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An algorithmic approach to decode patients unhappy post refractive surgery with regression, glare and asthenopic symptoms

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First Author: R.Mullick INDIA

Co Author(s):    R. Shetty   K. Gupta   P. Khamar   P. Sarbjana           

Abstract Details

Purpose:

To report a step-wise systematic evaluation of post-refractive surgery patients presenting with myopic, hyperopic shift or glare and delineate the role played by vergence/accommodative anomalies in the causation of the same.

Setting:

Department of Refractive Surgery and Department of Orthoptics at Narayana Nethralaya, Bengaluru

Methods:

56 eyes of 28 patients presenting with myopic, hyperopic shift or glare after refractive surgery between June 2017 to December 2019 underwent detailed evaluation including cycloplegic refraction, topography, ray-tracing aberrometry, and binocular vergence and accommodation testing. Office and home-based vision therapy (VT) exercises were initiated after the diagnosis of vergence or accommodative anomalies.

Results:

35% of the eyes showed postoperative myopic shift with a mean (SD) of -2.25D (0.75), 16.7% hyperopic shift with a mean (SD) of 1.75D (0.6), 68.3% had associated astigmatism with a mean (SD) of -1.5D (0.4) while 20% eyes had only glare. A detailed evaluation revealed true regression in 2 eyes, convergence insufficiency (ci) in 24 eyes, accommodative excess (ae) and insufficiency (ai) in 6 eyes each, divergence insufficiency (di) and fusional vergence dysfunction (fvd) in 4 eyes each and non-specific vergence and accommodative (nsva) anomalies in 10 eyes. The myopic shift was associated significantly with ae and ci (p<0.05), hyperopic shift with ai, nsva (p<0.05) and glare with ci. After 21 days of VT, the mean residual refraction significantly reduced to 0.35D (0.2) (p<0.05).

Conclusions:

Binocular vergence accommodative issues contribute to the majority of patients presenting with post-refractive surgery myopic, hyperopic shift or glare while a minor number constitutes true regression. Meticulous evaluation and VT exercises help avoiding unnecessary re-correction surgery in these patients.

Financial Disclosure:

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