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B. P. Vahjen, B. B. Markowitz, E. McCamant; Ocular Surface Dryness Associated With Contact Lens Wear in Patients Presenting for Refractive Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2848.
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Background: Refractive surgeons are becoming more aware of the importance of ocular surface health for obtaining postoperative outcomes satisfactory to the patient. Ocular surface dryness affects preoperative visual testing, as well as postoperative visual outcomes, subjective visual satisfaction, and comfort. Therefore, it is becoming increasingly important to identify the patients at risk for developing dry eye. This study focuses on contact lens wear as a possible risk factor for dry eye in patients presenting for refractive surgery.
The purpose of this study was to quantify and compare ocular surface dryness associated with contact lens and non-contact lens wear in patients presenting for refractive surgery.
A retrospective review of 104 eyes (52 patients) that presented for refractive surgery in 2007-2008 in which ocular surface dryness was measured with subjective and objective methods. The Schirmer I test was used in each eye to obtain objective data for ocular surface dryness. Subjective complaints of ocular dryness were obtained by a questionnaire. Patients were divided into two groups based on contact lens wear (34 patients) versus non-contact lens wear (18 patients).
A review of the data reveals that the contact lens group had 5 of the 34 patients (15%) with at least one eye with a Schirmer I test of less than 10, which is diagnostic of an aqueous tear deficiency. The contact lens group subjective questionnaire reveals 9 of the 34 patients (26%) had symptoms of ocular dryness. The non-contact lens group had 6 of the 18 patients (33%) with at least one eye with Schirmer I test of less than 10 and the subjective questionnaire had 1 of the 18 patients (6%) who reported symptoms of dryness.
Ocular surface dryness is commonly found in patients presenting for refractive surgery in both contact lens wearers and non-contact lens wearers. The subjective questionnaire reveals that the non-contact lens wearers were less likely to report symptoms from of ocular dryness even though this group was more likely to have an aqueous tear deficiency by more objective testing. Contact lens wearers were less likely to have aqueous tear deficiencies by objective testing but were more likely to report symptoms of dryness. Given these findings, an adequate aqueous tear production screening device (Schirmer testing, etc.) should be considered prior to performing refractive surgery in all patients, as subjective reporting by the patient does not appear to correspond with more accurate, objective screening devices.
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