Prevalence and Risk Factors of Dry Eye Disease after Refractive Surgery

Yong Son Dae; Hwang Sungsoon; Hyun Joo; Hui Lim Dong; MD Eui Sang Chung,; MD Tae-Young Chung,

doi:10.3341/jkos.2017.58.7.782

Journal List > J Korean Ophthalmol Soc > v.58(7) > 1010806

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Dae, Sungsoon, Joo, Dong, Eui Sang Chung,, and Tae-Young Chung,: Prevalence and Risk Factors of Dry Eye Disease after Refractive Surgery

Original Article

J Korean Ophthalmol Soc 2017;58(7):782-787.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.782

Prevalence and Risk Factors of Dry Eye Disease after Refractive Surgery

Yong Son Dae, M.D.¹, Hwang Sungsoon, M.D.¹, Hyun Joo, M.D.^1,², Hui Lim Dong, M.D.¹, MD Eui Sang Chung,, PhD^1,³, MD Tae-Young Chung,, PhD^1,

¹Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Saevit Eye Center, Goyang, Korea

³Rhee’s Eye Hospital, Daejeon, Korea

Address reprint requests to Tae-Young Chung, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: 82-2-3410-3548, Fax: 82-2-3410-0074 E-mail: tychung@skku.edu

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 17 March 201725 May 2017 Accepted 27 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the prevalence and the risk factors of dry eye disease after refractive surgery.

Methods

A retrospective study was performed on 180 eyes of 98 patients based on medical records. Those who had tear break-up time less of than 5 seconds or had an Oxford stain scale equal to or greater than 2 were defined to have dry eye disease. We analyzed the prevalence of dry eye, compared demographic and clinical features of the dry eye group and normal group, and found risk factors of dry eye after refractive surgery.

Results

The prevalence of postoperative dry eye was 62.2%. Compared to the normal eye group, the dry eye group had a sig-nificantly higher proportion of women (p = 0.016), older age (p = 0.001), and thin cornea (p = 0.002). The most significant risk fac-tor of dry eye after refractive surgery was presence of dry eye before refractive surgery (odds ratio [OR] = 9.02, confidence inter-val [CI] = 3.8-21.4). Old age was also found to be an independent risk factor of dry eye after refractive surgery (OR = 1.06, CI = 1.01-1.11).

Conclusions

The risk of dry eye after refractive surgery was increased in older age and preoperative dry eye disease. In order to prevent post-refractive surgery dry eye, caution should be exercised in middle aged patients with preoperative dry eye disease.

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Keywords: Dry eye, Prevalence, Refractive surgery, Risk factor

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Table 1.

Comparison of preoperative characteristics between pre-operative normal and dry eye group, and post-operative norma and dry eye group^*

	Pre-operative			Post-operative
Normal (n = 97)	Dry eye (n = 83)	p-value^†	Normal (n = 68)	Dry eye (n = 112)	p-value^†
Sex (% of female)	56.7	84.3	<0.001	58.8	75.8	0.016
Age (years)	31.0 ± 10.4	33.8 ± 12.5	0.102	28.3 ± 9.5	34.7 ± 11.9	<0.001
Contact lens (% of wear)	42.2	51.8	0.203	39.7	0.51	0.146
Corneal thickness (μ m)	551.2 ± 26.6	536.2 ± 30.9	0.001	553.0 ± 33.0	539.0 ± 26.1	0.002
Ablation depth (μ m)	103.5 ± 38.8	99.0 ± 35.8	0.423	107.7 ± 36.1	97.6 ± 37.9	0.079
Refractive surgery (n, %)
LASIK	53 (54.6)	57 (68.7)	-	33 (48.5)	77 (68.8)	-
LASEK	24 (24.7)	13 (15.7)	-	20 (29.4)	17 (15.2)	-
SMILE	20 (20.6)	13 (15.7)	-	15 (22.1)	18 (16.1)	-

Values are presented as mean ± SD unless otherwise indicated. LASIK = laser in situ keratomileusis; LASEK = laser subepithelial keratomileusis; SMILE = small incision lenticule extraction.

^* Definition of dry eye: tear break-up time < 5 sec or Oxford stain score ≥ 2;

^† p-value by independent t-test.

Table 2.

Results of univariate logistic regression analysis for postoperative dry eye

Variables	Odds ratio (95% CI)	p-value^*
Sex (female)	2.20 (1.15-4.22)	0.017
Older age (every 1 year)	1.06 (1.02-1.09)	0.001
Contact lens use	1.57 (0.85-2.90)	0.146
Dry eye before refractive surgery	10.9 (5.0-23.6)	<0.001
Refractive surgery
LASIK		(ref)
LASEK	0.36 (0.17-0.78)	0.010
SMILE	0.51 (0.23-1.14)	0.102
Corneal thickness	0.98 (0.97-0.99)	0.003
Ablation thickness	0.99 (0.98-1.00)	0.080

CI = confidence interval; LASIK = laser in situ keratomileusis; LASEK = laser subepithelial keratomileusis; SMILE = small in-cision lenticule extraction; ref = reference category.

^* p-value by univariate logistic regression.

Table 3.

Results of multiple logistic regression analysis for postoperative dry eye

Variables	B	SE	Wals	Df	p-value^*	Exp (B)	95% CI
Sex (female)	-0.02	0.48	0.00	1	0.971	0.98	0.38-2.52
Older age (every 1 year)	0.06	0.02	6.47	1	0.011	1.06	1.01-1.11
Contact lens use	0.73	0.40	3.24	1	0.072	2.07	0.94-4.57
Dry eye before refractive surgery	2.20	0.44	25.1	1	<0.001	9.03	3.82-21.4
Refractive surgery
LASIK	(ref)	(ref)	3.72	2	(ref)	(ref)	(ref)
LASEK	-1.01	0.52	3.72	1	0.054	0.37	0.13-1.02
SMILE	-0.26	0.54	0.23	1	0.635	0.77	0.27-2.24
Corneal thickness	-0.01	0.01	3.21	1	0.073	0.99	0.97-1.00
Ablation thickness	0.00	0.01	0.02	1	0.885	1.00	0.99-1.02

B = log odds; SE = standard err; Wals = Wald statistic; Df = degrees of freedom; Exp (B) = odds; CI = confidence interval; LASIK = laser in situ keratomileusis; LASEK = laser subepithelial keratomileusis; SMILE = small incision lenticule extraction; ref = reference category.

^* p-value by multivariate logistic regression.

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