Eyeworld

53 EW REFRACTIVE SURGERY October 2015 Contact information Galor: AGalor@med.miami.edu Levitt: alevitt@med.miami.edu clinical exam," she said, adding that even so patients will describe the symptoms of pain that can be quite debilitating. "This is very similar to neuropathic pain elsewhere in the body," Ms. Levitt said. "The fact that patients have pain and it's discon- nected from the pain processes at the site of the initial injuries is one indicator of neuropathic pain." There are a lot of parallels that make a compelling case for chang- ing how practitioners conceptualize the chronic dry eye symptoms they see after refractive surgery, she said. Clinical implications Dr. Galor views all of this as poten- tially important from both a preven- tative and a treatment perspective. "What we would like to do is study prevention using some of these agents like pregabalin and gabapen- tin at the time of LASIK to see if we can reduce persistent symptoms," she said. She currently has a large popula- tion of patients with neuropathic pain characteristics who can be chal- lenging to treat. "I try traditional things like artificial tears and topical cyclosporine; however, by the time they see me they've already tried ev- erything," she said. "My go-to right now is autologous serum tears that contain, among other factors, nerve growth factor." She had great success using this in patients who have had intractable symptoms of neuropath- ic pain such as burning and photo- phobia, which have been classified as dry eye. "My hypothesis is that nerve growth factor may normalize, enhance, or stabilize the function of the corneal nerves," she said. "We're interested in studying that more and seeing if it is nerve function and not something else that is being helped by the autologous serum tears." Dr. Galor hopes practitioners come away from the study with the understanding that not all "dry eye" symptoms are caused by dryness on the ocular surface and that these can be driven by the corneal nerve pathway. "Sometimes they're being driven because the corneal nerve pathway is dysfunctional, and if we ignore this component of 'dry eye,' we're missing the whole picture," she said, adding that dry eye also tends to travel in conjunction with overlapping pain conditions such as depression and anxiety. "To me dry eye is more than just the eye; it's the corneal pain pathway or the corneal sensory pathway, and it's also the entire patient," she said. "Taking the time to ask about depression and chronic overlapping pain and work- ing with pain specialists and mental health experts is vital to getting to the problem." EW Editors' note: The sources have no financial interests related to this article. The specialists in single-use. www.malosa.com • LASIK / LASEK / ReLEx / PRK • Phaco • Oculoplastics • IVT • Strabismus • Sub-Tenons ... "Malosa's single-use instruments and procedure packs provide optimal patient safety and brand new, flawless instruments for every eye." Prof. Dan Z Reinstein, MD MA(Cantab) FRCSC DABO FRCOphth FEBO - The London Vision Clinic • Brand new instruments, every time. • Zero cross-contamination risk. • Increased patient throughput. View our online brochure. Complete range of Instruments and Procedure Packs for all Ophthalmic specialties. Over 350 Instruments & 400 Packs for all specialties.

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