For Some Lasik Patients, No More Tears
Tuesday, July 10, 2001; Page HE05
On the long
list of daunting complications from Lasik surgery -- worse vision, an unfixable distortion known as irregular astigmatism
and even blindness -- dry eyes may seem trivial, a complaint often dismissed by laser eye surgeons who assure patients the
problem is temporary and can be treated with eye drops or, if necessary, the insertion of plastic plugs that reduce tear loss.
But a study of 48 patients who had Lasik in the past few years suggests that severely dry eyes, which feel chronically
irritated, can be a debilitating and long-lasting complication of the popular sur-gery for nearsightedness. The lead in-vestigator
of the study, published in the current issue of the journal Ophthalmology, said she believes many surgeons fail to adequately
warn patients of this complication -- which, the Food and Drug Administration notes on its Web site, can be permanent.
Refractive surgeon Lisa Battat, who conducted the study on a group of her patients and others at the Bascom Palmer Eye
Institute of the University of Miami School of Medicine, said that it is precisely the patients who are most motivated to
have surgery -- those who have developed an intolerance to their contact lenses -- who may be most at risk for Lasik-induced
dry eye. Contact lens intolerance, which can develop after years of wearing lenses, is often the result of decreased corneal
sensitivity, which causes inadequate production of tears. In some cases a person's eyes become progressively drier with age.
Battat and her colleagues measured tear production before and after Lasik. They concluded that the surgery, which
involves cutting a flap in the cornea and zapping the area beneath the flap with a laser, can cause or exacerbate dry eye.
"Everybody has dry eyes one week after Lasik," Battat said, because the surgery involves the severing of
corneal nerves. But she noted that many patients in her study were complaining 18 months later that their eyes felt very dry.
Often the problem improved after using artificial tears.
"Some patients blink less after Lasik [and produce
fewer tears] because the corneal nerve is cut and there is less sensation," she said.
While Battat said "probably
only a small percentage of patients" will have a serious problem with dry eye, she routinely tests her patients for the
condition. "If a patient has severely dry eyes, then I won't operate," she said. Testing tear production before
surgery is rare, Battat added, "but I think it should be something doctors perform routinely."
disagree. "It's part of my pre-op rap to patients that many people are going to have dry eyes for three months after
surgery" and possibly longer, said Roy Rubinfeld, a Chevy Chase corneal specialist who has performed thousands of Lasik
procedures. But Rubinfeld said he regards the test Battat uses as "notoriously inaccurate," saying its results can
vary considerably from day to day.
"I go with more functional measurements," such as what patients say
about how dry their eyes are, Rubinfeld said, and their ability to tolerate contact lenses.
But as for Battat's research,
he said, "I think the study is very good -- probably the best discussion of something experienced Lasik surgeons have
been noting" -- that dry eyes, once thought to affect a fraction of Lasik patients, are a much more common problem post-operatively
and can occasionally be serious.
Millard Stahle, 54, a former real estate agent who lives in Fairfax County, said
he wishes he'd been warned before undergoing surgery last year. He said that the six-page consent form he signed did not mention
dry eye as a possible complication.
Stahle, who had surgery because he could no longer wear contact lenses, said
that three months after the operation, he was in intense pain at night and couldn't sleep because he was getting up every
hour to put drops in his eyes.
Since then, he said, his condition has improved but his eyes remain uncomfortably
dry and he still must use drops several times each day.
Stahle, who has sought treatment at Johns Hopkins University,
Emory University and elsewhere, said doctors have told him they are mystified about why he is still experiencing such severe
To Battat, such cases have led her to take dry eyes seriously. "Just imagine working -- or driving
-- if you had to stop and put in drops every five minutes," she said. "Some doctors might think that the problem
was 'solved' with drops. But I doubt a patient would."
-- Sandra G. Boodman
© 2001 The
Washington Post Company