Pertinent Ocular History
The ocular history should focus on previous and current eye problems, such as dry-eye symptoms, blepharitis, recurrent erosions, glaucoma, and retinal tears or detachments. In addition, potentially recurrent conditions, such as ocular herpes simplex virus infection, should be recognized so that preventive measures can be instituted. Ocular medications should be noted. Prior ocular surgical procedures, such as radial keratotomy or penetrating keratoplasty, may affect clinical decision making in refractive surgery. A personal or family history of keratoconus may eliminate a patient from refractive surgery consideration. A history of previous methods of optical correction, such as glasses and contact lenses, should be taken. The stability of the current refraction is a very important consideration. A significant change in prescription for glasses or contact lenses is generally thought to be greater than 0.50 D in either sphere or cylinder within the past year. A contact lens history should be taken. Information gathered should include the type of lenses used (eg, soft, rigid gas-permeable [RGP], polymethyl methacrylate [PMMA]); the wearing schedule (eg, daily-wear disposable, daily-wear frequent replacement, overnight wear indicating number of nights worn in a row); the type of cleaning and disinfecting agents used; and the age of the lenses.
Because contact lens wear can change the shape of the cornea (corneal warpage), it is recommended that patients discontinue contact lens wear before the refractive surgery evaluation as well as before the surgery. The exact length of time the patient should be without contact lens wear has not been established. Current clinical practice typically involves discontinuation of soft contact lenses for at least 3 days to 2 weeks (toric lenses may require longer) and of rigid contact lenses for at least 2–3 weeks, but it may take months for the corneal curvature to return to normal in some long-term rigid contact lens wearers. For this reason, some surgeons keep patients out of rigid contact lenses for 1 month for every decade of contact lens wear. Before being considered for refractive surgery, patients with irregular or unstable corneas should discontinue wearing their contact lenses for a longer period and then be reevaluated every few weeks until the refraction and corneal topography stabilize. For patients who wear RGP contact lenses and find glasses a hardship, some surgeons suggest changing to soft contact lenses for a period to aid stabilization and regularization of the corneal curvature.
Bower KS, Woreta F. Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy. Curr Opin Ophthalmol. 2014;25(4):251–257.
de Rojas Silva V, Rodríguez-Conde R, Cobo-Soriano R, Beltrán J, Llovet F, Baviera J. Laser in situ keratomileusis in patients with a history of ocular herpes. J Cataract Refract Surg. 2007;33(11):1855–1859.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.