Risk Factors for Dry Eye After Refractive Surgery

Abstract

Purpose: To determine the factors associated with clinically significant dry eye after keratorefractive surgery. Methods: This is a large database retrospective study that included consecutive cases of myopic laser in situ keratomileusis (LASIK) or photorefractive keratectomy performed between 2008 and 2016 at Care-Vision Laser Center, Israel. Patients were divided into 2 groups according to whether they developed clinically significant dry eye. Results: A total of 25,317 right eyes of 25,317 patients, with a mean age of 27.0 ± 8.3 years, were included. Postoperative dry eye developed in 1518 eyes (6.0%). The dry eye group was older (29.2 ± 9.0 vs. 27.6 ± 8.3 yrs, P < 0.001) and had a higher proportion of women (48.5% vs. 44.8%, P = 0.005), lower preoperative spherical equivalent (3.7 ± 2.0 vs. 4.0 ± 2.3D, P < 0.001), lower preoperative best-corrected visual acuity (0.019 ± 0.057 vs. 0.016 ± 0.064 Logarithm of the Minimum Angle of Resolution (LogMAR), P = 0.04), and lower proportion of preoperative soft contact lens wearers (40.6% vs. 45.5%, P < 0.001). In the postoperative dry eye group, a high proportion underwent LASIK (52.4% vs. 38.7%, P < 0.001) and were treated with a 7.0-mm (as opposed to 6.0 mm) optic zone (18.9% vs. 16.3%, P < 0.001). In multivariable analysis, older age [odds ratio (OR) 1.013, P < 0.001], female gender (OR 0.87, P = 0.009), lower preoperative refractive error (OR 1.05, P < 0.001), and LASIK (OR 0.67, P < 0.001) were associated with postoperative dry eye. Conclusions: Patients who are of older age, are of female gender, and have a lower preoperative refractive error and those undergoing LASIK are more likely to develop dry eye disease after keratorefractive surgery.

Corneal Surface Irregularity and Surgically Induced Astigmatism Changes in the Small Incision Versus Microincision After SMILE

“…First, the statistical analysis showed that, more females were involved in current study, which could lead to a possible bias in the outcomes. Shehadeh-Mashor et al [1] determined that the development of DED after refractive surgery was associated with age, sex, a lower preoperative refractive error, and LASIK procedures. Moreover, recent studies have reported the occurrence of clinical signs of DED, showing controversial results after SMILE surgery [4,7,13].…”

“…This indicates that refractive surgery has evolved through the reduction of the limitations related to preoperative ocular dryness. However, some patients have experienced transient dryness of eye after refractive surgery, whereas others have reported severe symptoms over a long period [1,5,7,9,13]. Moreover, DED can affect visual quality and visual function, meanwhile tear lm instability and ocular surface damage lead to visual disturbances [14].…”

“…Refractive surgery is the most commonly used method for the correction of refractive errors, and it can help achieve spectacle or contact lens independence. However, while refractive surgery is popular, it is associated with the prevalence of postoperative complications, such as ocular dryness [1], corneal ectasia [2], and pain [3]. Today, procedures such as small incision lenticule extraction (SMILE) are widely used to correct myopia with less postoperative dryness and pain [4,5]; these procedures offer superior biomechanical stabilities compared to other types of refractive surgeries [6].…”

Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK

“…Increased risk of flap dislocation in older patients may be due to age-related changes in the cornea. Senescent changes of the cornea include a reduction in keratocyte and endothelial cell densities [ 18 , 19 , 20 ], corneal stiffening [ 21 , 22 ], epithelial barrier dysfunction [ 23 , 24 , 25 , 26 ], and a greater incidence of dry eye [ 27 , 28 , 29 , 30 ]. We postulate that these and other age-related changes may lead to slower corneal healing and decreased flap adhesion, resulting in a greater incidence of flap dislocation.…”

“…The correlation between the incidence of dry eye and age is well documented in the literature [ 27 , 28 , 29 , 30 ]. Dry eye may reduce lubrication between the eyelid and the corneal flap, possibly leading to an increased risk of flap dislocation.…”