title: Refractive surgery and the glaucoma patient.
abstract: OBJECTIVE
  Patients considering corneal refractive surgery undergo extensive preoperative testing, but current protocols may not address the management of glaucoma appropriately. This review outlines the current body of literature on the diagnostic and management challenges that exist in the treatment of glaucoma patients undergoing laser ablative surgery, and makes recommendations to improve current perioperative protocols.
  
  
  RESULTS
  As permanent structural alterations to the cornea after laser-assisted in-situ keratomileusis surgery make Goldmann applanation tonometry inaccurate, the advent of new diagnostic modalities and recommendations to accurately measure postoperative intraocular pressure (IOP) and subtle damage to the optic nerve have been further analyzed and tested.
  
  
  CONCLUSIONS
  As IOP is the only modifiable risk factor in the treatment of glaucoma to date, traditional diagnostic and treatment algorithms may not be appropriate for refractive surgery patients. Glaucoma remains a relative contraindication to refractive procedures, but as new diagnostic modalities emerge, our ability to diagnose and manage these patients may improve. More uniform recommendations need to be implemented to improve our long-term management of these patients.
authors.affiliation: Department of Ophthalmology, Glaucoma Service Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA. ashrivas@montefiore.org
authors.forename: Anurag
authors.initials: A
authors.lastname: Shrivastava
authors.forename: Assumpta
authors.initials: A
authors.lastname: Madu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schultz
mesh_terms: D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D009901:Optic Nerve Diseases / Q000175:diagnosis; D011300:Preoperative Care; D054140:Refractive Surgical Procedures; D015203:Reproducibility of Results; D012307:Risk Factors; D014065:Tonometry, Ocular