Intended for healthcare professionals

Rapid response to:

Clinical Review

Laser refractive eye surgery

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2345 (Published 20 April 2011) Cite this as: BMJ 2011;342:d2345

Rapid Response:

LASIK and isotretinoin: An important contraindication

Sir - We enjoyed the informative review on laser refractive eye
surgery and wish to raise awareness of a potential hazard with concurrent
isotretinoin (1).

Isotretinoin (13-cis-retinoic acid) has revolutionised the treatment
of refractory acne since the 1980s. Acne affects 85-90% of the population
at some time and the age of patients affected by acne approximately
overlaps that of patients undergoing LASIK (2,3). Dry eye is a side effect
of both LASIK and isotretinoin (4-6) and can result in serious sequelae
such as corneal ulceration, infection and loss of vision. Thus, LASIK is
contraindicated in patients taking isotretinoin (2,7), but this fact is
not well recognised, especially amongst British Dermatologists who
prescribe Isotretinoin. Previous surveys have highlighted the need to
routinely screen for isotretinoin use before approving LASIK and have
concluded that patients should wait 6 months after a course of
isotretinoin before having refractive eye surgery (8).

We recently surveyed the British Association of Dermatologists.
Although most physicians routinely counselled their patients about the
ophthalmic risks of isotretinoin, 65% did not know whether any of their
patients had undergone LASIK whilst on isotretinoin, only 30% enquired
about recent or forthcoming surgery and 89% were unaware that isotretinoin
may cause ocular problems if a patient had undergone LASIK in the
preceding 6 months.

Patients should avoid isotretinoin 6 months before or after LASIK
treatment. Similarly LASIK practitioners should check that isotretinoin
has not been taken for 6 months before laser refractive eye surgery.

References

1. Bastawrous A, Silvester A, Batterbury M. Laser Refractive Eye
Surgery. BMJ 2011; 342:d2345

2. James W D. Acne. N Engl J Med 2005; 352: 1463 - 72.

3. Ronge L J. LASIK shatters assumptions. Cornea 1994; 13: 379 - 82.

4. Cumurcu T, Sezer E, Kilic R, Bulut Y. Comparison of dose-related
ocular side effects during isotretinoin administration. Eur J Ophthalmol
2009; 19: 196 - 200.

5. Santodomingo-Rubido J, Barrado-Navascues E, Rubido-Crespo M J.
Drug-induced ocular side effects with isotretinoin. Ophthalmic Physiol Opt
2008; 28: 497 - 501.

6. Fraunfelder F W. Ocular side-effects associated with isotretinoin.
Drugs Today (Barc) 2004; 40: 23 - 7

7. Wilson S E. Use of lasers for vision correction of nearsightedness
and farsightedness. N Engl J Med 2004; 351: 470 - 5.

8. Miles S, McGlathery W, Abernathie B. The importance of screening
for laser-assisted in situ kertomileusis operation (LASIK) before
prescribing isotretinoin. J Am Acad Dermatol 2006; 54: 180 - 1.

Competing interests: No competing interests

18 May 2011
Moona Malik
Specialist Registrar, Dermatology
Rosalind C Simpson, Sandeep Varma
Nottingham University Hospitals, Queen's Medical Centre