At North Shore Eye Care in Smithtown and Riverhead New York, our board certified LASIK experts are often asked about LASIK and Dry Eye. As a leader in laser vision correction in Long Island, we understand that patients know LASIK patients that have encountered dry eye following LASIK. Our LASIK surgeons, Dr. Jeffrey Martin, Dr. Larry Zweibel, Dr. John Mauro and Dr. Paul Choinski feel that it is important to explain how LASIK relates to dry eye and why we rarely see dry eye today associated with LASIK.
The cornea is a clear membrane that covers the iris or colored part of the eye. The cornea helps to focus images on the retina along with the lens of the eye. In LASIK, the cornea is reshaped so that light is better focused on the retina without the need for glasses or contact lenses. Although the ablations are quite different, LASIK is effective for nearsightedness, farsightedness, and astigmatism. In the first step of LASIK, our Smithtown and Riverhead eye doctors make a small flap in the superficial layers of the cornea. The corneal surface has nerves that function to protect the ocular surface. This is why you blink when something comes near your eye. When your ocular surface becomes dry, a message is sent to the brain from the fifth cranial nerve of the cornea. The brain then tells the eyelid to blink and the lacrimal gland to create some more tears. Oversimplified, but the concept is clear. In making a flap, the nerves to the surface of the cornea are interrupted. Therefore, the cornea does not send as many messages to the brain communicating that the ocular surface is dry. Since the loop is interrupted, the blink rate is not increased and tear production is not ramped up. This is what leads to dry eye.
Even with the interruption of innervation to the surface of the cornea, the overwhelming majority of patients did not have clinically significant dry eye following LASIK even in the early days. When LASIK was first performed back in the late 1990's, we were using blade machines called microkeratomes to make flaps in LASIK. These machines were tougher on the ocular surface and they made thicker and larger diameter flaps. With these larger diameter flaps, much more of the corneal surface was affected leading to a higher degree of dry eye. We also learned early on that some patients are simply not good candidates for LASIK. Some patients with very dry eyes such as those with collagen vascular disease, Sjogren's syndrome, women with significant post-menopausal dry eye, and patients on certain medications should avoid LASIK. Other patients with moderate dry eye should be treated for dry eye prior to LASIK so that the ocular surface is optimized for the laser vision correction procedure. Treatment for dry eye includes artificial tears, Restasis, punctal plugs, nutritional supplements, environmental irritant avoidance among other modalities.
Today, the LASIK specialists in our practice perform all bladeless or blade-free LASIK. Instead of making the thin flap with a blade machine, we make the flap with Intralase, a blade-free laser that makes the most precise and thinnest flap possible. When North Shore Eye Care converted to Intralase five years ago, we noticed a change in post-operative dry eye immediately. Intralase makes a thinner flap and a smaller diameter flap. If a cornea is approximately 12 millimeters across, our blade-free flaps are only 8.5 millimeters. This leaves more cornea untouched so that nerve impulses from the cornea are almost normal right after LASIK. We find that patients with blade-free LASIK are less inclined to feel dry eye and quicker to recover if they do feel mild dry eye. Without the trauma of a blade machine, our eye doctors feel that the ocular surface returns to normal quickly. Of course, our LASIK doctors are also careful to fully treat dry eye prior to LASIK today. If we see significant dry eye, we will postpone laser vision correction until patients are asymptomatic.
North Shore Eye Care is committed to the best in laser eye surgery. We are the Official LASIK Provider of the New York Mets and the Official Eye Care Provider of the New York Islanders. We stand behind our LASIK with a LIFETIME COMMITMENT and we offer zero percent financing for two years to help our patients with the financial part of LASIK. Call today and find out why so many Long Islanders choose North Shore Eye Care.
North Shore Care is committed to providing continuing education opportunities for Optometrists. For more information, please see our previous symposia or a list of upcoming events.
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