How to predict dry eye after Lasik?

[Leonora]

Are there any dry eye red flags one should look for in terms of the tests they do to determine if you are a candidate for Lasik?

[Rebecca Petris]

Are there any dry eye red flags one should look for in terms of the tests they do to determine if you are a candidate for Lasik?

Low scores on Schirmer or TBUT indicate pre-existing dry eye conditions, which boots you into a higher risk group for worse dry eye after the surgery. On the other hand, normal test scores do not necessarily mean (a) that you don't have dry eyes and/or (b) that you will have a good outcome.

A history of contact lens intolerance is, in my opinion, sufficient indication you're in a higher risk group.

There are many other potential indicators of increased risk ranging from auto-immune diseases to things like gender, age and hormonal fluctuations.

[Scout]

http://www.revophth.com/index.asp?page=1_972.htm

Review of Ophthalmology
Vol. No: 13:07Issue: 7/10/2006

Screening for LASIK: Tips and Techniques
Surgeons share helpful strategies for identifying which patients are good candidates—and which could be trouble.
Christopher Kent, Senior Editor

Excerpt:

Dry Eyes, Allergies and Inflammation

To help minimize problems resulting from these causes:

•Don’t rely on Schirmer strips. “We’ve looked at Schirmer strips and found them to be of little value in this situation,” notes Dr. Schallhorn. “They’re not a very sensitive test for detecting who will have dry-eye problems after LASIK, because they only measure aqueous production—not the two other critical layers of the tear film: mucin and oil. As a result, a patient can have dry-eye symptoms but still have a robust Schirmer’s, or have no symptoms or signs despite a relatively low Schirmer’s. Patients who have blepharitis or meibomian gland dysfunction often have normal Schirmer’s. At the same time, if the test finds almost no wetting, the patient will likely have signs and symptoms of dry eye that can be picked up on a slit lamp exam without using the Schirmer test.”
•Look for patients with multiple allergies, asthma, or chronic sinusitis or bronchitis. Dr. MacRae notes that these individuals—some of whom may suffer from atopy, a genetically determined state of hypersensitivity to environmental allergens—tend to have more sensitized immune systems. As a result, they tend to have more inflammatory reaction after a surgical procedure. “If a patient fits this description,” he says, “you want to make sure the potential inflammation is controlled, especially when you’re doing PRK or epi-LASIK. I sometimes treat atopic patients with oral prednisone to control their inflammation for the first four or five days after surgery; then I taper them off very quickly.”

Scout

[Lmchelle]

I agree with Rebecca...

I have no scientific evidence, but I think I probably had some dry eye issues before my Lasik. It never bothered me except when I tried to wear contact lenses. I couldn't stand them...gas perms or soft. That should have been my red flag - but then no one asked me if contacts bugged me and I was too dumb to put 2 and 2 together. The fact that contacts bugged me encouraged me to have the Lasik. Catch-22 eh?

-Lori

[shells]

Hi Leonora,

Contact intolerance was my red flag, I ofcourse didn't know it at the time, and no one asked. Actually come to think of it, I suppose I don't know what my schirmers or TBUT were before lasik since they never bothered to take the 5 minutes to do the test, or ask me about my seasonal allergies, or ask me about my sinus problems, etc, etc. Anyway, if you are here already, then I'm assuming you have some sort of dry eye even if only mild. I would second what some of the others have said about that putting you into a higher risk category. Just be careful, if you do get lasik, no matter what you eyes are like before, you are taking the risk of making your dry eye worse, amongst other things.

-Shells

[Rebecca Petris]

Just be careful, if you do get lasik, no matter what you eyes are like before, you are taking the risk of making your dry eye worse, amongst other things.

That's an important point. In fact, there was a study published recently whose conclusion included the following rather disturbing statement:

"Dry eye occurs commonly after LASIK surgery in patients with no history of dry eye."

[dianat]

According to my LASIK doc prior to my surgery, my eyes looked great and did not look dry. I reported my contact lens intolerance, but he didn't factor that in. They looked good and declared me a great candidate for LASIK. I've now been burning for four years. It was a much bigger gamble than I thought.

[Leonora]

Thanks for your help!

This board is wonderful.

[Lucy]

Dry eye after lasik often occurs in people who had no history of dry eye prior, only because their doctors never bothered to check records carefully enough.

