I’m tightening ocular surface optimization before laser vision correction: osmolarity and MMP-9 on all evals, meibography when indicated, and cyclosporine + thermal pulsation if osmolarity >=308 or MMP-9 positive, with recheck at 3–4 weeks; we’ve seen fewer night-vision complaints and fewer enhancements using VisuMax 800 + EX500. Curious what thresholds, timelines, or epithelial thickness mapping protocols others are using to minimize regression and improve tear film stability.
I started requiring patients to be “MMP-9 negative twice” before booking — @OP, it’s annoying and adds a visit, but with our VisuMax 800 + EX500 we saw the same drop in halos. If osmolarity sits 304–307 with truncated glands on meibography, I add 2 weeks of loteprednol as a bridge to cyclosporine and push the recheck to 6 weeks; aligns well with the ASCRS OSD pathway: 404 | ASCRS.
Quick tip: we add a 2-week loteprednol bridge when starting cyclosporine after thermal pulsation, and if osmolarity drops ≥5–8 mOsm or the InflammaDry line fades from strong to faint, we go ahead and book rather than waiting for a second negative, @elopez44. If osm is ≥320 or inter-eye delta >10, I push the recheck to 6 weeks instead of 3–4, and I avoid plugs until epithelial thickness maps look smooth. Same platform here (VisuMax 800 + EX500) and this cut halos without adding extra visits.