title: Indications for and outcomes of tertiary referrals in refractive surgery.
abstract: OBJECTIVE
  To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery.
  
  
  METHODS
  A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention.
  
  
  RESULTS
  One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye.
  
  
  CONCLUSIONS
  No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedures.
authors.forename: Eliza K
authors.initials: EK
authors.lastname: Patryn
authors.forename: Violette
authors.initials: V
authors.lastname: Vrijman
authors.forename: Carla P
authors.initials: CP
authors.lastname: Nieuwendaal
authors.forename: Ivanka J E
authors.initials: IJ
authors.lastname: van der Meulen
authors.forename: Maarten P
authors.initials: MP
authors.lastname: Mourits
authors.forename: Ruth
authors.initials: R
authors.lastname: Lapid-Gortzak
mesh_terms: D000328:Adult; D000368:Aged; D002386:Cataract / Q000175:diagnosis / Q000628:therapy; D015331:Cohort Studies; D005128:Eye Diseases / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis / Q000628:therapy; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D054120:Phakic Intraocular Lenses; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012030:Refractive Errors / Q000175:diagnosis / Q000628:therapy; D054140:Refractive Surgical Procedures / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000534:rehabilitation*; D014792:Visual Acuity / Q000502:physiology