Considerations for Glaucoma Evaluation and Management in Refractive Surgery Candidates

Kasem Seresirikachorn,1– 3 Angela Y Zhu,1 Ta Chen Chang1 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 2Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand; 3Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, ThailandCorrespondence: Ta Chen Chang, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA, Email [email protected]: The popularity of refractive surgery has grown significantly in recent years, yet concerns about its effects on glaucoma evaluation and progression remain unclear. Various techniques in both corneal and lens-based refractive surgery have been developed, necessitating different strategies for monitoring glaucoma. With the advent of advanced technologies and instruments, our ability to detect and monitor glaucoma in patients undergoing refractive surgery has improved. This review provides comprehensive information on glaucoma risk assessment and monitoring from preoperative to postoperative stages for different types of refractive surgery, highlighting key considerations at each stage of care. We aim to raise awareness and confidence among refractive surgeons handling cases involving glaucoma suspects or patients with glaucoma at any stage of refractive surgery. Based on updated evidence, we provide key recommendations that include conducting a comprehensive glaucoma risk assessment, ensuring vigilant monitoring of high-risk cases, and selecting the most suitable tonometer for precise intraocular pressure measurement.Keywords: glaucoma, intraocular pressure, refractive surgery, keratorefractive surgery, myopia