Preoperative Patient Evaluation in Laser in Situ Keratomileusis (Lasik)
Hadil Mohamed Saad Ramah;
Abstract
Preoperative evaluation for refractive surgery follows a structured sequence that includes patient interview followed by a complete ophthalmologic examination. The aim of preoperative evaluation is to answer three broad questions in addition to generating specific refractive data for the actual treatment: 1) Is it possible to safely perform refractive surgery in the patient; 2) What is the risk of possible complications, given the patient specifics; and 3) Is it possible to meet the expectations that the patient has from the surgery?
A detailed history forms an important part of the patient selection process. The purpose is to identify patients who are either not expected to have a good postoperative outcome or not expected to be satisfied with the procedure. The goal of refractive surgery is to reduce the dependence on glasses and contact lenses in a safe and effective way. Postoperative vision can be invariably improved further with additional optical correction. Patients who expect perfect distance vision or presbyopes who expect equally good distance and reading vision may not be satisfied with the surgical outcome. There are multiple criteria by which the efficacy and safety of refractive surgical procedures can be measured. The most commonly cited metrics are those of uncorrected and best-corrected Snellen visual acuity, with the former serving as a measure of efficacy and the latter as a measure of safety. In addition, the magnitude of the residual refractive error serves as a measure of efficacy and precision of the correction technique. The refraction should be stable over at least 1 year. Patients in whom refraction has changed considerably over the past 1 year (more than 0.5 diopters), are poor candidates for surgery. Refractive surgery is contraindicated in patients with history of Herpes simplex or Herpes zoster ophthalmicus.. Refractive surgery is not performed in patients who have keratoconus. Relative contraindication for refractive surgery includes patients who have glaucoma, patients who are glaucoma suspect, or have ocular hypertension or those who have a history of uveitis. If the patient has a history of prior refractive surgeries, particularly radial or astigmatic keratotomy, then additional refractive procedures (PRK or LASIK) are associated with unpredictable refractive outcomes and greater potential complications.
A detailed history forms an important part of the patient selection process. The purpose is to identify patients who are either not expected to have a good postoperative outcome or not expected to be satisfied with the procedure. The goal of refractive surgery is to reduce the dependence on glasses and contact lenses in a safe and effective way. Postoperative vision can be invariably improved further with additional optical correction. Patients who expect perfect distance vision or presbyopes who expect equally good distance and reading vision may not be satisfied with the surgical outcome. There are multiple criteria by which the efficacy and safety of refractive surgical procedures can be measured. The most commonly cited metrics are those of uncorrected and best-corrected Snellen visual acuity, with the former serving as a measure of efficacy and the latter as a measure of safety. In addition, the magnitude of the residual refractive error serves as a measure of efficacy and precision of the correction technique. The refraction should be stable over at least 1 year. Patients in whom refraction has changed considerably over the past 1 year (more than 0.5 diopters), are poor candidates for surgery. Refractive surgery is contraindicated in patients with history of Herpes simplex or Herpes zoster ophthalmicus.. Refractive surgery is not performed in patients who have keratoconus. Relative contraindication for refractive surgery includes patients who have glaucoma, patients who are glaucoma suspect, or have ocular hypertension or those who have a history of uveitis. If the patient has a history of prior refractive surgeries, particularly radial or astigmatic keratotomy, then additional refractive procedures (PRK or LASIK) are associated with unpredictable refractive outcomes and greater potential complications.
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| Title | Preoperative Patient Evaluation in Laser in Situ Keratomileusis (Lasik) | Other Titles | تقييم المريض قبل إجراء عملية الليزك | Authors | Hadil Mohamed Saad Ramah | Issue Date | 2014 |
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