ICO International Clinical Guidelines:
Keratorefractive Surgery (Initial and Follow-up Evaluation)
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Initial Exam History
- Present status of visual function [A:III]
- Ocular history [A:III]
- Systemic history [A:III]
- Medications [A:III]
Initial Physical Exam
- Visual acuity without correction [A:III]
- Manifest, and where appropriate, cycloplegic refraction [A:III]
- Computerized corneal topography [A:III]
- Central corneal thickness measurement [A:III]
- Evaluation of tear film [A:III]
- Evaluation of ocular motility and alignment [A:III]
Care Management
- Discontinue contact lenses before preoperative exam and procedure [A:III]
- Inform patient of the potential risks, benefits, and alternatives to and among the different refractive procedures [A:III]
- Document informed consent process; patient should be given an opportunity to have all questions answered before surgery [A:III]
- For LASIK, residual stromal bed thickness should not be less than 250 um [A:III]
- Check and calibrate instrumentation before the procedure [A:III]
- Surgeon confirms the identity of the patient, the operative eye, and that the parameters are correctly entered into the excimer laser’s computer [A:III]
Postoperative Care
- Operating surgeon is responsible for postoperative management [A:III]
- For surface ablation techniques, examine on the day following surgery and every 2 to 3 days thereafter until the epithelium is healed [A:III]
- For uncomplicated LASIK, examine within 48 hours following surgery, a second visit 1 to 4 weeks postoperatively, and further visits thereafter as appropriate [A:III]
Patient Education
Discuss the risks and benefits of the planned procedure with the patient. [A:III] Elements of the discussion include the following:
- Range of expected refractive outcomes
- Residual refractive error
- Reading and/or distance correction postoperatively
- Loss of best-corrected visual acuity
- Side effects and complications (e.g., microbial keratitis, sterile keratitis, keratectasia
- Changes in visual function not necessarily measured by Snellen acuity, including glare and function under low-light conditions
- Night vision symptoms (e.g., glare, haloes) developing or worsening; careful consideration should be given to this issue for patients with high degrees of ametropia or for individuals who require a high level of visual function in low-light conditions
- Effect on ocular alignment
- Dry eye symptoms developing or worsening
- Monovision advantages and disadvantages (for patients of presbyopic age)
- Conventional and wavefront-guided ablations advantages and disadvantages
- Advantages and disadvantages of same-day bilateral keratorefractive surgery versus sequential surgery. Because vision might be poor for some time after bilateral same-day photorefractive keratectomy, the patient should be informed that activities such as driving might not be possible for weeks
- Postoperative care plans (setting of care, providers of care)
* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2008 (www.aao.org)
(Download this Guideline as a PDF file - 100 KB)
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