Surgeon offers advice for managing LASIK dry eye
Recognizing and managing dry eyes before and after LASIK is essential for patient satisfaction and good surgical outcomes, says Steven E. Wilson, MD.
Dr. Wilson, director of corneal research at Cleveland Clinic's Cole Eye Institute (Cleveland, Ohio), shared tips on dry eye detection and management with LASIK surgeons and other eye doctors gathered at the recent annual meeting of the American Academy of Ophthalmology.
Detecting dry eye prior to LASIK surgery
Detecting pre-existing dry eyes prior to LASIK surgery is the first step in eliminating problems, according to Dr. Wilson.
"Dry eye patients tend to self-select into a refractive surgery practice because they are having difficulties with contact lens wear and are looking for an alternative," he said. Dr. Wilson recommends that eye doctors carefully interview patients interested in LASIK, noting that a history of contact lens discomfort can indicate a problem with dry eyes.
Dry eye is a common LASIK complication, and patients with dry eyes prior to surgery are at risk of more severe dry eye problems after LASIK, according to Dr. Wilson. Dry eye problems before surgery also can cause inaccuracies in pre-operative eye measurements that can affect LASIK outcomes, he added.
Treatment of dry eyes before LASIK surgery
Dr. Wilson's preferred treatment for dry eyes prior to LASIK surgery is twice a day application of Restasis cyclosporine-A ophthalmic emulsion eye drops (Allergan), combined with frequent use of non-preserved artificial tears.
After one month of this treatment, at least 50 percent of cases of pre-operative dry eye are usually fully resolved, according to Dr. Wilson. But he also noted that in clinical trials of Restasis, up to 40 percent of patients will require treatment for at least three months before their signs and symptoms of dry eye disappear.
For more difficult cases of dry eye, adding punctual plugs and dietary omega-3 fatty acid supplements may also be beneficial, he said.
If signs and symptoms of dry eye persist after six to eight months of Restasis treatment, these patients should not be considered candidates for LASIK, according to Dr. Wilson.
Treatment of dry eyes after LASIK
Dr. Wilson recommends continuing Restasis dry eye treatment for at least six months after LASIK surgery. This allows nerve regeneration into the flap, which can alleviate post-LASIK dry eye. It's also possible that cyclosporine may promote corneal nerve regeneration, he added.
Fluctuating vision is one of the most troubling symptoms for patients who have dry eye problems after LASIK, as these people have just spent a lot of money on a procedure to improve their vision, according to Dr. Wilson. More than 85 percent of LASIK dry eye patients show a reduction of this and other signs and symptoms of post-LASIK dry eye after one month of Restasis treatment, he said.
Even if a person with LASIK dry eye does not respond to topical cyclosporine treatment, signs and symptoms of post-LASIK dry eye usually diminish on their own within six to eight months, said Dr. Wilson.
Femtosecond laser causes fewer LASIK dry eye problems
Post-LASIK dry eye appears to occur less frequently when a femtosecond laser rather than a microkeratome is used to create the corneal flap during surgery, according to Dr. Wilson.
When he and his colleagues compared eyes that underwent LASIK surgery with a flap created with a 60-kHz femtosecond laser (IntraLase, Advanced Medical Optics) versus a flap created with a microkeratome (Hansatome, Bausch & Lomb), only eight percent of the laser-flap eyes had post-LASIK dry eye problems, compared to 46 percent of the microkeratome-flap eyes.
SOURCE: "Detecting, managing dry eye in patients undergoing LASIK requires proactive approach." Ophthalmology Times. Vol 34, No 4, February 15, 2009.
Disclosure: Dr. Wilson is a consultant to Allergan, Inc. (Irvine, CA).
Last updated: February, 2010
