AN UNSTABLE TEAR FILM PLANS AN UNSTABLE SURGERY.

Untreated dry eye corrupts the very measurements a plan is built on — and predicts the unhappiest post-operative patients. RLES AI supports dry-eye assessment using the TFOS DEWS II framework and screens every incoming topography for tear-film artefacts, whether you asked or not.

ASSESSMENT WITH TWO ARMS, NOT ONE SCORE

DEWS II requires both a symptom arm (OSDI ≥ 13 or DEQ-5 ≥ 6) and at least one homeostasis marker — tear break-up time under 10 seconds, osmolarity ≥ 308 mOsm/L or an inter-eye difference over 8, or significant staining.^[2] One arm alone is graded BORDERLINE, and a symptomatic patient with clean signs is flagged for the neuropathic/preclinical distinction rather than dismissed. Subtyping (aqueous-deficient, evaporative-MGD, mixed)^[1] follows Schirmer and meibomian findings — MGD being the most common substrate — and results are recorded with their values, never as "done, normal".

THE SILENT SCREEN ON EVERY TOPOGRAPHY

• Mire distortion, inter-acquisition Sim-K discordance over 0.25 D, unstable axes
• False-keratoconus patterns: inferior steepening that migrates between acquisitions, resolves with artificial tears, and leaves the posterior surface untouched — unmasked before it triggers a wrong ectasia verdict
• Two or more signatures → a yellow block, and borderline anterior indices are no longer counted as keratoconus evidence on that map

THE GATE: STABILISE, THEN PLAN

Moderate-to-severe disease is a relative contraindication: staged treatment first, re-evaluation in 2–4 weeks, and no ablation finalised until two consecutive concordant topographies confirm a stable surface. Method notes are included — flap-based LASIK cuts more corneal nerves than SMILE, and hinge position matters for the ocular surface.

FREQUENTLY ASKED QUESTIONS