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Preoperative dry eye, ectasia risk factors can determine if PRK or LASIK is optimal
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NEW YORK — Both PRK and LASIK are effective refractive surgery procedures, but patients with preoperative dry eye and those who are at high risk for ectasia may be better candidates for PRK, according to a speaker here.
“LASIK and PRK are both excellent options for refractive surgery, and they provide excellent results. However, whatever criteria you use, the [residual stromal bed] or the [percent tissue altered], whatever that minimum number is, it’s important to not exceed that with a planned LASIK procedure, and if so, you should perform a surface procedure instead. Consider PRK rather than LASIK with people who are presenting preoperatively with mild to moderate dry eye. In either case, it’s important to identify and treat the dry eye preoperatively,” Jodi I. Luchs, MD, FACS, said at OSN New York 2016.
Luchs said a surgeon needs to weigh several factors when deciding if LASIK or PRK is the best option for a patient. The risk for ectasia, dry eye, occupation such as if a patient is a member of the armed forces, a patient’s risk for eye trauma or flap dislocation, and the surgeon’s comfort level all help determine which procedure is best.
A patient’s risk for ectasia can be determined using the Randleman criteria, Luchs said. The criteria take into account five factors — topography pattern, residual stromal bed thickness, age, preop corneal thickness and preop spherical equivalent manifest refraction — with an assigned score between 0 and 4. Patients with a score of 0 to 2 are at low risk for ectasia, which is safe for either LASIK or PRK. Patients with a score of 3 are at moderate risk, and surgeons should proceed with caution if performing LASIK, with many opting for a surface procedure. A patient with a score of 4 or more is at high risk; it is suggested that a surgeon not perform LASIK, and the safety of a surface procedure is not well established in these cases, Luchs said. – by Robert Linnehan
Reference:
Luchs JI. Patient selection for PRK vs. LASIK. Presented at: OSN New York annual meeting; Nov. 4-6, 2016; New York.
Disclosure: Luchs reports no relevant financial disclosures.