Glaucoma and Refractive Surgery
Andrew Caster MD shares important information about patients at risk for developing glaucoma require special management when undergoing refractive surgery. Regular follow-up visits with an ophthalmologist can help ensure that these patients avoid potential complications later in life.
Diagnosing glaucoma requires an accurate measurement of an individual’s intraocular pressure (IOP). Dr. Andrew Caster believes when a patient undergoes refractive surgery, the thickness of the cornea is altered; as a result, the patient’s IOP may “read” lower than it actually is. While IOP is not the only factor used to diagnose glaucoma, an increase in IOP is arguably the most important risk factor indicating development and progression of glaucoma; an erroneous IOP reading – especially one that is artificially low — can cause a developing condition to be overlooked. Moreover, because treatment of glaucoma is aimed at reducing IOP, accurate measurement of pressure is essential for effective treatment of the disease.
Andrew Caster MD says, because refractive surgery can make it difficult for an ophthalmologist to set a target IOP for patients postoperatively, these patients must be followed closely, and additional tests must be used to monitor for changes in IOP. Although newer tonometers may prove more accurate in measuring IOP even in refractive patients, most ophthalmologists use other indicators to help determine if glaucoma is developing. These factors include changes in the optic disc, nerve fiber layer and visual fields. In addition, measuring the patient’s IOP prior to surgery and then again after the eye is stabilized may also be used as a new baseline.
Dr. Andrew caster says, patients undergoing refractive surgery should understand the possible changes that can result in an erroneously low IOP reading in future eye care visits. Also, they should be advised to let their ophthalmologist know during routine visits that they have undergone refractive surgery, so that the doctor may take extra precautions to carefully screen for the presence of glaucoma.