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Reporting of ocular dryness symptoms may not correlate with screening results
Schirmer’s testing can be used to objectively assess ocular dryness in all patients who present for refractive surgery.
Objective screening of aqueous tear production did not agree with subjective reporting of ocular surface dryness symptoms among patients who presented for refractive surgery, according to a study.
Brian P. Vahjen, MD, Bethany Markowitz, MD, and colleagues summarized study data in a poster at the Association for Research in Vision and Ophthalmology meeting in Fort Lauderdale, Fla.
Non-contact lens wearers were less likely than lens wearers to report symptoms of ocular dryness but were more likely to have objective signs of aqueous tear deficiency. Lens wearers were less likely to have objective signs of aqueous tear deficiency but were more likely to report symptoms, the authors said.
Dr. Vahjen and colleagues said refractive surgeons are becoming more aware of the influence ocular surface health exerts on postoperative refractive outcomes, risk factors and patient satisfaction.
“Ocular surface dryness affects preoperative visual testing, subjective visual testing, as well as postoperative visual outcomes, subjective visual satisfaction and comfort,” they said. “Therefore, it is becoming increasingly important to identify the patients at risk for developing dry eye. This study focuses on contact lens wear as a possible risk factor for dry eye in patients presenting for refractive surgery.”
Results and observations
The study authors set out to quantify and compare ocular surface dryness associated with contact lens wear and non-contact lens wear in patients who presented for refractive surgery.
The retrospective study included 104 eyes of 52 patients. Investigators used subjective and objective methods to assess bilateral ocular surface dryness. The Schirmer I test was used to gather objective data on ocular surface dryness. A patient questionnaire was used to gather subjective data on complaints of ocular surface dryness.
Thirty-four patients wore contact lenses and 18 patients did not wear lenses.
Among contact lens wearers, five of 34 patients (15%) had at least one eye with a Schirmer I test score lower than 10, which is indicative of aqueous tear deficiency. Nine patients in the contact lens group (26%) subjectively reported symptoms of ocular dryness on the questionnaire.
Six of 18 patients in the non-lens group (33%) had at least one eye with a Schirmer I score of less than 10. On the questionnaire, one patient in the non-lens group (6%) reported symptoms of ocular surface dryness.
“Ocular surface dryness is commonly found in patients presenting for refractive surgery in both contact lens wearers and non-contact lens wearers,” the authors said. “The subjective questionnaire reveals that the non-contact lens wearers were less likely to report symptoms of ocular surface dryness, even though this group was more likely to have an aqueous tear deficiency by more objective testing. Contact lens wearers were less likely to have aqueous tear deficiencies by objective testing but more likely to report symptoms of dryness.”
The authors suggested that physicians employ an aqueous tear production screening device before performing refractive surgery in all patients. – by Matt Hasson
- Brian P. Vahjen, MD, can be reached at Greenwood Eye Clinic, 210 Wells Ave., Greenwood, SC 29646; 864-227-2020; e-mail: brianvahjen@yahoo.com.
- Bethany Markowitz, MD, can be reached at the University of South Carolina Department of Ophthalmology, 4 Med Park, Columbia, SC 29203; 803-434-6836.