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Up Front | Feb 2002

The Tear Factor: Two Dry Eye Experiences Using TheraTears (Part 1)

Using Therapeutic Drops in the LASIK Setting Promotes a More Comfortable Recovery

Punctate keratopathy and dry eye symptoms are common following LASIK (Figure 1). In our practice population we have a 37% incidence of punctate keratopathy in normal eyes during the first postoperative week following LASIK.1 In an attempt to decrease the incidence and severity of punctate keratopathy in the postoperative period, we chose to study the effect of pretreating eyes with lubricating drops. We performed a prospective, randomized study using artificial tears in patients 1 week prior to undergoing LASIK to improve the ocular surface and to determine the effect of the artificial tears (TheraTears, Advanced Vision Research, Woburn, MA) on the rate of punctate keratopathy, as well as dry eye symptoms following LASIK. Patients with pre-existing dry eye or punctate keratopathy on preoperative examination were excluded from the study. Thirty-two patients were randomly selected to have either their right or left eye treated with TheraTears four times daily for 1 week prior to undergoing simultaneous bilateral LASIK. The postoperative regimen was identical for both eyes of each patient, including the use of TheraTears hourly for the first postoperative day.

Study Results
We found that it was significantly beneficial in the early postoperative period to use lubricating drops prior to LASIK. Punctate keratopathy was worse in the control eye than in the lubricated eye in 37% of the patients, compared to 9% of the patients who had more keratopathy in the lubricated eye than the control eye at the 1-day postoperative examination (P=.035 McNamara test). The mean UCVA on the 1-day postoperative examination was also slightly better in the treated eyes than in the control eyes. The average UCVA was 20/30 in the control eyes, compared to 20/25 in the treated eyes (P=.04). In addition, the treated eyes tended to feel more comfortable than the untreated eyes, but the trend was not statistically significant. There was no significant difference between the treated and control eyes at the 1-week and 1-month postoperative examinations.

Optimizing Outcomes
We conclude that the use of lubricating drops on healthy eyes for 1 week prior to surgery can improve the early postoperative results of LASIK. I believe that this study confirms the importance of optimizing the ocular surface prior to the date of surgery. If a patient has any symptoms of dry eye or even a slight degree of punctate keratopathy on preoperative examinations, I aggressively manage the condition with lubricating drops. Frequently, I will also place punctal plugs prior to the date of surgery. If there is any suggestion of blepharitis, which can also contribute to dry eye, I will manage the condition prior to surgery, frequently using doxycycline.

Benefits of patient management
I find that discussing dry eye and LASIK with a patient preoperatively is invaluable if he or she develops persistent punctate keratopathy postoperatively. Patients are more likely to be more compliant with aggressive lubrication and more accepting of punctal occlusion than if they were not informed of the possibility preoperatively. During the TheraTears study, I felt as though the patients who were treated with lubricating drops before surgery also had a subtle additional benefit—they gained a sense of confidence about their ability to self administer eyedrops prior to having a LASIK flap to worry about. n

Ronald J. Smith, MD, FACS, is Assistant Clinical Professor at the Jules Stein Institute at the University of California, Los Angeles. He has no proprietary interest in any of the products mentioned herein. Dr. Smith may be reached at (310) 825-2737; lasik@pacbell.net
1. Smith RJ, Krasnow D, Richlin SB: A Prospective Evaluation of Artificial Tears Prior to LASIK. World Refractive Surgery Symposium, 1999
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