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LASIK could mask glaucoma’s onset, surgeon warns

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BOLTON LANDING, N.Y. — The inability to accurately measure patients’ intraocular pressures following LASIK could lead to missed diagnoses of glaucoma as the LASIK population ages, a surgeon here warned.

Allen E. Kolker, MD, said the number of people with normal tension glaucoma will increase dramatically in the next several years as people who have had LASIK age. Dr. Kolker spoke here at the Fall Foliage Focus, a regional meeting of the New York, New Jersey, Delaware and Pennsylvania ophthalmic societies.

Dr. Kolker said studies have estimated that there can be a difference of 1 mm Hg for every 30 to 35 µm of corneal tissue removed during LASIK. Some studies have indicated a change of up to 2 mm Hg, he said. These studies have followed patients only for about a year after LASIK, so no conclusive data exists yet, he noted.

One or 2 mm Hg is “not a huge amount, but the problem with this is that there can be considerable variability,” Dr. Kolker said.

According to Dr. Kolker, corneal thickness variations can confound IOP measurements. There is already a standard deviation of about 3 mm Hg in IOP measurements based on patients’ corneal thickness, which means that “fully one-third of individuals will have more than one standard deviation from this mean based purely on statistical factors, and in some instances that can be quite significant.”

IOP readings can also vary from the center of the cornea to the periphery, particularly after an eye has undergone LASIK, he said.

Dr. Kolker said his concern is that there will be a surge in patients with normal IOPs who nonetheless have glaucoma over the next several decades. Patients with the disease may not be diagnosed for years because their pressures remain normal, he added.

Any person with glaucomatous visual field loss and optic nerve damage before LASIK may be at risk for further loss after LASIK, Dr. Kolker said.

Dr. Kolker stressed that he is not advising patients with glaucoma not to undergo LASIK. Rather, all patients undergoing the procedure should have preoperative and postoperative IOP measurements and should continue to be monitored postop for any potential glaucomatous damage.