Patient assessment for refractive surgery from A to Z

This session will consider the comprehensive assessment of patients for refractive surgery to ensure successful outcomes. Patient evaluation, particularly in areas such as dry eye and corneal tomography, plays a vital role in this process. Refractive surgery options to be discussed will include LASIK, PRK, and SMILE, highlighting preoperative assessment and postoperative care. 

Corneal evaluation is another critical component, involving pachymetry to measure corneal thickness, and topography to identify surface irregularities. Advanced imaging techniques like Pentacam and Orbscan help assess both the anterior and posterior corneal surfaces, as well as the distribution of corneal thickness. Assessing for dry eye is equally important, requiring the use of symptom questionnaires as well as clinical tests. The results of these tests are used to stabilise the ocular surface preoperatively and to manage dry eye risks that may be exacerbated postoperatively. Management strategies typically involve artificial tears, lid hygiene, punctal plugs and prescription medications to optimise healing.

In addition to corneal and dry eye assessments, risk assessment and patient counselling will be explored, which are crucial for identifying high-risk patients and setting realistic expectations, particularly for those with pre-existing dry eye or corneal abnormalities. In conclusion, the importance of thorough preoperative assessments, including corneal tomography and dry eye evaluation, cannot be overstated. These steps, combined with ongoing management, are essential for achieving successful refractive surgery outcomes.