Wall Street Journal

[Rebecca Petris]

The Wall Street Journal published an excellent article yesterday about dry eye. I have not been able to post it yet as I'm still on the road and can only post from my phone. WSJ is subscription only but you can get the article if you sign up for the 2 week free trial.

I thought Rhonda Rundle did a terrific job on it - wide ranging, balanced and covered many of our hottest issues. I think this article may be instrumental in getting more in depth coverage for dry eye in local and national press. I'd encourage you to bring it to the attention of your local media.

[kurt]

WSJ article

WSJ article on dry eye.

[elaine]

Wsj

My brother scanned it to me. I was happy it mentioned the relationship between Lasix surgery and dry eye, and that it showed the goggles. Maybe there will be more awareness, and fewer people asking me if I'm getting ready to go swimming. But seriously, it was more comprehensive than anything else I have read for the general public.
Elaine

[YGB]

I found the article to be refreshing in this world of dry eye where misrepresentation and misinformation by MD's and other "professionals" is the unfortunate norm.

The quote that I have included below from the WSJ article intrigued me because it articulated an important point in the world of LASIK. I inserted the bold formatting.

"Dr. Bishop-Clark, 43 years old, says her dry eye was caused by Lasik surgery seven years ago. She says she was told by her surgeon that dry eye was a risk, but a very low one. Because she can't stand to have her eyes open all the time, she has had to curtail her leisure reading and hire people to assist her at work. "Dry eye just sounds so trivial, but it's a disability," she says."

The point that intrigued me was that supposedly there has been progress in LASIK because dry eye is now listed on many LASIK informed consent forms as one of the risks. However, the % of LASIK induced dry eye patients are likely understated and more importantly, almost all LASIK candidates view the term dry eye as a "trivial condition" (that's good for LASIK surgeons trying to close a deal right?).

However, as many of us on this BB know and as Dr. Bishop came to find out, this post-LASIK complication can certainly be debilitating. Of course, it is safe to say that at most LASIK clinics, the dirty secret that dry eye can be disabling with minimal treatment options is left out of LASIK informed consent forms and discussions.

[Lucy]

Wonderful article. It's been a long time since we've seen somethingof this dense with information and more than a passing mention of the dry eye/lasik connection.

It's even better because they actually named two sufferers, Rebecca and Cathy, to put a "picture" with the story. (Yes, I know there is no picture.)

Lucy

PS. Thanks, Kurt, for the link.

[Rebecca Petris]

OK finally home!! I have sooo much to tell you all about from ASCRS. I started a blog recently so I'll probably just post it all there in bits and pieces and post a link here.

Back on the WSJ article - every time I read it I like it more... it is just what we need to give greater credibility to the entire topic of dry eye as a disease; the severity of dry eye in many cases; the connection between lasik and dry eye and eyelid surgeries and dry eye; and more.

I'm waiting on permission to reprint the article in full here but in the meantime a couple more excerpts:

For some people, dry eye is more than a small irritation -- it can be a debilitating condition that causes painful scratchiness, light sensitivity and stinging in the eyes. But dry-eye patients say they often get perfunctory care from ophthalmologists and optometrists, who simply advise them to blink more and use over-the-counter lubricating drops. Such products may offer temporary relief, but they can be expensive, and many patients complain that they aren't very effective.

Sound familiar?

And many complaints are linked to the popularity of vision-correction surgery....

In addition, symptoms are mounting among patients who have had cosmetic eyelid surgery and find they can't fully close their eyes....

Ironically, chronic dry eye can also be caused by patients' efforts to relieve contact-lens discomfort. Some patients who find they can't wear contacts turn to laser surgery. But such intolerance is a warning sign of a possibly higher risk of dry eye, ophthalmologists say.

Would-be customers for lasik and blepharoplasty take note!

Two DEZ people were mentioned in the article - yours truly, and Cathy Bishop-Clark with a compelling story about very severe post Lasik dry eye (go Cathy!!!!!!!)

