Findings from a large population-based study of patients presenting themselves for refractive surgery, challenge conventional wisdom about dry eye and LASIK, reported Julie Schallhorn, MD, MS, at ASCRS Refractive Day, being held during the annual meeting at the Convention Center in San Diego, CA.
Dr. Schallhorn, assistant professor of Ophthalmology, University of California San Francisco, presented evidence addressing the following three commonly held beliefs:
- Dry eye that is present before LASIK will get worse after LASIK
- Women are much more likely than men to get bad dry eye after LASIK
- Patients with dry eye should have PRK instead of LASIK because LASIK will make their dry eye worse
According to the study:
- Dry eye that is present before LASIK tends to get better after surgery
- Female gender has a “very, very” small effect on worsening of dry eye after surgery
- At 3 months after surgery, patients who had PRK report more dry eye symptoms than patients who had LASIK
“LASIK has been around for a long time, and there are certain beliefs about it that according to data from our study do not hold true,” she said.
Power from a large population
The analyses examining the truths about LASIK and dry eye were performed using data collected from confidential questionnaires that were completed preoperatively and three months after surgery by patients who presented themselves for refractive surgery over a two-year period. It included more than 12,000 patients (>24,000 eyes) who represented a wide range of ages and were comprised of a slight preponderance of females.
“Because we had a very large population, our study had a lot of power to detect statistically significant differences,” Dr. Schallhorn said.
Overall, 41.5% of patients reported experiencing dry eye symptoms before surgery, and the severity ranged from very mild to very severe. Analyses to identify variables associated with dry eye identified only two factors – female gender and contact lens wear.
“Women were 23% more likely than men to reported dry eye symptoms and contact lens wearers were 45% more likely to report dry eye symptoms than their counterparts who were not wearing contact lenses,” Dr. Schallhorn said. “We found, however, that age, refractive error, and season of treatment were not associated with having dry eye symptoms post-operatively.”
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Facts about dry eye worsening
Analyses looking at changes in dry eye symptoms after surgery showed that some patients developed dry eye de novo after surgery. Patients who reported dry eye preoperatively, however, tended to get better. The tendency for improvement was observed across the spectrum of preoperative dry eye severity levels, but patients who reported the worst dry eye before surgery had the biggest improvement postoperatively.
“What our study shows is that dry eye before surgery does not necessarily equal dry eye after surgery,” Dr. Schallhorn said.
She proposed that the tendency for dry eye to get better after surgery is probably the result of several factors.
“We treat existing ocular surface diseases before surgery is performed, patients are getting engaged in their ocular health, and we are getting patients out of their habit of wearing contact lenses,” Dr. Schallhorn explained.
The gender effect
Across all age groups, females reported worse dry eye symptoms after surgery than men, but analysis of the change in symptoms from preoperative to postoperative showed that female gender had only a small effect on the change in dry eye symptom severity after surgery.
“The effect of gender was highly statistically significant because of our large population, but clinically, the effect was so small that I think it is not something that needs to be emphasized to patients,” Dr. Schallhorn said.
An overwhelming majority of patients in the study underwent LASIK. Data on preoperative dry eye symptoms showed no significant difference comparing patients who went on to have PRK versus those who had LASIK.
Results from multivariable regression modeling done to identify factors associated with change in dry eye symptoms from pre- to postoperatively found only three independent predictors, and of the three, PRK had the strongest effect. Female gender was also associated with greater worsening of dry eye, and there was an inverse correlation between preoperative dry eye symptom score and worsening after surgery, Dr. Schallhorn said.
Age, ablation pattern (wavefront-guided versus standard), type of refractive error (myopia versus hyperopia), and preoperative contact lens wear were not independently associated with worsening of dry eye after surgery.
Discussing the implications of the study for patient care, Dr. Schallhorn concluded that surgeons still have to inform patients that there is a possibility of developing dry eye after surgery.
“But the findings of our study give me greater confidence to tell patients who are contact lens wearers and uncomfortable because of dry eye symptoms that they will probably get better after surgery,” she said.
