Thorough evaluation of glaucoma patients vital before refractive procedures

NEW YORK — It is important to obtain a careful assessment of visual functional status, corneal thickness and optic nerve status, along with a thorough family history, when dealing with glaucoma patients who are looking to undergo refractive procedures, according to a speaker here.

Stephen A. Obstbaum

Stephen A. Obstbaum, MD, led a discussion at the East Coast Glaucoma Symposium on the necessary refractive surgical considerations for glaucoma patients. Dr. Obstbaum also spoke about refractive surgery patients who might develop glaucoma in the future.

"An issue that I think is critically important is that we're dealing with most of the surgeries being done on younger patients — many of whom are, maybe, genetically predisposed to glaucoma, and most of whom have not been identified," he said.

Obtaining thorough records of IOP and central corneal thickness will help surgeons and patients.

"I think that for eyes that have glaucoma that have had LASIK or PRK ... I think it's important to obtain records of the intraocular pressures, pressure measurements taken before the refractive procedure, to make multiple measurements of the intraocular pressure at various times of the day after the procedure, and if possible, obtain a record of the central corneal thickness before the PRK or LASIK were done," Dr. Obstbaum said.

In addition, he noted the importance of avoiding, if possible, any type of microkeratome suction ring in eyes with optic neuropathy, as the rings are designed to increase IOP, which could lead to visual field loss after refractive procedures.