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."

Other ophthalmologists 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 problems.

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