An algorithmic approach to decode patients unhappy post refractive surgery with regression, glare and asthenopic symptoms
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First Author: R.Mullick INDIA
Co Author(s): R. Shetty K. Gupta P. Khamar P. Sarbjana
To report a step-wise systematic evaluation of post-refractive surgery patients presenting with myopic, hyperopic shift or glare and delineate the role played by vergence/accommodative anomalies in the causation of the same.
Department of Refractive Surgery and Department of Orthoptics at Narayana Nethralaya, Bengaluru
56 eyes of 28 patients presenting with myopic, hyperopic shift or glare after refractive surgery between June 2017 to December 2019 underwent detailed evaluation including cycloplegic refraction, topography, ray-tracing aberrometry, and binocular vergence and accommodation testing. Office and home-based vision therapy (VT) exercises were initiated after the diagnosis of vergence or accommodative anomalies.
35% of the eyes showed postoperative myopic shift with a mean (SD) of -2.25D (0.75), 16.7% hyperopic shift with a mean (SD) of 1.75D (0.6), 68.3% had associated astigmatism with a mean (SD) of -1.5D (0.4) while 20% eyes had only glare. A detailed evaluation revealed true regression in 2 eyes, convergence insufficiency (ci) in 24 eyes, accommodative excess (ae) and insufficiency (ai) in 6 eyes each, divergence insufficiency (di) and fusional vergence dysfunction (fvd) in 4 eyes each and non-specific vergence and accommodative (nsva) anomalies in 10 eyes. The myopic shift was associated significantly with ae and ci (p<0.05), hyperopic shift with ai, nsva (p<0.05) and glare with ci. After 21 days of VT, the mean residual refraction significantly reduced to 0.35D (0.2) (p<0.05).
Binocular vergence accommodative issues contribute to the majority of patients presenting with post-refractive surgery myopic, hyperopic shift or glare while a minor number constitutes true regression. Meticulous evaluation and VT exercises help avoiding unnecessary re-correction surgery in these patients.