Expert Commentary
Prevention of dry eye lies clearly in the identification of patients at risk of such a complication, using the risk factors outlined earlier in this review. From there, a proper post-operative management of the patient can be planned, such as the use of cyclosporine A together with lubricant drops in patients with high risk of dry eye.
Patient counseling is a key component of pre-operative management. Patient satisfaction will be less affected if patients are given a more accurate prognosis of their post-operative discomfort. We also urge clinicians to extend the concept of post-operative care to peri-operative care in patients with especially high risk profiles, and that surgery should only proceed once there is significant improvement in ocular surface conditions.
Intra-operative factors, in general, seem inconsequential if the patient is properly managed for their dry eyes. Studies have not proven that differences in hinge position, type of procedure, or ablation systems have any drastic effect on post-operative dry eye. Clinicians hence need not be too concerned of the risk of dry eye in their selection of photorefractive procedure and laser ablation platforms, and should be free to choose the procedure, which is most suitable for the patient, considering his/her corneal thickness and magnitude of refractive error. Important exceptions are ablation depth and hinge width, which should be minimized in patients with a high risk profile for post-operative dry eye.
Research in the area of photorefractive surgery has always been influenced by substantial commercial interests. Negative findings may be under-reported and downplayed. The authors encourage researchers to publish even their negative findings such that literature in this field will be reliable and complete.
Expert Rev Ophthalmol. 2013;8(6):561-575. © 2013 Expert Reviews Ltd.
