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  • AAO OTAC Refractive Management/Intervention Panel, Hoskins Center for Quality Eye Care
    Refractive Mgmt/Intervention


    A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Refractive Management/Intervention Panel.

    Walter Allan Steigleman III, MD,1 Jennifer R. Rose-Nussbaumer, MD,2 Zaina N. Al-Mohtaseb, MD,3 Marcony R. Santhiago, MD,4 Charles C. Lin, MD,5 Seth M. Pantanelli, MD, MS,6 Stephen J. Kim, MD,7 Julie M. Schallhorn, MD8

    Ophthalmology, Vol. 130, 87-98, © 2022 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Objective: To evaluate current best practices for postoperative photorefractive keratectomy (PRK) pain control. 

    Methods: Literature searches in the PubMed database were last conducted in October 2021 and were restricted to publications in English. This search identified 219 citations, of which 84 were reviewed in full text for their relevance to the scope of this assessment. Fifty-one articles met the criteria for inclusion; 16 studies were rated level I, 33 studies were rated level II, and 2 studies were rated level III. 

    Results: Systemic opioid and nonsteroidal anti-inflammatory (NSAID) medications; topical NSAIDs; postoperative cold patches; bandage soft contact lenses (BCLs), notably senofilcon A contact lenses; and topical anesthetics were demonstrated to offer significantly better pain control than comparison treatments. Some other commonly reported pain mitigation interventions such as systemic gabapentinoids, chilled intraoperative balanced salt solution (BSS) irrigation, cycloplegia, and specific surface ablation technique strategies offered limited improvement in pain control over control treatments. 

    Conclusions: Systemic NSAIDs and opioid medications, topical NSAIDs, cold patches, BCLs, and topical anesthetics have been shown to provide improved pain control over alternative strategies and allow PRK-associated pain to be more tolerable for patients.

    1University of Florida College of Medicine, Gainesville, Florida 
    2Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
    3Baylor College of Medicine, Houston, Texas 
    4University of Sao Paulo, Sao Paulo, Brazil 
    5Stanford Eye Institute, Palo Alto, California 
    6Department of Ophthalmology, Penn State College of Medicine, Hershey, PA 
    7Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN 
    8Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California