This prospective multicenter cohort study followed 326 adults undergoing bilateral LASIK or PRK at 2 US academic centers (April 2021–July 2025), tracking ocular pain intensity via numerical rating scale (NRS 0–10) at baseline, postoperative day 1 (POD 1), and months 3 and 6 (POM 3, POM 6) to characterize longitudinal pain trajectories and identify baseline risk factors.
Pain trajectories were heterogeneous: 28.8% had no clinically relevant pain (NRS ≥3), 43.9% had pain only at POD 1, and 18.1% had prolonged pain (POM 3 or 6). Prolonged pain was independently associated with PRK vs. LASIK (OR 2.73; 95% CI 1.29–5.77), preoperative lubricating drop use (OR 2.41), chronic low back pain (OR 2.45), and higher dry eye symptom burden (DEQ-5 OR 1.11 per point); corneal staining at 6 months was protective (OR 0.79).
- Single-country, 2-center academic sample limits generalizability. - Prolonged pain group was small (n=59), reducing statistical power for subgroup analyses. - Causal mechanisms linking baseline factors (e.g., chronic low back pain) to prolonged ocular pain remain unexplained.
Before refractive surgery, screen patients for preoperative lubricating drop use, chronic pain conditions, and elevated dry eye symptom scores—these independently predict prolonged postoperative ocular pain and may guide counseling and perioperative management. PRK patients carry roughly 2.7× the odds of prolonged pain compared to LASIK patients and warrant closer follow-up.
