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Home > Archive > Lasik Eyes Surgery > December 2005 > Pain and dry >6 months post-op common in PRK and LASIK
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Pain and dry >6 months post-op common in PRK and LASIK
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| [b]Pain and dry >6 months post-op common in PRK and LASIK[/b]
http://www.ncbi.nlm.nih.gov/entrez/...1627&query_hl=6
[b]Symptoms of dry eye and recurrent erosion syndrome after refractive
surgery.[/b]
J Cataract Refract Surg. 2001 Apr;27(4):577
Hovanesian JA, Shah SS, Maloney RK.
Jules Stein Eye Institute and the Department of Ophthalmology, UCLA
School of Medicine, Los Angeles, California, USA.
PURPOSE: To determine the incidence and severity of patient complaints
typical of dry eye and recurrent erosion syndrome after excimer laser
refractive surgery and to compare the incidence of these symptoms after
photorefractive keratectomy (PRK) and laser in situ keratomileusis
(LASIK). SETTING: Outpatient university practice.
METHODS: A questionnaire was mailed to 1731 patients who had had
primary myopic PRK or LASIK at least 6 months previously. Questions
were designed to determine the incidence and character of ocular
dryness and recurrent erosion symptoms and their impact on patient
satisfaction and willingness to have surgery again. Responses from PRK
and LASIK patients were compared.
RESULTS: Responses from 231 PRK patients and 550 LASIK patients
revealed an incidence of dryness symptoms in 43% and 48%, respectively
(P >.05). Soreness of the eye to touch was reported by 26.8% and 6.7%,
respectively (P <.0001). Sharp pains occurred in 20.4% of PRK patients
and 8.0% of LASIK patients (P =.0001). Complaints of the eyelid
sticking to the eyeball occurred in 14.7% and 5.6%, respectively (P
=.0001). All symptoms occurred predominantly on waking. Frequency of
eyelid sticking (P <.0005) and sharp pain (P <.005) symptoms, as well
as severity of sharp pain symptoms (P <.0001), were significantly
greater in PRK patients than in LASIK patients. On a scale of 0 to 10
(10 high), median overall patient satisfaction with surgery was 9 in
both groups. Soreness of the eyelid to touch occurred significantly
more frequently among patients with symptoms of sharp pains on waking
(P <.001) and the sensation of the eyelid sticking to the eyeball (P
<.001). Patients with 1 or more symptoms were twice as likely as
asymptomatic patients to have a satisfaction score of less than 8 (P
<.001).
CONCLUSIONS: Ocular dryness symptoms occurred commonly after PRK and
LASIK. Symptoms suggestive of mild recurrent erosions included sharp
pains, the sensation of the eyelid sticking to the eyeball, and
soreness of the eyelid to touch, a previously unrecognized symptom of
this condition. These symptoms occurred commonly after excimer laser
procedures but were significantly more common, more severe, and more
prolonged after PRK. The presence of these symptoms had a significant
effect on patient satisfaction.
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| The symptoms of damaged nerves due to lasik and even prk. I see
patients complain of dry eyes all the time, not a fun thing indeed!
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| Glenn - USAEyes.org 2005-12-26, 6:02 pm |
| This is an interesting study that has been cited many times in
subsequent studies. It provides detailed information regarding the
OCCURRANCE of dry eye symptoms temporarily induced by PRK and LASIK,
but does not provide the incidence of UNRESOLVED dry eyes induced by
refractive surgery.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| No, not a fun thing indeed. Can you believe that DOCTORS are doing this
to patients without fully informing them about nerve damage and the
fact that it is likely permanent? The Mayo clinic did a study showing
that corneal nerve desity is decreased more than 40% at the 3 year
point (patients actually lost nerve density between years 2 and 3,
demonstrating the trend is NOT toward recovery, and suggesting that
progressive nerve damage may in fact continue.
No peer reviewed study has demonstrated that corneal nerve denstity
returns to pre-operative levels after excimer laser surgery.
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| I would like to see a study demonstrating that nerve damage from
refractive surgery is ever resolved!
According to the Mayo Clinic, nerve damage from LASIK becomes WORSE
between years 2 and 3 post surgery. This trend may very well continue!
Consider this happy 20/20 (story below) who suddenly developed
debilitating dry eye 1 1/2 years after surgery, lost her career,
couldn't take care of her own children and had an amnotic membrane
transplant. When Corneal nerves are damaged, over time patients may be
pushed over the threshold into clinical dry eye. See patient
narrrative, reposted with permission of the author:
"This is what I posted on the Dry Eye Website, so you can put it in
another website if you like.
I had lasik in May, 2000. I was 20/20 the day after surgery. My eyes
were dry, but after 6-8 months they weren't. But my right eye always
felt like I had a little something in it, even with a schirmers of 25.
I was quite happy. My headaches were gone and I could see everything. I
stayed that way for 1 1/2 years after the surgery. Then, my eyes
started hurting and after four months of pain, I finally went to the
doctor and found out my eyes went dry. The doctors have never been able
to figure it out. I don't have sjorgren's syndrome or any other
symptoms.
I'm cauterized in my lower left and have two Herrick plugs in my right.
Before lasik, I was a 30 schirmers, then one year after lasik I was a
25 schirmers, now, who knows, I stopped taking schirmers.
I have many tears in my right eye, but I still have more pain in that
eye. I've had the amniotic tissue resurfacing (only partially I found
out), and will probably need to have the rest of the outer eye
resurfaced, next year.
I have two small children and it was extremely difficult to care for
them and have the amount of pain, depression and anxiety I had. I cried
constantly and had to put my children in daycare. I'm not as social as
I used to be and air in stores is a killer.
Because of dry eye, I cannot hold a full-time, professional job like I
used to. Now I am a part-time, office worker. I wear glasses that fit
close to my face to protect my eyes. I also have to have a 1 hour rest
every afternoon to bring down the irritation and start the day again.
That has really helped because I have some muscle tightness on the
right side of my face. Relaxation really helps me.
I spend a lot more money now and I don't make as much money. I had no
idea that this could be the outcome. I should have listened to my gut
more. I never had any problems with my eyes, and now, that's all I
think about. I was always very independent, outgoing, physically active
person. Now I'm not, and that saddens me."
Chris
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| Glenn - USAEyes.org 2005-12-26, 6:02 pm |
| "Eye" has yet again misinterpreted (deliberately or otherwise) the
Mayo clinic study and its follow-up report. The study showed that
sub-basal nerve density returns to preoperative levels at about three
years postop for PRK and about five years postop for LASIK.
What is truly important is that the nerve sensitivity returns much,
much earlier than density, and it is the sensitivity that determines
function.
I am sure that "Eye" is going to go on and on about how the follow-up
to the Mayo study is not yet peer-reviewed and published, but the
follow-up is by the same team who did the first study with the same
patients and the same protocols.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| Glenn - USAEyes.org 2005-12-26, 6:02 pm |
| "Eye", I have cited the follow-up to the Mayo study you cite on
numerous occasions. This follow-up affirms that nerve density returns
to preoperative levels at about three years postop for PRK and five
years postop for LASIK. If you refuse to see it, that is your problem,
not mine.
Of course, what is significantly more important is the return of nerve
density, which is the function necessary. Sensitivity returns much
earlier...normally within the six month healing period.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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