Study: Who's highest risk for dry eye after elective vision surgery?

Oooooh a large study - >25,000 people who had LASIK or PRK over a ten year period!

So if you were one of the 25,000, you were more likely to have dry eye afterwards if:

  • You had LASIK (not PRK)

  • You are female

  • You are older (but not that much! we’re talking average 29.2yo versus 27.6yo)

Other points of interest:

  • 6% got postoperative clinically significant dry eye.

  • Larger optic zones (which helps prevent night vision issues after surgery) meant higher dry eye risk.

  • Lower (!) prescriptions were higher risk for dry eye. This was the only one that seemed counterintuitive to me.

Risk Factors for Dry Eye After Refractive Surgery. Shehadeh-Mashor R, Mimouni M, Shapira Y, Sela T, Munzer G, Kaiserman I. Cornea. 2019 Dec;38(12):1495-1499.

PURPOSE:

To determine the factors associated with clinically significant dry eye after keratorefractive surgery.

METHODS:

This is a large database retrospective study that included consecutive cases of myopic laser in situ keratomileusis (LASIK) or photorefractive keratectomy performed between 2008 and 2016 at Care-Vision Laser Center, Israel. Patients were divided into 2 groups according to whether they developed clinically significant dry eye.

RESULTS:

A total of 25,317 right eyes of 25,317 patients, with a mean age of 27.0 ± 8.3 years, were included. Postoperative dry eye developed in 1518 eyes (6.0%). The dry eye group was older (29.2 ± 9.0 vs. 27.6 ± 8.3 yrs, P < 0.001) and had a higher proportion of women (48.5% vs. 44.8%, P = 0.005), lower preoperative spherical equivalent (3.7 ± 2.0 vs. 4.0 ± 2.3D, P < 0.001), lower preoperative best-corrected visual acuity (0.019 ± 0.057 vs. 0.016 ± 0.064 Logarithm of the Minimum Angle of Resolution (LogMAR), P = 0.04), and lower proportion of preoperative soft contact lens wearers (40.6% vs. 45.5%, P < 0.001). In the postoperative dry eye group, a high proportion underwent LASIK (52.4% vs. 38.7%, P < 0.001) and were treated with a 7.0-mm (as opposed to 6.0 mm) optic zone (18.9% vs. 16.3%, P < 0.001). In multivariable analysis, older age [odds ratio (OR) 1.013, P < 0.001], female gender (OR 0.87, P = 0.009), lower preoperative refractive error (OR 1.05, P < 0.001), and LASIK (OR 0.67, P < 0.001) were associated with postoperative dry eye.

CONCLUSIONS:

Patients who are of older age, are of female gender, and have a lower preoperative refractive error and those undergoing LASIK are more likely to develop dry eye disease after keratorefractive surgery.