Top refractive surgery pearl: Pay attention to the tear film

Refractive surgeons need to remember that the tear film is themost important refracting surface of the eye, and if it isabandoned, surgical outcomes will suffer, said Eric D.Donnenfeld, MD, clinical professor of ophthalmology, New YorkUniversity.

"We all know that dry eye is very common after LASIK and PRK,"Dr. Donnenfeld said. "A recent review of the world literatureshowed about one-third of patients have dry eye before LASIK andthe same proportion have dry eye after LASIK. Paying attention todry eye will yield dividends in terms of providing patients withbetter visual acuity and quality of vision."

Surgeons should consider the multiple treatment options availableto improve the condition of the ocular surface. Significantadvances have been made in artificial tear technology, and theseproducts continue to play an important role. Dr. Donnenfeld,however, also advocated more aggressive strategies, includingimmunomodulation with a topical cyclosporine ophthalmic emulsion(Restasis, Allergan).

"There are now several good studies to show that topicalimmunomodulation with cyclosporine both improves dry eye andprevents progression of the disease as well as studies to showthat when used preoperatively, topical cyclosporine dramaticallyimproves the ocular surface and outcomes after LASIK," hesaid.

Dr. Donnenfeld also said that he strongly believes inrecommending nutritional supplements, and that, in his opinion,punctal occlusion is not used often enough. In addition, surgeonsshould remember that treating the ocular surface encompassesaddressing eyelid disease in addition to the tear film. Patientsshould be evaluated for blepharitis/meibomianitis and treatedappropriately with hyperthermia and pharmacologic therapy, hesaid.