By Rahul T. Pandit, MD
Postoperative complaints after LASIK have been attributed to unrealistic patient expectations, patient personality, and psychopathologic conditions, such as preoperative depression. Some psychiatric conditions may even be linked to a higher rate of post-LASIK complications, including flap dislocation after abnormal rubbing in patients with obsessive–compulsive disorder or borderline mental illness.
The authors of this study hypothesize that patients with psychological illnesses would report lower levels of visual acuity, poorer outcomes, and more perioperative complications. However, results from their retrospective study show that patients with severe but stable psychiatric disorders such as schizophrenia, obsessive–compulsive disorder, and bipolar disorder can have excellent results, suffer no remarkable complications and enjoy a high level of satisfaction.
Of the 82 patients who underwent myopic LASIK, 42 patients suffered from clinically diagnosed bipolar disorder, 32 from schizophrenia and eight from obsessive-compulsive disorder. Notably, no depressive patients were included. Patients were considered psychiatrically stable prior to undergoing surgery and were treated with medications.
Patients achieved excellent visual results, similar to those of patients in the general population, with 85.71 percent of the bipolar group, 88.52 percent of the schizophrenia group and 93.75 percent of the obsessive–compulsive group achieving a spherical equivalent (SE) of ± 0.50 D. Of the 75 percent of patients who completed a post-surgical questionnaire, more than 97 percent stated that their quality of life had improved and would undergo surgery again.
The authors suggest that the association between depression and poor postoperative outcome may be due to the fact that these individuals were not stable. Had their illness been treated in advance, outcomes may have been better.
When an undiagnosed psychiatric disorder is suspected, they advise against immediate surgery. The patient should first be diagnosed with the help of information provided by family members or the primary care physician and then referred to a psychiatrist for appropriate treatment before undergoing surgery. For patients who already received a psychiatric diagnosis, surgeons must ensure that the disease is stable and that the psychiatrist has approved the surgical procedure. In addition, the surgeon must feel the patient is a good candidate after a discussion of procedure and its benefits and risks.
Lastly, they note that psychiatric patients often take psychoactive drugs that can present a number of adverse effects and interactions. The most important issue for the refractive surgeon is that many drugs have a more or less significant anticholinergic component. These drugs can produce mydriasis, make miosis difficult, and inhibit tear secretion.