The importance of screening for laser-assisted in situ keratomileusis operation (LASIK) before prescribing isotretinoin

Abstract

I n an age where isotretinoin (Accutane, Roche Laboratories Inc., Nutley, NJ) has revolutionized the treatment of nodulocystic and refractory acne, the number of prescriptions each year has increased from approximately 800,000 in 1992 to more than 2 million in 2000. Although an effective drug if used under the proper guidelines, these guidelines do not warn dermatologists or patients of the potential dangers if prescribed before or after laser-assisted in situ keratomileusis (LASIK) eye operation. LASIK is an ophthalmologic corneal operation that has soared in popularity since its initial approval in 1992. The American Academy of Ophthalmology reports that 500,000 Americans had LASIK operations in 1999 and it is estimated that more than 1.1 million LASIK cases were performed in the United States in 2003. Although the average age of patients undergoing LASIK is 40 years, many are between the ages of 18 and 30, which overlaps with the population of patients with acne, whose average age is 24 years. LASIK is a revolutionary procedure allowing for vision correction by use of an excimer laser to ablate the corneal stroma. A well-known and documented complication of LASIK operation is dry eye. Given that isotretinoin can also cause dry eye, it is a contraindication to perform LASIK operation on a patient taking isotretinoin. The complications of severe acute and chronic dry eye can be serious including structural corneal damage and ulceration, infection, decreased vision, and loss of vision. The general consensus from a survey of 50 ophthalmologists