Thursday, November 17, 2005 

Dry Eye After LASIK?

More nonsense has been written about dry eye than almost any other eye condition. Dry eye is caused by a deficiency of tears, the fluid that constantly bathes the eyes, and keeps the surface moist and clear. Tears are slightly reduced as we age. They are also reduced by certain drying medications, like antihistamines and diuretics. The most severe form of dry eye is caused by an autoimmune disease known as Sjogren's Syndrome. People with Sjogren's Syndrome typically have dry eye, dry mouth, and an autoimmune condition, such as rheumatoid arthritis, or lupus. LASIK reduces tear production temporarily, because when the LASIK flap is created, corneal nerves are cut, and the neural pathways that signal the production of tears are interrupted. But the dryness is temporary. The nerves regenerate completely in six months, and symptoms of dryness rarely last longer than a few weeks. Artificial tears, available without a prescription, are the mainstay of dry eye treatment. They are soothing, and can be used safely as often as desired.


Phakic Intraocular Lenses

Many LASIK surgeons are now recommending intraocular lenses to correct nearsightedness and farsightedness, instead of LASIK or PRK. Intraocular lenses are the plastic or silicone lenses that are implanted in the eye after cataract removal. "Phakic" intraocular lenses are implanted without removing a cataract. They are placed in front of the natural lens of the eye. I have not been impressed with these lenses. I believe the science is in its infancy. Most patients do not want an intraocular procedure. They want a laser procedure that is as non-invasive as possible. You have to be an incredibly good surgeon to insert a phakic intraocular lens without damaging the natural lens or some other delicate structure inside the eye. You don't want to be part of the surgeon's "learning curve". The better part of valor, at this juncture, is to pass on a phakic intraocular lens, and stick with conventional LASIK or PRK.


State-Of-Art LASIK

LASIK, or laser vision correction, has evolved rapidly into an astonishingly good procedure. New innovations occur almost daily. Some are important, but most are "bells and whistles", and do not change LASIK in any meaningful way. At Scripps Clinic, we consider state-of-the-art LASIK to consist of:
1. An up to date excimer laser. We use the VISX Star S4 (the latest model and software).
2. Wavefront technology. This individualizes the treatment and produces high definition.
3. Intralase. This is a femtosecond laser that creates the LASIK flap. No cutting involved.
Your LASIK surgeon should have these, or similar, equipment available. Keep in mind, not everyone is a candidate for LASIK. In some eyes, it is safer to use PRK, or photorefractive keratotomy, the original laser vision procedure. And some eye conditions, like presbyopia (the need for reading glasses in people over 42), may not be correctable with current technology.

About me

  • I'm LASIKblog
  • From La Jolla, California, United States
  • Mitchell Friedlaender, M.D., is Head of the Division of Ophthalmology, and Director of the Laser Vision Center at Scripps Clinic, in La Jolla, CA, and Adjunct Professor at The Scripps Research Institute. He is a cum laude graduate of the University of Michigan Medical School, and received his ophthalmology training at Harvard University, and the University of California, San Francisco. He was a full time faculty member at the University of California, San Francisco before joining Scripps Clinic in 1986. He is the author of 6 books and over 250 scientific articles. He has lectured at universities throughout the world on conditions such as blepharitis, allergy, dry eye, and infection. He is the recipient of the Senior Honor Award of the American Academy of Ophthalmology, and a member of the American Ophthalmological Society, an honor society composed of 300 leaders in ophthalmology. He has been listed every year, since 1986, in The Best Doctors in America.
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