All clinicians know to warn their patients of dry eye symptoms after refractive surgery, whether it’s LASIK or photorefractive keratectomy (PRK); it’s the most common post-op complaint.1 Now, a retrospective study of 25,317 eyes that underwent PRK or LASIK shows a 6% chance of post-op dry eye.2 Several factors play into whether or not a patient is at an increased risk for the complication, the study found.

Those who developed dry eye were more likely to be older (29.2 ± 9.0 years vs. 27.6 ± 8.3 years), female (48.5% vs. 44.8%) and with a lower pre-op spherical equivalent and best-corrected visual acuity. Dry eye incidence specific to procedure type was 52.4% for LASIK patients and 38.7% for those who had PRK.2

The researchers were surprised to find the association between lower refractive error and dry eye, considering previous studies link higher refractive error with the condition. They speculate their study’s use of both clinical signs and patient symptoms to define dry eye may have swayed the findings. “Patients with a lower refractive error might have greater postoperative expectations and thus are more sensitive and symptomatic postoperatively,” they noted in the study.2

In addition, the team found a difference in post-op dry eye rates between surgeons. However, that difference wasn’t related to surgeon experience, number of procedures or procedure type performed by the surgeon. Instead, they suspect the difference lies in the surgeon’s ability to detect and treat dry eye preoperatively. “Surgeons who were less diligent in detecting and treating preoperative dry eye might have higher rates of dry eye postoperatively,” they noted in the study.2

Understanding these risk factors is crucial to identifying at-risk patients preoperatively and preventing dry eye by either initiating preventative measures or avoiding surgery altogether, they concluded.2

1. Solomon KD, Holzer MP, Sandoval HP, et al. Refractive surgery survey 2001. J Cataract Refract Surg. 2002;28:346-55.

2. Shehadeh-Mashor R, Mimouni M, Shapira Y, et al. Risk factors for dry eye after refractive surgery. Cornea. September 17, 2019. [Epub ahead of print].