Can LASIK Fix Corneal Scarring?

The short answer is no, LASIK cannot directly fix corneal scarring. 

However, it can sometimes help improve vision affected by certain types of corneal scars, depending on the scar’s severity and location. Understanding the nuances of corneal scarring and LASIK’s capabilities will help you determine if the procedure is a viable option for you.

Understanding Corneal Scarring

Corneal scarring refers to damage to the cornea, the clear, dome-shaped surface at the front of the eye. This damage leads to opacity on the corneal surface, impairing the passage of light into the eye and distorting vision. Scarring can range from minimal to severe, affecting a person’s ability to see clearly.

Causes of Corneal Scarring

Corneal scarring can result from various conditions or injuries, including:

• Trauma: Physical injuries from accidents, chemical burns, or foreign objects can damage the cornea.
• Infections: Severe eye infections like keratitis, caused by bacteria, fungi, or viruses, can leave scars.
• Eye Surgery Complications: Certain surgeries may occasionally lead to irregularities on the corneal surface.
• Diseases: Progressive eye diseases like keratoconus, which thins and distorts the cornea, can result in scars.
• Contact Lenses: Prolonged, improper use of contact lenses may cause damage or small scratches that lead to scarring.

The severity of the scar and its impact on vision depend on its depth and location. Scars in the central cornea, where light focuses, tend to have a greater effect on vision than scars near the periphery.

What is LASIK Surgery?

Laser-Assisted in Situ Keratomileusis (LASIK) is a popular refractive eye surgery designed to correct common vision problems like nearsightedness, farsightedness, and astigmatism. LASIK works by reshaping the cornea to ensure that light entering the eye is properly focused onto the retina, resulting in clearer vision.

How LASIK Works?

During LASIK surgery:

1. A surgeon creates a thin, hinged flap on the cornea.
2. Using a specialised excimer laser, they reshape the underlying corneal tissue.
3. The flap is then repositioned, acting as a natural bandage to aid healing.

LASIK’s Role in Treating Vision Impairments

Although LASIK is often hailed for fixing refractive errors, its role is more limited when it comes to corneal abnormalities like scars. LASIK is designed for reshaping the cornea, not removing scar tissue, so many factors determine whether the procedure may be helpful.

Can LASIK Help with Corneal Scarring?

The Limitations of LASIK

LASIK cannot completely remove or repair corneal scarring. Because the laser reshapes the corneal stroma but does not remove or replace scar tissue, LASIK may not directly improve vision impaired by scarring. However, for some patients, LASIK can help correct residual refractive errors unrelated to scarring, resulting in improved overall vision.

When LASIK May Be Suitable for Patients with Corneal Scarring?

While LASIK is not a cure for corneal scars, it can sometimes be performed in cases where:

1. The scarring is minor: If the scar does not significantly alter corneal topography or interfere with the laser’s precision, LASIK may be considered.
2. The scar is located in the corneal periphery: Scars located outside the visual axis generally do not affect central vision, allowing LASIK to safely correct coexisting refractive errors.

When is LASIK Not Recommended?

LASIK is generally not a suitable option for:

• Patients with significant or deep corneal scarring, especially if it distorts corneal topography or compromises the smooth ablation required for LASIK.
• Scarring associated with progressive corneal disorders like keratoconus, which require disease-specific management such as corneal cross-linking or specialty lenses.
• Individuals with thin or irregular corneas, as these conditions increase the risk of post-LASIK complications like ectasia.

Alternatives to LASIK for Corneal Scarring

If LASIK is not an option for addressing corneal scarring, several other treatments may offer better outcomes depending on the type and severity of the scar.

Phototherapeutic Keratectomy (PTK)

PTK is an excimer laser procedure designed to precisely remove superficial corneal opacities and smooth irregular corneal surfaces. Unlike LASIK, PTK aims to smooth the corneal surface rather than reshape it for refractive correction. It’s effective for:

• Reducing superficial scarring.
• Alleviating pain from recurrent corneal erosions.
• Modestly improving vision if the scar is superficial and not located in the visual axis.

Corneal Transplantation

For severe or deep scarring that cannot be addressed by laser procedures, corneal transplantation may be the best solution. This procedure entails the replacement of the damaged cornea with healthy donor tissue. Types of corneal transplants include:

• Full-thickness (penetrating keratoplasty).
• Partial-thickness (anterior lamellar keratoplasty).

Corneal transplants are typically considered when scarring significantly impacts vision and quality of life.

Scleral Lenses

Custom-made scleral lenses may help manage vision issues caused by corneal scarring. These lenses create a smooth surface over the cornea, bypassing irregularities and improving vision. While they do not treat the scar itself, they can provide an effective non-invasive solution.

Other Medical Treatments

Milder cases of scarring may benefit from:

• Eye drops or ointments are designed to reduce inflammation or prevent the formation of scars.
• Procedure-specific interventions such as corneal cross-linking, which can halt progression in keratoconus and may help stabilise the cornea, though it does not reverse existing scars.

The Importance of Consultation with an Eye Specialist

Determining whether LASIK or another treatment is suitable requires a comprehensive evaluation by an experienced ophthalmologist. They will assess:

• The type and depth of the scar.
• Corneal thickness and health.
• Overall eye health and medical history.

Here’s what to expect during a consultation:

1. Detailed mapping of the corneal surface using topography to examine irregularities.
2. Tests for corneal thickness and refractive errors.
3. Discussion of available treatment options and their potential risks and benefits.

Always consult with an eye care professional before making decisions about surgical or medical treatments for corneal scarring.

Factors to Consider Before Pursuing LASIK

If you’re considering LASIK for issues potentially complicated by corneal scarring, factor in:

• Potential risks: Corneal scarring can increase the risk of flap complications, irregular ablation, or suboptimal visual outcomes due to surface irregularities.
• Predictable outcomes: It’s crucial to have realistic expectations about the results LASIK can offer in cases of corneal scarring.

Final Thoughts on LASIK and Corneal Scarring

LASIK cannot repair corneal scarring but may improve vision in select cases by correcting residual refractive errors. Understanding the nature and extent of your corneal damage and exploring alternatives such as PTK, corneal transplantation, or scleral lenses with your eye care specialist is essential to determine the most appropriate treatment.

If you are considering LASIK or are unsure about the right path to take, consult an experienced eye care provider for personalised advice. Your vision deserves expert care.