Videoconferencing with the Hospitalized Premature Infant while Expressing Milk: A Randomized Crossover Trial.

Laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) gained widespread acceptance as options for correcting refractive error in the 1990s and today remain some of the most commonly performed elective procedures in the world. Thanks to advances in surgical technology and patient screening, LASIK and PRK have excellent records for safety and patient satisfaction; however, 10 – 40% of patients experience persistent symptoms including mild to severe eye pain past the usual postoperative healing period.[] In 2022, the US FDA released draft guidance for updated patient labeling information on LASIK devices, including a warning that chronic eye pain is a potential risk of surgery.[] We and others have reported clinical factors predictive of persistent eye pain after refractive surgery, including depression, eye discomfort prior to surgery, and intensity of acute pain after surgery.[, ] Tear fluid “omics” studies have also recently shed light on postoperative symptoms and states of corneal healing, but there remains a need to identify risk biomarkers for persistent postoperative eye pain, so that patients can make informed decisions when considering LASIK or PRK.[-] This prospective, observational clinical study sought to identify pre-surgical baseline differences in the tear fluid proteins of patients who went on to develop pain 3 months after corneal refractive surgery, compared to their counterparts who reported no pain 3 months after surgery. According to the International Association for the Study of Pain, pain that persists or recurs for at least 3 months is considered chronic.[] Following unbiased protein quantification using tandem mass tag (TMT)-based mass spectrometry, we evaluated fold-changes and built statistical models to identify preoperative tear fluid proteins that could accurately classify pain at 3 months post-surgery. Analyses of tear proteins from Pain and No Pain patients determined a set of proteins present prior to surgery with consistently good predictive performance and biological relevance in corneal physiology. Patients were recruited from refractive surgery clinics at 2 different sites in Portland, Oregon and Miami, Florida. Eligible patients were scheduled for bilateral LASIK or PRK, had no history of previous refractive or other ocular surgeries, and had no active diagnoses of ocular diseases (including dry eye) based on a comprehensive dilated examination with their surgeon to determine surgical candidacy. With the exception of one No Pain patient who used topical olopatadine drops daily, enrolled patients were not using any topical eye medications other than occasional non-prescription lubricants. The protocols used in this study have been approved by the Institutional Review Boards at both sites: Casey Eye Institute at the Oregon Health & Science University (IRB #00020444) and Bascom Palmer Eye Institute at the University of Miami (IRB #20200807). The study was conducted in accordance with the principles of the Declaration of Helsinki and complied with the requirements of the United States Health Insurance Portability and Accountability Act. Written informed consent was obtained from all patients prior to any study activities.