Dry Eye Q&A with Dr. Andrew Holzman

Dr. Holzman recently made a change to his artificial tear protocol to better serve our LASIK and PRK patients.  Dr. Holzman’s clinical team asked him more about dry eye management.

What prompted you to consider this change in artificial tears?  

The lipid layer is largely ignored by many of the artificial tears on the market.  It is the lipid layer of the tear film that protects the tears from evaporating.  With Optive Advanced, the lipid component is bolstered and fortified which decreases evaporative dry eye. This type of dry eye is, in many cases, due to computer usage, air conditioning or heating vents, fans, or simply larger apertures.  I personally tried the new drop and found it to be very comfortable, long lasting, and it did not cause a significant blur.  Thank you to all of the Doctors who participated in our survey on this topic by voicing their own opinions.  We used all of this data in making our decision to move to Optive Advanced. 

How does using the IntraLase laser help you minimize dry eye symptoms post-LASIK?

The IntraLase laser creates planar-shaped flaps as opposed to meniscus-shaped flaps with a keratome  (blade).  This means that the peripheral flap thickness with IntraLase is the same as the central thickness, NOT twice as thick as can be the case in keratome flaps.  With less corneal tissue disrupted in the periphery, there is less disruption of the corneal nerves and neural loop which regulates tear function and lacrimation, thus less dry eye symptoms.  

Should PRK be a consideration for patients with moderate dry eyes pre-op and why?   

PRK has been shown to disrupt even fewer corneal nerves in the periphery than IntraLase, so if a patient has moderate to severe dry eye pre-op, PRK may be more appropriate.  However, with the use of Restasis, omega three fish oils and lubricants pre-op, many of these patients do quite well with LASIK. 

What are some risk factors that make a patient more prone to having dry eyes post-LASIK?  

We look at patients that have: problems with their contact lenses, burning or stinging late in the day, or larger palpebral fissures.  Also, patients that are:  over the age of 40, females, hyperopic, using certain medications like anti-depressants or anti-histamines.  These patients are at higher risk for post-op dry eyes.

We use Restasis pre-op for a few weeks and continue it post-op for a few months on these patients.  Restasis reduces inflammation in the lacrimal gland and likely also at the level of the conjunctival goblet cells.  This allows for a more healthy ocular surface and more consistent post-op results.

Do you have a question for Dr. Holzman?  E-mail us your questions now and then look for your answers in a future post!