Survey finds a range of causes for dissatisfaction in refractive surgery

Richard L. Lindstrom, MD, led the session on refractive surgery complications at Hawaii 2004: the Royal Hawaiian Eye Meeting.

KOLOA, Hawaii — A survey of patients dissatisfied with the outcomes of refractive surgical procedures identified “a spectrum of complications” that contributed to the visual complaints, said a physician speaking here.

The results of the survey, conducted among patients seeking consultations at the Wilmer Eye Institute, were outlined by Terrence P. O’Brien, MD, here at Hawaii 2004, the Royal Hawaiian Eye Meeting.

Among the notable findings of the survey were these: More than 50% of patients had bilateral problems. The number of previous surgeries was not correlated with worse outcomes. Irregular astigmatism was most commonly associated with loss of best corrected visual acuity.

Many of the dissatisfied patients had good corrected visual acuities, Dr. O’Brien said; 56% of eyes had a BCVA of 20/20 or better, and more than 90% had a BCVA of 20/40 or better.

The survey included 161 eyes of 101 patients, Dr. O’Brien said. Average time between the patients’ first surgery and their consultation at Wilmer was slightly more than 2 years, he said.

The most common complaints were blurred distance vision (59%), glare (27%), dry eyes (21%) and blurred near vision (19%), Dr. O’Brien said. LASIK or LASIK enhancement were the most common types of surgery reported.

In the consultations at Wilmer, nonsurgical treatment was recommended for 47% of the patients, Dr. O’Brien said. These treatments included lubrication, glasses, soft and rigid contact lenses and punctal plugs. Surgical options, recommended to 53% of the patients, included LASIK or LASIK enhancement, flap lifting and irrigation, and corneal transplant.

In a large number of patients (33% of eyes), the recommendation was to wait for future technology to become available, Dr. O’Brien said.