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Refractive surgery in glaucoma patients ‘is not business as usual’
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LAS VEGAS — Err on the conservative side when a glaucoma patient is interested in having refractive surgery, one surgeon advised.
According to Richard L. Lindstrom, MD, glaucoma and refractive surgery is a “cautious symbiosis. This is uncharted territory, and increased surveillance is needed. This is not business as usual.”
Speaking at the First Annual Ocular Surgery News Symposium — Glaucoma: Improving Your Odds, Dr. Lindstrom discussed how to manage glaucoma patients who were interested in improving their vision through refractive surgery. “Patients with glaucoma are as handicapped by refractive errors as the normal population but are more likely to be contact lens intolerant. They also may have iatrogenic anisometropia,” he said.
He said there are numerous refractive surgical options for these patients, including LASIK; laser epithelial keratomileusis (LASEK), photorefractive keratectomy (PRK); conductive keratoplasty; refractive lensectomy and Intacs (Addition Technology).
Special precautions include measuring and recording intraocular pressure levels with pachymetry pre- and postoperatively. He said to watch for steroid-induced IOP spikes postop. He added that the surgeon should document the visual field and optic nerve status preop and postop.
Finally, Dr. Lindstrom said to utilize extra informed consent. “The surgeon is at greater risk than the patient,” he warned.