Abstract: Phakic IOL & dry eye
This abstract covers exactly the kind of thing I have known must be going on but which I still dread seeing in print:
a) People getting phakic IOLs instead of LASIK/PRK because they have dry eye (and heaven forbid that someone should NOT be a candidate for some refractive surgery somewhere, especially in the military), PLUS
b) Nobody (apparently?) looking seriously at the ocular surface impact in the long run.
This latter point may sound like a stretch as regards the study whose abstract appears below. Honestly, I would be delighted to be contradicted with facts. If you can tell me that in this study, ocular surface assement methods which are now standard in OSD studies (OSDI, staining, TBUT and so on) were employed at 3 months postoperatively and NO PATIENTS had clinical signs or symptoms of dry eye at 3 months postop, I'll happily stand corrected. On the other hand if you tell me that "significant postoperative complications" is not intended to include dry eye - which is statistically the most frequently occurring complication of the more popular LASIK, and is disclosed as such in most informed consent forms - , I will be not the least bit surprised.
I hear from a ton of LASIK patients with dry eye because a ton of LASIK is done and a small percentage of the ones with dry eye end up on the internet. Very little phakic IOL is done (compared to LASIK) and I rarely hear from patients, but I have enough reports of dry eye after cataract surgery that I can't imagine it's not happening with elective lens implants.
Understand that I'm not bashing Phakic IOLs as such (I might but that's a different blog post). I just don't like any elective refractive surgery on already dry eyes, nor yet the tendency to assume it won't affect the ocular surface in healthy eyes.
Phakic Intraocular Lens Implantation in United States Military Warfighters: A Retrospective Analysis of Early Clinical Outcomes of the Visian ICL.
To assess short-term clinical outcomes after implantation of phakic intraocular lenses (Visian ICL, STAAR Surgical Co) in US military warfighters who are not good candidates for laser vision correction.
A retrospective interventional consecutive case series analysis of all eyes that underwent ICL surgery during a 14-month time period was performed. Main outcome measures included indications for surgery, efficacy, predictability, and early adverse events.
Three-month postoperative visual data were available for 135 eyes of 69 patients who underwent ICL implantation during the study period. Indications included abnormal corneal topography (37%), thin predicted residual bed following LASIK (32%), history of dry eye (13%), thin corneal thickness (11%), or other (7%). Mean patient age was 30.9±6.6 years. Mean preoperative spherical equivalent refraction was -6.00±1.92 diopters (D) (range: -2.63 to -11.50 D). Three months postoperative, uncorrected distance visual acuity of 20/20 or better was found in 129/135 (96%) eyes and 91/135 (67%) were 20/15 or better. Manifest refraction and corrected distance visual acuity (CDVA) data were available for 128 eyes. Forty-two (33%) eyes had improvement of one or more lines of CDVA. One hundred fifteen eyes (90%) were within ±0.50 D of emmetropia, and predictability within ±0.75 D was found in 127/128 (99%) eyes. No significant intra- or postoperative complications were observed.
This retrospective analysis of 3-month outcomes suggests that Visian ICL implantation in myopic warfighters provides excellent refractive and visual results. Further study is needed to evaluate long-term results.
Darned tootin' further study is needed. But geez, IOLs have been around long enough. Why ain't we doing this yet? If it's been done where is it? I've had a MedLine feed on anything with dry eye in the abstract for years. [URL="http://www.journalofrefractivesurgery.com/"]JRS[/URL] scarcely ever even gives dry eye a cursory glance. Much to be expected, I guess.
J Refract Surg. 2011 Jan 17:1-9. doi: 10.3928/1081597X-20110106-03. [Epub ahead of print]
Parkhurst GD, Psolka M, Kezirian GM.