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Extended eye opening diminishes visual acuity more with soft contact lenses than LASIK
J Refract Surg. 2009;25(1):69-73.
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Prolonged eye opening was shown to diminish visual performance more significantly in eyes with soft contact lenses than in eyes that underwent LASIK.
The study included 31 eyes of 17 patients who wore soft contact lenses before undergoing LASIK. Mean patient age was 30.8 years. Patients underwent visual performance testing immediately after eye opening and 10 seconds later. Functional visual acuity, surface regularity and surface asymmetry, and higher-order aberrations were assessed.
Results showed functional visual acuity significantly diminished 10 seconds after eye opening compared with just after eye opening in eyes with contact lenses and after LASIK. The decrease was greater in eyes with soft contact lenses. Surface regularity and surface asymmetry were significantly greater 10 seconds after eye opening compared with just after eye opening in eyes with soft contact lenses and after LASIK. Higher-order aberration was greater 10 seconds after eye opening in eyes with soft contact lenses, but not after LASIK, the study authors said.
“Because the quality of vision of eyes with soft contact lenses is more compromised than that after LASIK in some patients, LASIK is a reasonable indication for symptomatic dry eye patients with soft contact lenses,” they said.
Many ametropic patients are successful contact lens wearers in their younger years but have difficulty later in life when dry eye syndrome develops, causing dissatisfaction with quality of vision and ocular comfort. Many of these patients will investigate and pursue laser vision
correction, the most common being LASIK, for their visual needs. Further, it is a fact that LASIK will exacerbate dry eye for a transient period of time following this surgery. This study points out through the metrics of functional visual acuity, surface regularity index, surface asymmetry index and higher-order aberrations, that patients who have pre-existing dry eyes and wear contact lenses have greater difficulty with their vision than the same dry eye patients in the early (first month) postoperative period following LASIK surgery. This is helpful for patients with dry eyes who have been contact lens wearers and then choose refractive surgery. As the dry eye exacerbation effect of LASIK is a self-limited problem that persists for only a few months after surgery, it should be reassuring to patients and surgeons alike that LASIK remains a convenient solution to help improve quality of vision and quality of life in these difficult to manage dry eye patients. This study suggests that these dry eye patients, on balance, should have fewer dry eye problems immediately following LASIK surgery than they had before surgery with soft contact lens wear.
– Richard J. Duffey, MD
OSN Refractive Surgery Board Member