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"The Incidence and Risk Factors for Developing Dry Eye after Myopic LASIK", Cintia S. de Paiva MD et al, Am J Ophthalmol 2006;141:438-445, Elsevier.
This is an excellent study on dry eye in the March issue of the American Journal of Ophthalmology, which I just got in the mail this morning. Among the impressive line up of co-authors are Doug Koch, editor-in-chief of JCRS and Stephen Pflugfelder, one of the leading dry eye specialists worldwide.
I know many of you would like to see research on some of the finer points of pre-operative risk factors and this might dispose you to be disappointed with the study's failure to address those, however, please don't be discouraged because this is (I believe) going to be an impactful, breakthrough study in terms of the simplicity of design, length of follow-up period (6 months), and certain aspects of results contradicting earlier studies or reaching some surprising conclusions.
Excerpts:
"The unique aspect of this study was the determination of the incidence of dry eye over the 6-month postoperative observation period. The criterion used to diagnose dry eye was a corneal fluorescein staining score of 3 or more.... None of the study participants had evidence of dry eye before surgery with this criterion.... The incidence of dry eye gradually decreased over the observation period in both groups [nasal and superior hinge] to a 36.36% overall incidence... at 6 months.... These findings suggest that LASIK carries a considerable risk for developing dry eye that may persist in more than one quarter of patients to at least 6 months after surgery."
Ladies, you may be surprised at this one and men considering lasik, please take note:
"Our study found no gender-related difference in development of dry eye after LASIK.... These factors [decreased androgen hormones] do not appear to increase the risk of developing post-LASIK dry eye."
And for all you informed consent champions [highlights mine]:
"Patients should be counseled about the risk of developing dry eye after LASIK...."
This study certainly isn't the last word (sample size was small, among other things) - I would view it more as an important beginning and a challenge to the profession to reconsider what it's doing. An adverse effect affecting "more than one quarter of patients", and commonly affecting patients with no preexisting dry eye, SIX MONTHS after surgery, is sobering.
CONCLUSIONS: Dry eye occurs commonly after LASIK surgery in patients with no history of dry eye. The risk of developing dry eye is correlated with the degree of preoperative myopia and the depth of laser treatment.
I know many of you would like to see research on some of the finer points of pre-operative risk factors and this might dispose you to be disappointed with the study's failure to address those, however, please don't be discouraged because this is (I believe) going to be an impactful, breakthrough study in terms of the simplicity of design, length of follow-up period (6 months), and certain aspects of results contradicting earlier studies or reaching some surprising conclusions.
Excerpts:
"The unique aspect of this study was the determination of the incidence of dry eye over the 6-month postoperative observation period. The criterion used to diagnose dry eye was a corneal fluorescein staining score of 3 or more.... None of the study participants had evidence of dry eye before surgery with this criterion.... The incidence of dry eye gradually decreased over the observation period in both groups [nasal and superior hinge] to a 36.36% overall incidence... at 6 months.... These findings suggest that LASIK carries a considerable risk for developing dry eye that may persist in more than one quarter of patients to at least 6 months after surgery."
Ladies, you may be surprised at this one and men considering lasik, please take note:
"Our study found no gender-related difference in development of dry eye after LASIK.... These factors [decreased androgen hormones] do not appear to increase the risk of developing post-LASIK dry eye."
And for all you informed consent champions [highlights mine]:
"Patients should be counseled about the risk of developing dry eye after LASIK...."
This study certainly isn't the last word (sample size was small, among other things) - I would view it more as an important beginning and a challenge to the profession to reconsider what it's doing. An adverse effect affecting "more than one quarter of patients", and commonly affecting patients with no preexisting dry eye, SIX MONTHS after surgery, is sobering.
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