Mist can offer comfort, ease of use with dry eye after LASIK

A preservative-free moisturizing ocu-lar mist consisting of tissue-culture-grade medical water bottled to pharmaceutical standards (Nature's Tears, Bio-Logic Aqua Technologies) is a first-line recommendation for treating dry eye following LASIK. The eye mist is favored because of the ease of use and comfort level of the product and high patient compliance, according to two ophthalmologists who regularly recommend the product.

William Mathers, MD, a cornea/external disease specialist and professor of ophthalmology, Casey Eye Institute, Oregon Health Sciences University, Portland, gives his post-LASIK patients the choice of the ocular mist, artificial tears, or both. Artificial tears and the mist both have advantages and work in slightly different ways, he added.

"The mist is very, very easy to apply. It's very comfortable. People like to use it, so they do it more frequently. That's the big advantage," said Dr. Mathers, who helped develop the product and is a consultant to Bio-Logic Aqua Technologies, Grants Pass, OR.

Darwin Liao, MD, MPH, an ophthalmologist with Seattle Eye MDs, has noticed better compliance among patients who use the water mist for LASIK-induced dry eye.

"We know it is so easy to use that people will do it," he said, explaining that patients who come for follow-up visits after being advised to use drops often say they no longer do so because they do not feel the drops give them relief for more than a few minutes or they report their eyes feel sticky or worse a few minutes after administration of the drops. In contrast, the particles in the water mist are so small that they do not disrupt the natural oils on the surface of the eye and cause no such irritation, while providing better relief.

Ease of use is also a factor among elderly patients, who may have arthritis that hinders their ability to open and handle the small bottles containing drops but can manage the spray bottle of mist, Dr. Liao said.

Lubrication is essential for all patients who have undergone LASIK, although not all will go on to develop significant dry eye problems, both doctors said.

"Sometimes [lubrication] is critical and sometimes it is not. Everyone gets a little bit of dry eye after surgery, but the problems we saw in the past with really difficult dry eye afterward are not seen much anymore," Dr. Mathers said. "I think that is because we pay a lot more attention to it and are more aggressive about treating it and maintaining a healthy surface after surgery. Part of that is maintaining a healthy tear film and keeping the eye wet."

He strongly recommends a preservative-free product, whether artificial tears or the mist, although the single-use vials in which preservative-free artificial tears are packaged are more expensive and may be harder for some patients to apply.

"Some patients prefer one or the other, but I tell them they can use both," he added. "I think the mist definitely adds to our armamentarium in treating these patients, and if you treat them aggressively, you will not see very many problems with dry eye after laser surgery."

He recommended that patients use mist and/or artificial tears for about 2 weeks after laser surgery, applying the lubricant at least a few times a day, depending on the severity of the dryness.