Factors predicting persistent ocular pain and dryness sensations following refractive surgery

Abstract

Purpose : To examine the frequency and risk factors for ocular pain and dryness sensations after laser assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK).

Methods : Prospective study of individuals undergoing refractive surgery at 2 eye care centers. Individuals were enrolled before surgery and followed post-operatively at day 1, 3 months (3M), and 6 months (6M). Questionnaires were administered at all time points. We set the criteria for pain (Numerical Rating Scale [NRS]≥3) and dryness symptoms (5 Item Dry Eye Questionnaire [DEQ-5]≥6 or Ocular Surface Disease Index [OSDI]≥13) and examined frequencies along with risk factors for persistent pain and dryness (present at both 3M and 6M after surgery).

Results : 197 individuals underwent refractive surgery (35±8 years; 60% female; 81% White; 30% Hispanic), with 87% having LASIK. 10 individuals (5%) reported ocular pain prior to surgery, with the frequency increasing to 18% at 3M and 19% at 6M. 66 individuals (34%) met criteria for dryness prior to surgery, with the frequency increasing to 63% at 3M and 48% at 6M. Next, participants were grouped based on the presence or absence of symptoms at both 3 and 6M, excluding those with symptoms at only one time point; 9% (n=17) met criteria for pain and 41% (n= 81) for dryness symptoms at both time points. Factors predicting persistent post-surgical pain on multivariable analysis included (1) pre-surgery ocular pain (odds ratio (OR): 14.8; 95% confidence interval [CI]: 1.9-114; p=0.01); (2) ocular pain day 1 after surgery (OR 9.9; 95% CI: 1.6-60.5; p=0.01); and (3) ocular allergies prior to surgery (OR 9.2; 95% CI: 2.4-35.5; p=0.001). Factors predicting persistent post-surgical dryness included (1) pre-surgery dryness symptoms (OR 10.4; 95% CI: 3.5-30.9; p<0.001); (2) pre-surgery depression symptoms (Patient Health Questionnaire-9: OR 1.2; 95% CI: 0.99-1.4; p=0.06); and (3) neuropathic pain symptoms day 1 after surgery (Neuropathic Pain Symptom Inventory modified for the Eye: OR 1.1; 95% CI: 1.04-1.2; p=0.002).

Conclusions : Persistent ocular pain and dryness can be experienced after refractive surgery. Some pre- and perioperative factors, such as ocular symptoms and allergies, increased the risk of symptoms up to 6 months after surgery. An improved understanding of risk factors may translate into improved counseling of refractive surgery candidates.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.