For all refractive surgeries, including corneal inlays, patients benefit from a healthy ocular surface, so it is essential that we optimize the ocular surface before surgery. Irregular tear film can negatively affect retinal image quality 20% to 40%,1 making it necessary to achieve a healthy tear film both pre- and postoperatively.
Another reason to optimize the ocular surface before surgery is that the Raindrop (ReVision Optics, Inc.) procedure involves creating a LASIK-like flap, typically even deeper than traditional LASIK. Transected nerves in the cornea can cause neurotrophic dry eye after surgery—a problem made all the worse by untreated preexisting ocular surface problems.
Finally, patients seeking treatment for presbyopia are generally in their 40s and 50s, so they tend to be drier and have some meibomian gland dysfunction (MGD). Oftentimes, they are on other medications, and they spend long hours using computers.
My colleagues and I are currently carrying out a investigator-driven clinical study of Raindrop subjects with optimized and non-optimized ocular surfaces.2 We have enrolled 40 patients with mild to moderate dry eye. We believe that early optimization will provide good visual recovery after surgery.
Half of the subjects were randomized to undergo ocular surface optimization and half to proceed without treatment. The study group had LipiFlow (Johnson & Johnson Vision) thermal pulsation treatment for MGD before surgery, as well as high-dose DHA/EPA omega 3 supplements (Dry Eye Omega Benefits, PRN) and artificial tears to optimize the ocular surface both before and after surgery. Early interim data show that patients who had dry eye treatment before and after surgery have improved tear break-up time and better initial distance vision.
In our practice, we find that optimizing the ocular surface requires very little additional chair time and does not delay surgery. We make ocular surface optimization part of the discussion for each of our Raindrop patients, and they are quite comfortable and willing to invest in getting the best possible result.
1. Tutt R, Bradley A, Begley C, Thibos LN. Optical and visual impact of tear break-up in human eyes. Invest Ophthalmol Vis Sci. 2000;41:4117–4123.
2. ClinicalTrials.gov. A prospective study to evaluate the Raindrop Near Vision Inlay in presbyopic patients with treatments to optimize the ocular surface before implantation. https://clinicaltrials.gov/ct2/show/NCT03126877. Updated July 14, 2017. Accessed November 27, 2017.