[Julie1]

I've just got to say that this article was successful in preventing at least one person that I know from having LASIK surgery. I just had brunch with my aunt this morning, and she mentioned the WSJ article because she knew about my dry eye problems. She stated that she had considered having the surgery at one point, but that it is not worth the risk to be in the 5% of the population that has complications. I was impressed that she realized that a 5% risk is a large one when you consider all the people that have LASIK every year. I also pointed out that the risk is likely greater than 5% because not all dry eye complications are reported. I don't know exactly how serious she was about having the surgery, but she told me that she defiinitely would not have it after reading the article. Plus, she recently purchased a new pair of cute glasses and would not want to have to give those up.

She also understood a little better what I've been going through from reading the article and was very impressed about the extent of article's coverage.
I hope we see more coverage of dry eye in the media and that there will be a greater focus on developing better treatments.

-Julie

[GeorgeT]

Hi everyone,
How do we know that only 5% of laser surgery pts get chronic dry eye ?
It might be much more than 5%....
Is there a serious study on this or just some numbers?
All the best !!

George

[Rebecca Petris]

There are a great many studies about lasik and dry eye. I am not aware of any that focus on severe/debilitating dry eye.

In the existing studies, the numbers vary depending on (among other things) what metric is used.

As in all dry eye studies (including studies done on new drugs) there is always the classic signs vs symptoms problem: what they see under the slit lamp, or with Schirmer or TBUT or staining or any other test method, does not necessarily correlate well with what the patient actually experiences.

Here's a blurb from one of my newsletters last year - gives you at least a little flavor of what's out there:

OF FORESTS, TREES, LASERS AND DRY EYES: Don't miss "The incidence and risk factors for developing dry eye after myopic lasik", Cintia de Paiva MD et al, Am J Oph 2006;141:438-445 (click here for abstract). The ink was probably still wet when the arguing began about the definition of dry eye, the relevance of corneal staining, and the price of legumes in large Asian countries. We dare to opine that a conclusion of "Dry eye occurs commonly after LASIK surgery in patients with no history of dry eye....", supported by numbers like "36.36% at 6 months" and with names like Pflugfelder and Koch wafting through the credits, speaks for itself, and describes a forest more interesting for its sheer acreage than its leaf veining patterns. Somebody in December's JCRS seems to be on that page too: "The grittiness, burning sensation, ocular irritation, foreign-body sensation, photophobia, diplopia, and fluctuation of vision with blinking that are associated with dry eyes have been frequently reported after LASIK" (Chen et al, "LASEK for dry eye associated with soft contact lenses", J Cat Refr Surg 2005;31:2299-2305, click here for abstract.) But the inspiring faith that has long characterized the practice of LASIK will no doubt prevail over the ravings of us skeptics. Adeste fideles, prescribamus restasis.

It would be interesting to tabulate the statistics from all of the LASIK dry eye studies out there. Another spare time project

[sazy123]

She said 5% was the statistic for chronic/deliberating dry eye lasting 6+ months. But this is probally higher becuase of the people who develop dry eye months or years after the surgery coz the surgery has put them at higher risk maybe, and these people plus other people whose doctors dont think their dry eye is bad or they think the dry eye has healed even though the patient is still symptomatic do not go in to that 5%.

Anyway 5% is a is not a small risk..

But then i thought i read 50% get dry eye anyway lasting up to 6 months. Of which some peoples eyes will be dryer as a result but may not realise.

[dianat]

I'm quite certain I've not been included in any statistic.

[shells]

I am not included in any statistic either. Although even hearing them admit the number 5% is refreshing. My surgeon told me long term complications with dry eye were "certainly less than 1%". 1 out of 20 sounds much worse than 1 out of 200.

[Rebecca Petris]

I'm getting calls every day from people who read the WSJ article and they are commenting about how they never realized that LASIK was such a big cause of dry eye. I spoke with one lady today with Sjogrens who mentioned that as a result she'll be warning young people she comes across who are thinking of getting LASIK. Rah rah Rhonda....

