Patient-perceived pain during laser in situ keratomileusis: comparison of fellow eyes.

Purpose: To compare pain scores during laser in situ keratomileusis (LASIK) between first-eye surgery and second-eye surgery.

Setting: Private practice, Beirut, Lebanon.

Design: Cohort study.

Methods: Sequential bilateral LASIK was performed between January 2010 and January 2011 by the same surgeon using a Schwind Amaris excimer laser. Hemodynamics and intraocular pressure (IOP) were monitored intraoperatively. Patients graded their pain perception on a 4-point scale after the completion of each eye's surgery.

Results: The study enrolled 154 patients. The first surgery was performed in the right eye in 106 patients and in the left eye in 48 patients. Patients reported discomfort during suction (mean pain score 0.80 ± 0.56 [SD]). More pain was reported during second-eye surgery by 74% of patients; 2% reported more pain in the first eye, and 24% reported equal pain in both eyes. The mean pain score was 0.63 ± 0.35 in the first eye and 0.93 ± 0.51 in the second eye (P=.01). Pain was higher during second-eye surgery whether the procedure was started in the right eye or in the left eye. Systolic blood pressure was also higher during second-eye surgery (P=.001). There was no statistically significant difference in diastolic blood pressure, heart rate, IOP, or suction-ring pressure.

Conclusions: Patients had more pain during second-eye LASIK for reasons that are not clear. A psychological explanation or regional sensitization processes are potential factors and should be studied.

Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.