 years) may cause permanent discoloration of the teeth. Tetracycline drugs should not be used during tooth development or in pregnant or nursing mothers. Photosensitivity can occur with any tetracycline-class drugs. For full prescribing information, visit www.ocudox.com. NDC 54799-535-60 © 2011 OCuSOFT, Inc., Richmond, TX 77406 1 'DWDRQ¿OH2&X62)7,QF -VYTVYLPUMVYTH[PVUJHSS VY]PZP[^^^VJ\KV_JVT sÛ.BTCNW ™ Û +V_`J`JSPUL/`JSH[LTN*HWZ\SLZ<:7 sÛÛ."T2.%3 ® Û+HCÛ2BQTA ™ Û/+42Û,_[YH:[YLUN[O,`LSPK*SLHUZLY *VU]LUPLU[¸SLH]LVU¹MVYT\SHVMMLYZHU[PIHJ[LYPHSWYVWLY[PLZ sÛ3D@QRÛ F@HM ® ÛHK]HUJLK+HONRNLDÛ2OQ@XÛ

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