When Is Lasik Not Recommended?

LASIK (laser-assisted in situ keratomileusis) has become a household name, symbolizing the dream of vision without glasses or contacts. Yet, it’s not a one-size-fits-all solution

For some individuals, the pursuit of perfect vision through LASIK could be fraught with potential complications. Is LASIK the right choice for you? Or are you among those for whom LASIK isn’t recommended? It’s time to peer into the details.


Understanding LASIK Candidacy

LASIK is a procedure that reshapes the cornea, the transparent covering at the front of the eye, to address vision issues. To ensure its safety and efficacy, specific criteria must be considered:

  • Age: While LASIK is approved by the FDA for individuals over 18, most eye specialists advise waiting until the early to mid-twenties when vision prescription stabilizes.
  • Corneal Thickness: Adequate corneal thickness is necessary for the safe removal of tissue during LASIK.
  • Eye Health: Candidates should have overall healthy eyes without any existing eye conditions that could affect the outcome of the surgery.
  • Overall Health: Besides eye health, general well-being, and physical health are important factors in assessing LASIK candidacy.
  • Prescription Stability: Your prescription for eyeglasses or contact lenses should remain stable for at least a year before undergoing LASIK surgery.


Reasons Why LASIK Might Not Be Recommended

  • Unstable Vision: LASIK may not be suitable for fluctuating prescriptions. The procedure aligns with your current prescription, and future changes can impact results.
  • Eye Diseases and Conditions: Certain eye conditions can increase LASIK risks, such as:
    • Dry Eye Syndrome: LASIK can worsen dry eyes, and some medications used may affect healing post-LASIK by reducing cornea lubrication.
    • Keratoconus: LASIK can further weaken a weakened cornea.
    • Eyelid Conditions: Severe eyelid issues or infections can affect LASIK results.
    • Glaucoma: LASIK may elevate eye pressure, worsening glaucoma.
    • Blepharitis: Eyelid inflammation with crusting of eyelashes, increasing infection, or corneal inflammation risks post-LASIK.
  • Large Pupils: If your pupils are dilated, especially in low light, LASIK surgery may not be advisable. It could lead to bothersome symptoms like glare, halos, starbursts, and ghost images.
  • Medical Conditions: Specific health conditions can impact healing post-LASIK and heighten infection risks. Examples include:
    • Uncontrolled Diabetes: Elevated blood sugar from diabetes. LASIK might be an option if blood sugar is well-managed. Otherwise, especially with diabetic retinopathy, LASIK is not recommended.
    • Autoimmune Diseases (e.g., lupus, rheumatoid arthritis): Biologic medications such as Enbrel (etanercept) and Humira (adalimumab) for autoimmune disorders can weaken the immune system, affecting healing and increasing infection risks post-LASIK.
  • Medications: Some prescription medications can cause vision fluctuations leading to LASIK complications. For instance, corticosteroids like prednisone, which suppress the immune system, can delay healing significantly. Long-term steroid use can also impact vision, affecting LASIK outcomes. Other drugs like latanoprost, cyclosporine, bimatoprost, moxifloxacin, travoprost, brimonidine, and olopatadine may induce dry eyes, affecting healing and causing corneal scarring.
  • Corneal Anatomy: Your eye specialist will evaluate corneal thickness and health. LASIK may not be safe if the cornea is too thin or irregular, potentially leading to severe complications.


Other Factors to Consider

  • Pregnancy and Breastfeeding: Hormonal changes and retention of fluids can alter your corneal shape and vision prescription, potentially causing dry eyes. It is generally advised against undergoing LASIK during these periods due to the risk of uncertain outcomes and slower healing.
  • Consideration for Lifestyle: If your job or hobbies expose your eyes to significant injury risks, LASIK may not be the most suitable choice. Individuals in physically demanding professions or engaging in contact sports could face a higher likelihood of flap displacement (in the case of LASIK) or damage to the treated cornea.


Alternatives to LASIK

If LASIK isn’t suitable for you, consider these alternative vision correction options:

  • PRK (photorefractive keratectomy): Like LASIK, PRK reshapes the cornea using a laser but without creating a corneal flap. The surgeon removes the outer layer of the cornea (epithelium) before the laser ablation. While PRK has a longer recovery time and more discomfort than LASIK, it may be ideal for individuals with thin corneas or specific eye conditions.
  • Implantable Collamer Lenses (ICLs): These lenses are surgically implanted in the eye to correct vision issues, particularly for those with high prescriptions, severe dry eye, or corneas unsuitable for LASIK or PRK.
  • Refractive Lens Exchange (RLE): Similar to cataract surgery but for individuals without cataracts seeking vision enhancement. The surgeon replaces the natural crystalline lens with an artificial intraocular lens (IOL) to fix refractive errors. RLE is beneficial for individuals with high prescriptions, presbyopia, or certain corneal conditions.
  • Orthokeratology (Ortho-K): This non-surgical method involves wearing rigid contact lenses overnight to reshape the cornea temporarily, providing clear vision during the day without lenses. Ortho-K is a great choice for those averse to surgery or involved in activities where glasses or contacts are inconvenient.


Making the Right Choice for You

Deciding on vision correction is a personal choice. If LASIK isn’t advised, consult with your ophthalmologist for other suitable options. They will evaluate your individual requirements, eye health, medications, and lifestyle to suggest the most appropriate procedure for optimal vision correction.

Consider these tips:

  • Undergo a thorough eye exam: A comprehensive evaluation by your ophthalmologist is vital to determine if LASIK or another vision correction procedure is right for you.
  • Ask questions: Feel free to inquire about LASIK, alternative treatments, and associated risks and benefits with your ophthalmologist.
  • Factor in your lifestyle: When evaluating vision correction options, think about your daily routines and hobbies. Select a procedure that aligns with your lifestyle and minimizes potential complications.


In Summary

While LASIK is a valuable tool for vision correction, it may not suit everyone. Understanding why LASIK might not be recommended allows you to explore other choices. With numerous safe and effective procedures at your disposal, achieving clear vision without glasses or contacts remains feasible. Discuss your vision objectives and worries with your ophthalmologist to determine the ideal route for a lifetime of clear and self-sufficient vision.


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