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Identify allergies before performing LASIK, PRK
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ORLANDO, Fla. — Surgeons must identify ocular allergies in their patients before proceeding to refractive surgery, according to one surgeon, because patients taking allergy medications tend to have poor refractive outcomes.
“When you think about it, you wouldn’t think those things would have any influence on each other, but allergy can affect the refractive outcome,” said Deepinder K. Dhaliwal, MD.
Dr. Dhaliwal spoke at the Alcon exhibit here during the joint meeting of the American Academy of Ophthalmology and the Pan-American Association of Ophthalmology.
She cited a study that found that 46% of patients with grade 2 to 3 diffuse lamellar keratitis had a history of ocular allergy. She also quoted information from a laser manufacturer’s training manual, which noted that PRK patients who took Claritin (loratidine, Schering) had an increased mean time to re-epithelialization. The manual stated that patients should be instructed to discontinue loratidine use before refractive surgery.
Surgeons should take a careful patient history, specifically searching out the use of medication.
“Patients taking Claritin or other antihistamines don’t even consider them to be medications, so be specific when you ask about ocular allergy use,” Dr. Dhaliwal said.
She said she gives her refractive surgery candidates a short survey, including the following questions: “Do you take eye drops for ocular allergy, like Visine?” and “Do you take an antihistamine, like Claritin, Allegra or Zyrtec?”
She also recommended against use oral antihistamines for ocular allergies because “it’s best to treat a topical disease topically.”
She recommended that patients use Patanol (olopatidine, Alcon) alone for ocular allergy symptoms, and Patanol with Flonase (fluticasone propionate, GlaxoSmithKline) if nasal symptoms are associated. Patients also should stop wearing contact lenses before refractive surgery, she said.
After 2 to 3 weeks, the ocular surface should be reassessed, Dr. Dhaliwal said.
She said Patanol is effective because it is a “potent antihistamine; it is a mast-cell stabilizer; it is an anti-inflammatory and it is an extremely comfortable agent.”