When last we met, I was saying that dry eyes is a known complication of LASIK, but that the fuller picture is that dry eyes was a relatively common complication of LASIK, and that we rarely see it now. Since “rare” is vague, I’ll be more specific with a semi-specific educated guess of a number. At Hunter Vision, probably 1 in 50 people who are good LASIK candidates and take the prescribed drops still need to be cured of dry eyes after the three month LASIK post-op visit.
The reason dry eyes is less common now is that we have access to the reason that dry eyes is common for the first three months. The corneal nerves need some time to recover, and once they do, all is well. We use that information in four actionable ways to limit the incidence of dry eyes:
- Don’t do LASIK if someone already has a compromised level of tears.
That means saying “no” or “do this treatment first” to a lot of people, which is sad, but still overall a very nice thing to do if you like people, which I do. I should point out, however, that difficulty with contacts because of dry eyes is a “no” but is very different from the much more common difficulty with dry eyes because of contacts. People in the second group are some of the happiest LASIK patients. I was one of them.
- Recommend Restasis to every LASIK patient for the first eight weeks after laser.
It makes the corneal nerves heal faster during that initial period. It isn’t required for most people, but it is recommended for all of them.
- Use artificial tears every two hours for two months.
While we are waiting for the tear film to return to normal, artificial tears do an honorable job keep the surface of the eye quiet and smooth, which keeps unnoticeable, low levels of inflammation away. That makes healing easier.
- When doing LASIK, take the extra time to perfectly, beautifully, symmetrically, obsessive-compulsively finish the procedure so precisely that it is difficult to impossible to tell that you just did LASIK.
It adds about one minute of operating time. And I can just feel the technicians around me rolling their eyes on around the 15th round of smoothing (they’re nice, so they probably aren’t). But if you want those nerves to heal perfectly, you’ve got to be the type of surgeon that feels physical pain and gets hives when watching a YouTube video of a LASIK surgery that was done competently but not perfectly.
When those four points are adhered to, we just don’t hear a lot about dry eyes anymore. It’s why I like when people do their research on this stuff. It usually leads to good questions, and good questions should either have good answers, or if not, set off some alarm bells for the doctor and the patient to re-evaluate the path ahead.