Use of Psychotropic Medications in Patients Undergoing Primary LASIK, LASIK Retreatment, and Contact Lens Fitting

1
Use of Psychotropic Medications in Patients
Undergoing Primary LASIK, LASIK Retreatment, and
Contact Lens Fitting
Thomas J Dingle, MD, Jay S Pepose, MD, PhD, Susan
K Feigenbaum, PhD, Mujtaba A Qazi, MD
None of the investigators have any financial
interests related to this presentation
2
Purpose

• The percentage of US adults with a diagnosable
  mental disorder may be as high as 20.1
• The prevalence of psychotropic drug use in the
  general, non-institutionalized United States
  population is between 8.1 and 11.1.2,3
• Depression and mood disorders have been
  associated with a poor psychosocial outcome for
  various surgical procedures,4-7 including
  refractive surgery.8
• On April 25, 2008 the FDA Ophthalmic Devices
  Advisory Panel meeting heard both expert opinion
  and family and patient testimony on post-LASIK
  depression and suicide.
• The are over 700,000 refractive surgery
  procedures performed each year in the USA, and
  this population includes patients with
  psychiatric disorders.

3
Purpose

• To assess the prevalence of psychotropic
  medication use in various patient populations at
  one institution (Pepose Vision Institute)
• To compare the prevalence of psychotropic
  medication use in the pre-refractive surgery
  population compared to
• a) the general US population over age 18
• b) the contact lens population over age 18
• c) the LASIK retreatment population
• To compare the prevalence of psychotropic
  medication use prior to primary refractive
  surgery and prior to retreatment
• To assess the odds ratio of psychotropic
  medication use associated with age and gender in
  the refractive surgery and contact lens groups,
  and to compare these odds ratios to the general
  population

4
Methods
Retrospective chart review of patients in one
high volume, refractive practice (Pepose Vision
Institute) The charts were selected randomly
from previous office visits from 2002 to
2008. The data collected was analyzed using
Linear Prob, Probit, Logit qualitative choice
estimation models
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Results
Three Study Populations
Primary Refractive Surgery Retreatment Contact Lens Users
Number N120 N120 N115
Mean age (SD) and Range 40.510.8 (20-60) 44.913.1 (18-70) 43.99.3 (20-63)
Male 52.1 33.0 39.0
Mean Spherical Equivalent and range -3.52.8 (-10.4 to 2.75D) -2.793.9 (-14.24 to 7.25D) MRx prior to primary surgery -4.142.46 (-11.25 to 5.0D)
Absolute Spherical Equivalent 3.842.39D 3.862.84D 4.642.46
6
Psychotropic Drug Use
Drug Indications Primary Refractive Surg. Retreatment Contact Lens Users
Nortryptyline TCAntidepressant 1 0 0
Buspirone General anxiety disorder 1 0 0
Duloxetine SNRI Antidepressant 0 0 (1 added between treatment) 1
Venlafaxine SNRI Depression, GAD, panic disorder 5 4 2
Doxapine TCA 0 1 0
Amitryptyline TCA 1 2 2
Escitalopram SSRI, Depression, GAD 2 1 (1 added between treatment) 2
Paroxetine SSRI depression, OCD, panic disorder 0 0 3
Fluoxetine SSRI depression, OCD, panic disorder 3 3 0
Trazadone TCA 3 1 (1 added between treatment) 0
Diazepam Anti-anxiety 1 1 0
Buproprion Anti-depressant, ADD 3 1 (1 added between treatment) 3
Alprazolam Anti-anxiety, Panic Disorder 1 0 1
Sertraline SSRI Depression, OCD, panic Disorder 3 1 (1 added between treatment) 4
7
Psychotropic Drug Use(one or more medications)
Primary refractive surgery Retreatment Contact Lens Users General Population (NHANES 1999-2002)
N120 N120 N115 N12,060
16.7 15 prior to primary surgery 15.8 prior to retreatment 13.9 11.1
8
Psychotropic Drug Use by Gender
Primary Refractive Surgery Retreatment Contact Lens User Drug Use in 3 Study Groups Drug Use in NHANES
Men n63 n48 n38 n149 n396
Men 8.0 6.3 10.5 8.1 8.0
Women n57 n72 n77 n206 n687
Women 26.3 20.8 15.6 20.4 13.9
Psychotropic drug use was higher in female
compared to male subjects (p0.001)
Psychotropic drug use in females was higher in
study subjects compared to the general population
(p0.001)
9
Results

• Variables affecting CTL fitting versus refractive
  surgery
• Psychotropic drug use and age (with and without
  gender as an independent variable) were not
  significant predictors of the probability of
  refractive surgery versus contact lens use.
• Male gender was a significant predictor of the
  probability of refractive surgery (p0.02).
• Higher spherical equivalent was a significant
  predictor of the probability of contact lens
  fitting (p0.02)

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Results
Variables affecting the probability of retreatment

• Psychotropic drug use did not increase the
  probability of retreatment
• Adding a psychotropic medication after primary
  treatment did not increase the probability of
  retreatment
• Older age (p0.003) increased the probability of
  retreatment
• Men were 14 less likely than women, on average,
  to have retreatment surgery (p0.04)
• Higher pre-LASIK spherical equivalents increased
  the likelihood of retreatment p0.06 (Logit
  p0.05)
• The probability of adding a psychotropic
  medication after initial refractive surgery and
  prior to retreatment was not correlated with the
  pre-retreament spherical equivalent or the time
  from initial surgery to retreatment

11
Conclusions

• In aggregate, choosing keratorefractive surgery
  does not appear to pre-select for patients taking
  psychotropic medications.
• Use of anti-depressant/anti-anxiety medications
  is more common in women than men and has similar
  prevalence in patients electing to undergo
  refractive laser surgery or contact lens fitting.
  
• The incidence of psychotropic drug use in both
  contact lens and LASIK patients was significantly
  higher than that reported in the general US adult
  population. This could reflect regional,
  socioeconomic, other demographic differences, or
  changes in national drug use since 2002.
• There were few changes in psychotropic drug use
  in patients between primary LASIK and
  retreatment, and no changes in the other 2
  groups.
• The length of time between primary LASIK and
  retreatment did not increase the likelihood of
  adding psychotropic drugs.

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Conclusions

• Further studies are indicated to assess any
  effect of preoperative depression, anxiety or
  mood disorder on a patients perceived outcome of
  LASIK surgery and the surgical experience.
• Some anti-depressant medications can cause dry
  eye and mydriasis, which may independently
  decrease patient satisfaction post-LASIK
  surgery.9 These potential drug side effects
  should be screened for and aggressively managed.
• .

13
References

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