title: Referrals to the Wills Eye Institute Cornea Service after laser in situ keratomileusis: reasons for patient dissatisfaction.
abstract: OBJECTIVE
  To review the symptoms, findings, and management options in patients referred to the Cornea Service who were unsatisfied with results after laser in situ keratomileusis (LASIK).
  
  
  METHODS
  Cornea Service, Wills Eye Institute, Philadelphia, Pennsylvania, USA.
  
  
  METHODS
  A retrospective chart review was conducted of all patients seen for consultation between January 1, 2004, and December 31, 2006, who had LASIK performed elsewhere. The parameters extracted were demographic data, history, symptoms, postoperative best corrected and uncorrected visual acuities, surgical complications, examination findings, and treatment recommendations. The data were also compared with previously unpublished data collected at Wills Eye from 1998 to 2003.
  
  
  RESULTS
  One hundred fifty-seven eyes of 109 patients seen in consultation after LASIK were identified. Twenty-eight percent were referred by the LASIK surgeon and 54%, by another eye doctor; 17% were self-referred. The most common chief complaints were poor distance vision (63%), dry eyes (19%), redness/pain (7%), and glare and halos (5%). Forty-four eyes (28%) had surgical complications or enhancements. The most common diagnoses were dry eye or blepharitis (27.8%), irregular astigmatism (12.1%), and epithelial ingrowth (9.1%). Eleven percent were referred in the first month after LASIK; 23% and 10% were referred between 1 and 6 months and 7 and 12 months, respectively. Medical management (eg, artificial tears, steroids, other dry-eye treatment) was offered in 39% of cases, surgical intervention in 27%, and observation only in 7%. Nonsurgical therapy was offered in 73% of cases.
  
  
  CONCLUSIONS
  Most patients who came for consultation were referred by a doctor other than their LASIK surgeon. Poor distance vision, dry eye, redness/pain, and glare and halos were the most common chief complaints and dry eye or blepharitis, irregular astigmatism, and epithelial ingrowth, the most common diagnoses.
authors.affiliation: Wills Eye Institute, Philadelphia, Pennsylvania, USA.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Levinson
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Rapuano
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Cohen
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Hammersmith
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Ayres
authors.forename: Peter R
authors.initials: PR
authors.lastname: Laibson
mesh_terms: D000328:Adult; D000368:Aged; D001762:Blepharitis / Q000209:etiology / Q000628:therapy; D015352:Dry Eye Syndromes / Q000209:etiology / Q000628:therapy; D005260:Female; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014786:Vision Disorders / Q000209:etiology / Q000628:therapy; D014792:Visual Acuity / Q000502:physiology