EyeWorld Asia-Pacific December 2015 Issue

44 EWAP REFRACTIVE December 2015 Beyond untouchable refractive status by Maxine Lipner EyeWorld Senior Contributing Writer Treating dry eye LASIK and PRK patients W hile patients with dry eye may not seem optimal for refractive surgery, with appropriate pretreatment they may ultimately do well, according to Steven E. Wilson, MD , professor of ophthalmology, Cole Eye Institute, Cleveland Clinic. Study results published in the Journal of Cataract & Refractive Surgery indicated that for such patients undergoing PRK and LASIK, topical cyclosporine treatment can help to improve the eye preoperatively so they can successfully undergo PRK or LASIK, he reported. Dr. Wilson said it’s very common for dry eye patients to appear for a screening, with many wanting to pursue refractive surgery because they can no longer comfortably wear their contact lenses. “It’s a much higher proportion of people in the refractive surgery screening population than in the population at large,” he said. Considering surface optimization Armed with the idea that it might be possible to ready dry eye patients for refractive surgery with Restasis (cyclosporine, Allergan, Dublin, Ireland), investigators launched the study on this. “Our clinical impression has always been that cyclosporine can help prepare patients for refractive surgery who didn’t used to be candidates because their dry eye was to the point that we wouldn’t consider them candidates,” Dr. Wilson said. “Now that cyclosporine is available, many of those patients with pretreatment can become candidates at least for PRK if not LASIK.” Of the two refractive procedures, Dr. Wilson finds LASIK can be less forgiving in dry eye patients. “The difference to me is that when you do LASIK, you cut the nerves that are involved in tear production and corneal sensation all the way out in the periphery, and it takes them 6 to 8 months to grow back; in PRK you just ablate the nerve endings, and I think they can regenerate much faster,” he explained. He described the study as a large one that initially included 1,056 consecutive patients screened to undergo refractive surgery. Of these patients, 81 were diagnosed with dry eye, with 55 considered potential candidates for refractive surgery, Dr. Wilson reported. “Most of those we could effectively pretreat primarily with cyclosporine, but we also allowed them to use non-preserved artificial tears and ointments,” he said, adding that on rare occasions punctal plugs were also used. Patients were followed for several months and if all of their corneal staining cleared, typically as long as their Schirmer’s reading was greater than 5, they Some patients who show no signs of dry eye preoperatively can develop LASIK-induced neurotrophic epitheliopathy postoperatively. Source: Steven E. Wilson, MD