PRK (photorefractive keratectomy) and LASEK (laser epithelial keratomileusis) are excellent alternatives for people with glaucoma. Glaucoma may not be an absolute contraindication for laser-assisted in-situ keratomileusis (LASIK), but it is still considered a relative contraindication. LASIK is a popular eye procedure that is relatively painless and is performed with extremely precise computer-controlled excimeric laser emission. Glaucoma is a group of diseases that are manifested by damage to the optic nerve with changes in the visual field.
Patients who experience a transient but significant increase in intraocular pressure during the LASIK procedure are at risk of further damage to the optic nerve. In addition, steroids commonly used after refractive surgery can increase intraocular pressure (IOP), especially in people who respond to steroids, which are more common among patients with glaucoma. Glaucoma patients interested in LASIK surgery can visit a glaucoma specialist or other LASIK surgeon who has experience performing LASIK on patients with glaucoma. Refractive surgeons may consider giving patients a picture of their optic nerve, a drawing, or an objective record of their preoperative exam.
Glaucoma patients who request corneal refractive surgery represent challenges for the refractive surgeon, the glaucoma specialist and the primary eye doctor. Debate continues around the world about whether modern corneal refractive surgery should be performed on these patients. In the author's consultation, patients with glaucoma who undergo refractive surgery participate in a thorough analysis of their expectations, as well as the risks, benefits and limitations of the available procedures. While refractive surgery is not likely to cause or worsen glaucoma, the issue has not yet been well studied.
Therefore, the author explains to patients that glaucoma is a relative contraindication for LASIK or PRK and that the choice to proceed requires careful reflection, given the lifelong care they require. PRK is used to treat nearsightedness (myopia), farsightedness (farsightedness), and astigmatism. The goal of PRK is to correct refractive error to improve vision. PRK can reduce your need for eyeglasses or contact lenses.
In some cases, it may even allow you to do without them altogether. People with high intraocular pressure or predisposed to glaucoma may not be suitable for LASIK surgery or may be at greater risk of developing permanent glaucoma. It makes sense to take the patient's interest seriously and give advice based on in-depth knowledge of the current state of refractive surgery alternatives and of the patient's individual status and needs. In this outpatient procedure, a laser is used to reshape the cornea and improve the way light rays are focused on the eye.
It's easy to fall behind in this area when your main concern is to protect your patients from vision loss due to glaucoma, but your ability to help a patient who wants to undergo refractive surgery can be compromised if you're not fully informed about the latest developments. Here are some strategies that can help you treat a patient with glaucoma who wants to undergo refractive surgery: Of course, the wise thing to do if you are the refractive surgeon is to obtain the patient's complete history and perform all appropriate preoperative tests. Changes in technology and technique can make a big difference in the relative safety of refractive surgery for patients with glaucoma. In this regard, it was reported that a case of unilateral angle-closing glaucoma after hypermepic correction with LASIK was successfully managed by laser iridotomy (Paciuc et al.).
The vast majority of patients who undergo modern corneal refractive procedures for ametropia have no ocular comorbidities. If you are going to have LASIK surgery, it's important to tell your optometrist or eye doctor if you or your family have a history of glaucoma so that they can take special precautions before, during, and after surgery. After LASIK or PRK surgery, patients with glaucoma should know that future IOP measurements must be adjusted to determine a true reading. Steroid-induced glaucoma is secondary open-angle glaucoma that results from the use of topical or systemic corticosteroids.
Physicians should be aware of the risk factors for glaucoma who undergo LASIK surgery, such as myopia, hyperopia, a family history of glaucoma, high intraocular pressure, diabetes, and suspicious onset of the optic nerve. Issues related to refractive surgery in patients with glaucoma are rarely discussed. This may be due, in part, to the fact that glaucoma specialists have an understandable tendency to focus on the disease that endangers vision and worry less about the patient's refractive error.