DRY EYES AND LASIK
Findings from a large population-based study of patients presenting themselves for refractive surgical treatment challenge conventional wisdom about dry eye and LASIK. An Assistant professor of Ophthalmology, University of San Francisco, provided evidence resolving the myths associated with three typically held notions:
- Dry eye that exists before LASIK will certainly get worse after LASIK
- Females are far more likely than men to get severe dry eye after LASIK
- Patients with completely dry eye must have PRK instead of LASIK due to the fact that LASIK will certainly make their completely dry eye worse
According to the study:
- Dry eye that exists prior to LASIK often tends to improve after surgical procedure
- Women gender has a “extremely, really” little effect on getting worse dry eye after surgical treatment
- At 3 months after surgical treatment, people that had PRK report even more dry eye signs and symptoms than clients who had LASIK
” LASIK has been around for a very long time, and also there are particular beliefs about it that according to data from our research do not apply,” she claimed.
Power from a big population
The analyses checking out the facts concerning LASIK and dry eye were executed using information gathered from private questionnaires that were completed preoperatively as well as 3 months after surgical treatment by people who presented themselves for refractive surgery over a two-year period. It consisted of greater than 12,000 patients (> 24,000 eyes) who had a large age range and also consisted of a small over-prevalence of ladies.
” Due to the fact that we had a very large population, the research had a lot of power to identify statistically considerable distinctions,” stated ophthalmologist.
In general, 41.5% of people reported experiencing completely dry eye symptoms prior to surgery, and the intensity ranged from really light to very severe.
Evaluations to identify variables connected with completely dry eye identified just 2 elements– women gender as well as contact lens wear.
“Ladies were 23% more likely than guys to report completely dry eye symptoms and contact lens wearers were 45% more likely to report dry eye symptoms than their counterparts who were not using contact lenses,” A team of doctors said “We discovered, nevertheless, that age, refractive mistake, and season of treatment were not associated with having dry eye signs post-operatively.”
Truths regarding completely dry eye intensifying
Evaluations checking out adjustments in dry eye symptoms after surgical treatment revealed that some patients established dry eye afresh after surgery. Patients who reported dry eye preoperatively, nonetheless, tended to improve. The propensity for improvement was observed throughout the spectrum of preoperative dry eye seriousness levels, yet individuals who reported the most awful dry eye prior to surgical treatment had the greatest improvement postoperatively.
“What our study reveals is that dry eye prior to surgical treatment does not always equivalent completely dry eye after surgical treatment,” the doctor stated.
She recommended that the tendency for dry eye to improve after surgery is possibly the outcome of several aspects. “We deal with existing eye surface disease before surgery is done, patients are getting engaged in their ocular health and wellness, and we are getting patients out of their habit of contact lenses,” the doctor clarified.
The gender result
Throughout every age group, women reported even worse completely dry eye signs after surgical procedure than males, however analysis of the modification in signs and symptoms from preoperative to postoperative showed that women sex had just a tiny impact on the change in completely dry eye extent after surgery. The effect of gender was highly statistically significant due to our huge population, yet scientifically, the effect was so tiny that I think it is not something that requires to be stressed to people,” the doctor claimed.
A large majority of individuals in the study undertook LASIK. Information on preoperative dry eye signs and symptoms revealed no considerable distinction contrasting patients who took to having PRK versus those who had LASIK.
Results from multivariable regression modelling done to identify variables connected with adjustment in dry eye signs from pre- to post-operatively discovered only three independent predictors, as well as of the 3, PRK had the greatest result. Female gender was likewise related to greater worsening of dry eye, as well as there was an inverse correlation in between preoperative completely dry eye signs and symptom score and also worsening after surgical treatment, ophthalmologist stated.
Age, ablation pattern (wave front-guided versus standard), some sort of refractive error (myopia versus hyperopia), and preoperative contact lens wear were not separately associated with worsening of completely dry eye after surgery.
Going over the implications of the study for patient treatment, the doctor concluded that cosmetic surgeons still have to educate patients that there is an opportunity of establishing dry eye after surgery.
“However, the findings of our study give me higher self-confidence to inform patients that are contact with lens wearers as well as are uneasy because of dry eye signs that they will most likely get better after surgical procedure,” she claimed.