A prospective, non-interventional, multicentre, single-visit study to determine the prevalence and severity of dry eye in patients seeking LASIK therapy

Session Details

Session Title: LASIK Outcomes II

Session Date/Time: Tuesday 16/09/2014 | 14:00-16:00

Paper Time: 15:26

Venue: Capital Hall B

First Author: : D.Maychuk RUSSIA

Co Author(s): :    -. Maychuk D for the Dry Eye Prevalence Study Group              

Abstract Details

Purpose:

Not all patients with dry eye disease are correctly diagnosed prior to corneal refractive surgery, and this can adversely affect post-operative clinical outcomes and patient satisfaction. This study was conducted to assess the prevalence and severity of dry eye disease in patients considered for corneal refractive surgery with laser-assisted in situ keratomileusis (LASIK).

Setting:

Svyatoslav N. Fyodorov State Institution, Eye Microsurgery Complex, Moscow; Svyatoslav N. Fyodorov State Institution, Eye Microsurgery Complex, Saint-Petersburg; Svyatoslav N. Fyodorov State Institution, Eye Microsurgery Complex, Krasnodar; Medical Clinic ‘Professorskaya Plus’, Ekaterinburg; Medical Center for Laser Correction of Sight LLC ‘Oftalma’, Stavropol; Railway Clinical Hospital ‘Russian Railways’, Nizhny Novgorod; Regional Medical Clinical Hospital, Ivanovo; Ophthalmology Center of the Federal Medico-Biological Agency, Moscow; Ophthalmology Center ‘Vostok-Prozrenie’, Moscow

Methods:

In this prospective, observational, single-visit study, patients ≥18 years of age attending an ophthalmology consultation for LASIK therapy were enrolled between May and Sept 2013 for the following dry eye assessments: Schirmer test, tear break-up time (TBUT) test, Lissamine Green ocular surface staining (Oxford scheme), Dry Eye Workshop (DEWS) dry eye severity grading, and Ocular Surface Disease Index (OSDI) questionnaire. Schirmer and TBUT assessments were performed on both eyes, and results were summarized for the worse eye in each case. Information on patients’ ophthalmological and other medical histories, home/workplace environment, current ocular medication, and contact lens use was also collected. No specific study exclusion criteria were applied.

Results:

In total, 400 patients [263 females and 137 males, mean (±SD) age 29.7 (±10.0) years] were evaluated at 9 study sites. Among the study population, 145 (36.2%) patients wore contact lenses (mean duration of use 85.4 months), 81 (20.2%) patients were using dry eye medications, and 42 (10.5%) patients had a family history of dry eye. Mean (±SD) Schirmer test score for the study population was 15.2 (±8.8) mm; no clear correlation between alterations in Schirmer test score and other indices of dry eye was noted. TBUT values were <5 seconds (signifying high likelihood of dry eye symptoms) for 40 (10.0%) patients, 5‒10 seconds (marginal) for 172 (43.0%) patients, and >10 seconds (normal) for 183 (45.8%) patients. Based on physicians’ assessments of DEWS severity grading, dry eye was classified as mild in 260 (65.0%) patients, moderate in 116 (29.0%) patients, and severe in 17 (4.2%) patients. Lissamine green staining was categorized as Grade 0 in 149 (37.2%) patients, Grade 1 in 156 (39.0%) patients, Grade 2 in 66 (16.5%) patients, Grade 3 in 22 (5.5%) patients, and Grade 4 in 2 (0.5%) patients. Mean (±SD) OSDI score was 48.5 (±26.0), indicating an overall mild-to-moderate level of dry eye.

Conclusions:

In this young population of corneal refractive surgery (LASIK) candidates, the investigator-assessed DEWS severity grading system was shown to be most informative for dry eye screening purposes. The proportion of study patients who required dry eye therapy, as determined by TBUT, Lissamine green staining, DEWS severity and OSDI findings, was at least 2-times higher than the proportion who reported using it. The results of this study indicate that up to 10% of patients seeking corneal refractive surgery (namely those patients with a prolonged history of dry eye or contact lens use, and patients unresponsive to long-term artificial tear therapy) require more active dry eye treatment than artificial tears alone.

Financial Interest:

One or more of the authors... research is funded, fully or partially, by a competing company