Ocular Symptoms After Refractive Surgery.

Abstract

Importance Characterizing individual ocular symptom trajectories following laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) may provide a longitudinal, patient-centered perspective on postoperative recovery and help identify patients at risk of prolonged symptom courses. Objective To characterize longitudinal ocular symptom trajectories after refractive surgery, describe associated symptom descriptors over time, and identify baseline factors associated with pain trajectories. Design, Setting, and Participants This prospective, multicenter cohort study was conducted at 2 academic ophthalmology centers in the US from April 2021 to July 2025. Adults undergoing bilateral LASIK or PRK were enrolled and evaluated preoperatively and at postoperative day 1 (POD 1) and months 3 (POM 3) and 6 (POM 6). Participants eligible for refractive surgery were included. Exclusion criteria included pregnancy, corneal abnormality (scar, ectasia, corneal surgery), eye diseases that could confound ocular pain (glaucoma, herpetic eye disease), and age younger than 18 years. Main Outcomes and Measures Ocular pain intensity measured using numerical rating scale (NRS; 0-10) at baseline, POD 1, POM 3, and POM 6. Clinically relevant pain was defined as an NRS score of 3 or greater. Trajectories were classified based on clinically relevant pain presence across time points; baseline demographic, clinical, surgical, and ocular surface factors were evaluated as associated factors. Results Among 326 participants with complete pain data (mean [SD] age, 34.3 [7.9] years; 196 [60.1%] female), pain trajectories were heterogeneous. No clinically relevant pain was observed in 94 participants (28.8%), pain at POD 1 only in 143 participants (43.9%), and prolonged pain (at POM 3 or POM 6) in 59 participants (18.1%); 30 participants had uncommon pain trajectories. Prolonged pain was independently associated with PRK (vs LASIK: odds ratio [OR], 2.73; 95% CI, 1.29-5.77) and several preoperative factors, including lubricating drop use (OR, 2.41; 95% CI, 1.17-4.96), chronic low back pain (OR, 2.45; 95% CI, 1.14-5.25), and greater ocular symptom burden (5-Item Dry Eye Questionnaire score: OR, 1.11; 95% CI, 1.01-1.22). The presence of corneal staining at 6 months after surgery was associated with lower odds of prolonged pain (OR, 0.79; 95% CI, 0.64-0.97). Conclusions and Relevance In this cohort study, postoperative ocular symptom trajectories after refractive surgery followed distinct longitudinal patterns, suggesting these trajectories may have been associated with specific baseline factors. This trajectory-based, symptom-specific approach may provide clinically relevant insight into patient recovery and may improve risk stratification, counseling, and targeted perioperative management, but further corroboration is warranted.