When a patient expresses interest in refractive surgery, it may be due not simply to their myopia, but also to concomitant pigment dispersion syndrome (PDS). According to a newly published study in the Journal of Glaucoma, PDS was diagnosed in approximately a quarter of patients undergoing evaluation for refractive surgery.

PDS results from dispersion of iris pigment throughout the anterior segment. Its clinical signs include Krukenberg spindles, dense pigmentation of the trabecular meshwork, a deep anterior chamber, posterior bowing of the irides and midperipheral transillumination defects of the iris in a slit-like shape. Patients may be unlikely to present for these complications as they rarely cause clinically or visually significant symptoms. However, severe or chronic PDS is associated with pigmentary glaucoma with subsequent optic nerve atrophy, and up to 10% of patients with PDS progress to pigmentary glaucoma within five years.

The study looked at 637 eyes of 319 preoperative patients. Based on the clinical signs mentioned, 25.9% (165 eyes) were diagnosed with PDS. The study also found that Caucasian patients with blue eyes were most likely to have PDS.

 The researchers suggested this early diagnosis isn’t a reason to cancel surgery, but could be a reason to follow these patients more closely in the future, to monitor for conversion to pigmentary glaucoma.

Doane J, Rickstew J, Tuckfield J Cauble J. Prevalence of pigment dispersion syndrome in patients seeking refractive surgery. J Glaucoma. January 15, 2019. [Epub ahead of print].