Invited Discussion on: Impact of Full-Incision Double-Eyelid Blepharoplasty on Dry Eye Symptoms in Young Asian Patients
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Impact of Full-Incision Double-Eyelid Blepharoplasty on Dry Eye Symptoms in Young Asian Patients Julian D. Perry1
Received: 2 August 2020 / Accepted: 17 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. The authors should be congratulated for their efforts in exploring the relationship between double-eyelid blepharoplasty and dry eye symptoms and signs [1]. The data basically support the author’s conclusion that dry eye symptoms temporarily increase after double-eyelid surgery but return to baseline within three months postoperatively. However, several caveats may apply. First, the authors studied a young group of patients. This makes sense, as this age group often seeks double-eyelid blepharoplasty. However, very few 25-year-old patients actually suffer from dry eye disease, a condition more often associated with advancing age. These results cannot be translated to middle-aged patients and especially not to older patients. It is interesting that almost one in eight of these youthful patients complained of dry eye symptoms prior to surgery. Rather than suffering from a significant primary tear film abnormality, most patients in this study likely had conditions associated with dry eye symptoms such as contact lens wear, history of refractive surgery, allergies, excessive near work (computer, cell phone), negative vector, canthal tilt or inferior scleral show. Accounting for these confounding variables would have added to the study.
& Julian D. Perry [email protected] 1
Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, USA
Making up for this weakness is the use of the OSDI. Because these younger patients may be expected to have normal ocular surface parameters, the subjective data using this instrument are crucial to understanding the impact of surgery on what matters most: patient symptoms. This study tells us that, regardless of their etiology, ocular irritative symptoms in youthful patients do not significantly worsen after healing from double-eyelid blepharoplasty. While the double-eyelid blepharoplasty may not have worsened or produced symptoms, it still could have had an effect. The authors point out that the three-month OSDI increase was not statistically significant. While this is true, it is also true that the difference (an OSDI increase from 6.4 preoperatively to 8 after surgery) still has a high chance of being real (p = 0.07). The authors also state that the increase to 8 is within normal limits, but this is not quite true. A study of the receiver operating characteristic curve of the OSDI [2] indicates that the threshold where the sensitivity and specificity are maximum (each about 0.8) is 6. Thu
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