Title : Dry eye disease in the context of refractive surgery: Prevalence metrics and treatment outcomes among military personnel
Abstract:
The study included 185 military personnel indicated for refractive surgery. Group I (n=90) with preoperative mild dry eye disease (DED) confirmed and managed with standard ocular-surface therapy and Group II (n=95) without indication for preoperative DED treatment. Postoperatively, both groups received DED therapy. At 1 month functional visual performance remained high in both groups, however for selected activities (reading small print, driving in low illumination, screen use), the proportion reporting “no difficulty” was statistically higher in Group II (χ², p<0.05), consistent with residual DED symptoms in Group I during the early postoperative period. By month 6 the majority in both groups selected “no difficulty.” VF-14 scores corresponded to the “good” range (76–100) and most between-group differences were no longer statistically significant (p>0.05). Preoperative ocular-surface therapy in patients with DED accelerates rehabilitation and facilitates attainment of comparably high functional outcomes after refractive surgery by month 6.
Keywords: Refractive surgery, dry eye disease (DED), preoperative management, VF-14, military personnel.
Significance: Refractive errors (myopia, hyperopia, astigmatism) are among the most prevalent causes of visual impairment. According to the WHO’s 2010 global assessment, approximately 285 million people worldwide have visual impairment and roughly 42–43% of this burden is attributable to uncorrected refractive errors [1]. Among conscripts the detection of high-grade refractive errors typically leads on the basis of the Military Medical Expert Commission’s conclusion to a determination of unfitness for military service [2]. Defense agencies in several countries widely implement laser correction of refractive errors—LASIK, PRK, and related programs as a strategic instrument to enhance the combat effectiveness of their personnel [3].
Objective: To evaluate the impact of preoperative management of dry eye disease on postoperative functional outcomes after refractive surgery as measured by the VF-14 at 1 and 6 months in comparison with patients who did not receive preoperative treatment.
Materials and methods: A total of 185 active-duty military personnel scheduled for laser refractive correction due to refractive errors were enrolled. Group I (n=90) received preoperative treatment for dry eye disease whereas Group II (n=95) had no indication for preoperative therapy. Postoperatively, both groups received dry-eye management. Functional outcomes were assessed using the VF-14 scale at 1 and 6 months.
Results: In 1 month in the early postoperative period, VF-14 responses indicated that, although functional vision across several activities remained high in both groups, notable between-group differences were detected on specific items. For the skill of “recognizing people at close distance,” 7 patients (7.8%) in Group I and 9 (9.5%) in Group II reported some difficulty. “Distinguishing steps and curb edges”: 18 patients (20.0%) in Group I and 14 (14.7%) in Group II reported “minor difficulties.” The month 1 survey indicated that overall functional visual performance was rated higher in Group II. For activities such as “reading small print,” “driving under low illumination,” and “screen viewing,” the proportion selecting “no difficulty” was statistically higher in Group II than in Group I (p<0.05).
Pearson’s χ² test confirmed the statistical significance of these differences. Nonetheless, the observed discrepancies are clinically explicable and may be attributable to slower reinnervation of the ocular surface in Group I during the early postoperative period as well as to the persistent influence of residual DED symptoms. At the 6-month re-assessment, functional visual capacity was virtually fully restored in both groups. For the “reading small print” item, 89 patients (98.9%) in Group I selected “no difficulty,” whereas in Group II, 14 patients (14.7%) chose the same response and 60 (63.2%) reported “minor difficulties” (χ²=132.755; p<0.001).
Discussion: The analysis of statistical indicators showed that the relative lag observed in Group I one month postoperatively across several visual activities was transient. By month 6, visual function in both groups had recovered to a comparable high level. As a result of preoperative management of dry eye disease (DED), the stability and comfort of visual function normalized earlier in Group I and by the end of month 6 the metrics had fully converged. Clinically, these findings indicate that preoperative ocular-surface therapy accelerates postoperative rehabilitation after refractive surgery and enhances patient satisfaction.
At six months repeat assessment on the VF-14 scale demonstrated that visual function was nearly fully restored in both groups. The vast majority of participants selected “no difficulty” across all daily activities and total VF-14 scores corresponded to the “good” range (76–100). At this stage, most between-group differences were no longer statistically significant (p>0.05). These findings indicate that over the longer term outcomes converge and that preoperative DED management contributes to an accelerated recovery.
