# Refractive surgery in glaucoma and suspected glaucoma patients: Critical analysis of the literature and clinical recommendations

## TL;DR

This paper discusses the challenges of detecting glaucoma in myopic patients who undergo refractive surgery and provides clinical recommendations for monitoring and managing the disease.

## Contribution

The paper provides new clinical recommendations for evaluating and monitoring glaucoma in refractive surgery patients with myopia.

## Key findings

- Structural and functional assessments are essential before and after refractive surgery for glaucoma detection.
- Postoperative corneal biomechanical changes can affect intraocular pressure monitoring.
- Long-term glaucoma management is necessary regardless of intraocular pressure in these patients.

## Abstract

Myopia is a significant risk factor for glaucoma and a growing public health
problem worldwide. Detecting glaucomatous changes in highly myopic eyes is
diagnostically challenging due to the abnormal appearance of the optic nerve
head. These patients also have a greater biomechanical susceptibility to
pressure-induced glaucomatous damage. Refractive surgery has become increasingly
popular, and many candidates for refractive surgery are myopic. Therefore, we
sought to review the aspects of patient evaluation in those who have undergone
refractive surgery for myopia concerned with the detection and monitoring of
glaucoma development. We identified several important elements of patient
evaluation for glaucoma after refractive surgery. These included the need for
both structural and functional assessments before and after surgery, and the
importance of monitoring for postoperative biomechanical changes in the cornea
and their impact on intraocular pressure. We conclude that, in patients who
undergo refractive surgery for myopia, it is essential to assess for the
presence of glaucoma, to identify staging, and to plan for long-term control of
the disease, regardless of IOP.