LASIK patients are young, so it is crucial that surgeons understand the mechanisms of secondary glaucoma—they have many more years in which to develop glaucoma.
Myopia is a known risk factor for developing glaucoma, and most population-based studies have shown an increased prevalence of glaucoma among myopes with a stronger association noted with moderate to high myopia, according to Sarwat Salim, MD.
“Myopia is also a known risk factor for steroid-induced ocular hypertension, and many LASIK patients are placed on steroids for an extended time postoperatively,” said Dr. Salim, professor of ophthalmology and visual sciences, Medical College of Wisconsin, Milwaukee.
“These factors make it important that refractive surgeons inquire about patients’ family history of glaucoma as well as perform a complete exam with testing,” Dr. Salim said.
The complete exam should include retinal nerve fiber layer imaging, visual field testing, measure of central corneal thickness, gonioscopy, and disc photos (Figure 1), with the latter two being often overlooked, she noted.
“Gonioscopy is important because there have been reports of acute angle-closure glaucoma after hyperopic LASIK1–2,” Dr. Salim said. Gonioscopy is necessary for identifying some cases of pigment dispersion syndrome.
“Delayed wound healing and less predictable visual outcomes have been reported after LASIK in eyes with pigment dispersion syndrome,” she said.
The syndrome is also a contraindication for the placement of phakic IOLs.3 (See sidebar, “Phakic IOLs Contraindicated Glaucoma Suspects”)