Eyecare After Refractive Surgery

Regular eye examinations are important after refractive surgery in order to monitor vision and detect complications and eye diseases for both successful and unsuccessful cases. A article (2018) stated that recent estimates showed that 3.8% to 20.8% of patients require retreatment after myopia correction by refractive surgeries. Risks and complications of refractive surgery can be found on US FDA website: https://www.fda.gov/medical-devices/lasik/what-are-risks-and-how-can-i-find-right-doctor-me.

Some of the cases have been diagnosed and managed after refractive surgery are as below:

Moderate To Severe Dry Eye Syndrome

Patient: Early 50's Caucasian male

 

Symptoms: Increased blurriness, double and unstable vision especially with contact lens wear, foreign body sensation, red eye.

History: Very high myopia before refractive surgery (multiple cut radial keratotomies (RK)) about 25 years ago. Right corneal graft. Right retinal detachment with vitrectomy. Cataract surgery of both eyes with hypotony.

Right glaucoma. Uses monthly disposable contact lenses. Often apply tear supplement. Spent over $150,000.00 for eye health issues since the refractive surgery.

Signs: Scanty tear meniscus at lower eyelid margin (insufficient tear), decreased tear-up time (tear film instability / poor quality), moderate to severe punctate corneal fluorescein stainings and mixed injection. Deposits on contact lens surfaces.

Management: Extended Wear Synthetic Absorbable Punctal Plugs were inserted to retain tear. Apply tear supplement as required. Happy with the outcome without problems until now (over 2 years).

Guide: This showcases the importance of myopia management/control which is proven to slow down and minimize myopia progression and the risk of associated common vision threatening eye diseases, such as retinal detachment, glaucoma and cataracts. Myopia management and control require early detection and management in young age, even as young as 3 year-old. Patients/guardians were not convinced of the need for myopia management is one of the most common barriers for the kids to have myopia management/control for minimizing the risks of all these vision threatening diseases. Your children deserve good vision, good eye health and good life for life!

Myopia Regression and Dry Eyes

Patient: Early 40's Asian female

 

Symptoms: Left eye red, itchy and feeling swollen, sometimes more severe.

History: Very high myopia in both eyes (-6.00 to -8.00DS) before refractive surgery about 20 years ago.

Myopia returned after 15 years.

Signs: Scanty tear meniscus at lower eyelid margin, decreased tear-up time, moderate punctate conjunctival fluorescein stainings.

Management: Permanent Punctal Plugs was inserted. Apply tear supplement as required. Happy with the outcome without problems until now (over 1.5 years).

Guide: Dry eye syndrome and regression of refractive errors are common problems after refractive surgery.

Patients with regression of refractive errors might need to wear spectacles or contact lenses again. Most people, including those with refractive surgery done, 

need to wear spectacles or contact lenses after 40 year-old due to presbyopia which causes progressive deterioration of near vision. In addition, common eye diseases which cause refractive changes, such as cataracts and diabetes, often start in the middle age.

Therefore, it is rare that people can get rid of spectacles and contact lenses completely. In fact, non-invasive and modifiable orthokeratology can help people free from daytime spectacles and contact lenses even when their prescriptions change progressively.