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Does the method of dry eye testing impact the outcomes in refractive surgery patients?

Session Details

Session Title: Special Issues

Session Date/Time: Friday 15/02/2013 | 08:30-10:00

Paper Time: 09:29

Venue: Hall 2

First Author: : A.Cummings IRELAND

Co Author(s): :    A. Masterson   R. Corkin           

Abstract Details


Pre-operative screening for dry eye, and its treatment before surgery, is increasingly advocated as a way to minimize this post-op complication that can impact a patient’s quality of vision. This consecutive case series sought to determine if there is a difference in postoperative results based on the type of preoperative test used to assess the presence of dry eye.


Wellington Eye Centre


The results obtained with the practice’s standard method for preoperatively diagnosing dry eye – the Schirmer test – were compared to the results obtained with a tear osmolarity test. This was a consecutive series of 112 eyes of 59 patients presenting for laser vision correction assessment Jan 2012 at the Wellington Eye Clinic. All patients underwent Schirmer’s I tear test and an osmolarity testing (TearLab® Osmolarity System). Evidence of superficial punctate keratopathy (SPK) was also noted and graded. Patients were assessed at their 6-week post-operative visit for evidence of dry eye using SPK grading.


The mean age was 38.46 ± 12.29 (Range = 20 – 63yrs, 50% <33, 21.6% >50) with 17 male (29.3%) and 41 females (70.69%), a 2:5 ratio of women to men. Preoperative, the mean Schimrer test was 11.9 mm ±9.7, while the mean preoperative osmolarity test was 305 mOsm/l, range of 275 to 335 mOsm/l (Normal is considered to be 308 mOsm/l or less). There was no evidence of SPK in 93% of eyes preoperatively, compared to 60% at 6-weeks postoperative. Twenty-four percent of eyes had grade 1 SPK preoperatively, compared to 33.6% postop. Grade 2 SPK was present in 2.7% of eyes preoperatively, compared to 5.5% postoperatively. There were no dry eye symptoms in 57% of patients preoperatively.


There was no correlation in the 111 eyes between the preoperative Schirmer’s test and the osmolarity results, which is in line with previously reported results. In patients with SPK at six weeks post-op, there was a slight trend of correlation between higher preop tear osmolarity and post op SPK. In eyes where the osmolarity test was ≤ 308mOsm/L, 68% went on to have successful refractive surgery with 77% undergoing LASEK and 23% having LASIK.

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