Like many, I never heard the word Schirmers until after it was too late. My doctor, however, had noted a low Schirmers in my records prior to my surgery. Did he miss this, or just not bother acknowledging it?

The patient comes out on the short end of the stick each time when dealing with dry eyes.

[Dotanne]

I was told my eyes were fine for Lasik but they did not do a test for dry eye (just go on what they see I think) and still say they do not test for dry eye! I have never suffered from allergies etc and never had to use drops and my eyes were perfectly normal to me pre-Lasik. I had never heard of dry eye. In hindsight - the only possible symptom I had that could be a sign of dry eye was that I could not stay focused easily without blinking on that picture you have to look at in the pretesting. When I queried they say that happens to others too and is not a sign. My only other possible sign is the fact that I go to sleep easily when watching TV, while travelling or am at a boring meeting etc. I wonder that maybe my eyes were feeling dry and that was why they wanted to close!!!! I used to do a lot of outdoor work in our commercial gardens and often came in at the end of the day with sore gritty eyes from the dust. Maybe that didn't help either. But they came OK after a sleep! After my Lasik treatment and my eyes were not good I was told "That's because of your age and gender!" How I wish they had told me that beforehand! Too late now!

[Lucy]

Dotanne, your "age and gender" are a cop out for an excuse. After my lasik almost 7 years ago, I got a lot of responses from docs like "what with you being older and female." Well, I listened to that for awhile. It wasn't long before just as many males, and young ones at that came along with post lasik dry eyes. Sort of blows the "older female" dry eye excuse. Women, many quite young are troubled just the same. That was just the first response docs could think of when it became apparent that lasik did and could cause dry eye.

It also gives them an "excuse" for not doing proper screening prior to surgery. Being an older female, they should have screened us even more carefully than the general population if they "knew" this was the case. If docs erred on the side of caution, perhaps some of us would not have been lasered.

[shells]

5 months ago, when my surgeon was assuring me that by the 1-year mark my eyes would be back to normal, I asked why some people DIDN'T get back to normal. He basically said that the people who claim not to get better are older woman who would have gotten dry eye anyway. That is probably the time I have come closest to slapping him. I haven't seen him since that day. I'm 27, it's been 13 months, I'm not better yet, and I'm not the only one. So unless I'm about to hit menopause about 20 years early, there goes his theory. I can only imagine how frustrating it is for the women who are being told their lasik induced dry eyes are related to age though...yeah right...that and having their corneas sliced and lasered.

[sazy123]

Im 21 and if id of had lasik i would have got dry eye for sure! instead i got another way.

[Natalie06]

Severe Dry eye 4 days post Lasik

I have been telling my Optician for 4 years that my eyes hurt and were uncomfortable at the end of every day. I have tried every contact available but couldn't tolerate any of them. I have difficulty driving at night. I have chronic sinus problems and have been in premature menopause from Lupron therapy for endometriosis for 5 years. And I told all of this to the Lasik surgeon ahead of time...I made it a point to do so because I was concerned about my eyes post surgery. But I was an "ecellent candidate"!

So here I am today in misery. I am not even 2 weeks post op and it just gets worse. I have 4 punctual plugs, am on Restasis and other eye drops constantly. Work is a misery due to the air conditioning, a job that is 85% computer time and staring at large, complex spreadsheets.

Worst of all, I almost certainly will require an "enhancement" due to undercorrection. I am too afraid to even think about how much worse this could make my eyes and am not even sure I can go through with that. Thousands of dollars down the drain and I am praying that I am not left with severe dry eye for the rest of my life.

Obviously, you can tell I am upset! My new eye drops from the DEZ should arrive today amd I am praying for relief.

Thanks for letting me vent. I can see already that only people with dry eyes really understand how this impacts your life.

Natalie

[Lucy]

Natalie, you won't "require" an enhancement. They may want you to have one. Your vision may be less than 20/20, however "having to have an enhancement" is not a reality. You do NOT have to have any more surgery and it most likely would make your dry eye situation worse.

You are two weeks post-op so you do not have any idea of how things will be in 6 or 12 months. Hopefully and most likely better. But the use of glasses and or contact lens to correct any left-over visual problems would be the safe way to go. Good luck and stay away from thoughts of more surgery at least for some time.