[sazy123]

A study thats say about the 5% dry eye lasting after 6 months. And 28% in asain eyes

Dry Eye After LASIK
Written by Administrator
Clin Exp Optom. 2005 Mar;88(2):89-96.

comparison of outcomes for Asian and Caucasian eyes.

Albietz JM, Lenton LM, McLennan SG.

Queensland University of Technology, Brisbane, Australia.

BACKGROUND: Dry eye is a common complication of LASIK surgery. Our clinical impression was that post-LASIK dry eye was more problematic for our Asian patients. The aim of this study was to determine if dry eye after LASIK is more prevalent, more sustained and more severe in Asian eyes compared with Caucasian eyes.

METHODS: This study was based on a retrospective analysis of a clinical database. Data (n = 932 eyes, 932 patients) was collected before and after (week 2 and months 1, 3 and 6) LASIK surgery. Patients were defined as Asian if both parents were of East Asian ethic origin. Assessments included dry eye symptoms, ocular surface staining, tear volume, tear secretion, tear film stability and corneal sensation.

RESULTS: Asian eyes had greater ocular surface staining, poorer tear film stability and lower tear volume before LASIK and at all times after LASIK. Dry eye symptoms occurring 'often or constantly' were more prevalent at all time points after LASIK in Asian eyes. Chronic dry eye persisting six months or more after LASIK was diagnosed in 28 per cent of Asian eyes and 5 per cent of Caucasian eyes (p < 0.001). Asian patients with chronic dry eye were predominantly female, reported dry eye symptoms, had greater ocular surface staining and lower tear secretion, stability and volume before surgery. After LASIK, Asian eyes had a slower return to pre-operative values for ocular surface staining, tear volume and corneal sensation.

DISCUSSION: The risk of chronic dry eye after LASIK was significantly higher in Asian eyes. Contributing factors could include racial differences in eyelid and orbital anatomy, tear film parameters and blinking dynamics and higher attempted refractive corrections in Asian eyes.Chronic dry eye and regression after laser in situ keratomileusis for myopia

[sazy123]

Dont know if this has been posted but:

Eur J Ophthalmol. 2007 Jan-Feb;17(1):1-6.

Dry eye after LASIK for myopia: Incidence and risk factors.Shoja MR, Besharati MR.

Department of Ophthalmology, Shahid Sadoughi University of Medical Science, Yadz - Iran.

PURPOSE. Patients frequently experience dry eye symptoms after laser-assisted in situ keratomileusis (LASIK). The purpose of this study was to determine the incidence and risk factors of dry eye after myopic LASIK.

METHODS. In this retrospective case series 190 eyes that underwent LASIK were examined for a dry eye syndrome. All patents were asymptomatic for dry eyes before surgery. Assessments included subjective complaints of dry eye, tear break-up time (TBUT), corneal staining, corneal sensitivity test, and Schirmer I test. All values were compared before and at 1 week and 1.3 and 6 months after surgery.

RESULTS. For the 190 eyes, chronic dry eye persisting 6 months or more after LASIK was diagnosed in 20 percent of the eyes. Mean patient age was 31 +/- 8 years. The risk for chronic dry eye was significantly associated with higher attempted refractive correction, greater ablation depth, and female * (p=0.001). Subjective score for dryness was increased after LASIK. The greatest change from preoperative levels for all parameters was noted at 1 week. There were obvious decreases in TBUT and Schirmer value at 1, 3, and 6 months postoperatively relative to preoperative level (p<0.05). The Schirmer I test result was higher at 1 day but without statistical significance (p>0.05), but lower at 1 week and 3 and 6 months (p<0.05) after LASIK. Corneal sensitivity was decreased at 1 month and 3 months, and returned to the preoperative level at 6 months after LASIK. There was a statistically significant effect of age, *, and mean spherical equivalent refraction on corneal sensitivity (p<0.001).

CONCLUSIONS. Patients undergoing LASIK for myopia develop dry eye with compromised tear function at least 6 months after surgery. Women and patients requiring higher refractive correction have an increased risk for developing dry eye.