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Who Should Not Have Laser Eye Surgery?

DR. AKASH YADAV In Eye Hospital

Sep 12, 2023 | 4 min read

Laser eye surgery, also known as refractive surgery, has gained immense popularity over the years as a revolutionary way to correct vision problems and reduce dependency on glasses or contact lenses. It’s a life-changing procedure that has brought clearer vision to millions of people worldwide. However, while laser eye surgery offers significant benefits, it’s not suitable for everyone. In this comprehensive guide, we will explore who should avoid refractive eye surgery and why.

Understanding Laser Eye Surgery

Before delving into who should avoid laser eye surgery, let’s briefly understand the primary types of eye procedures:

  1. LASIK (Laser-Assisted In Situ Keratomileusis): LASIK is the most common and well-known laser eye surgery. It involves the creation of a thin flap on the cornea, followed by reshaping the cornea using an excimer laser to correct vision problems such as nearsightedness, farsightedness, and astigmatism.

    LASIK (Laser-Assisted In Situ Keratomileusis)

  2. PRK (Photorefractive Keratectomy): PRK is an alternative to LASIK. Instead of creating a corneal flap, the outer layer of the cornea (epithelium) is removed to expose the corneal tissue beneath, which is then reshaped with an excimer laser.
    PRK (Photorefractive Keratectomy)
  3. SMILE (Small Incision Lenticule Extraction): SMILE is a newer, minimally invasive refractive eye surgery that involves creating a small, thin lenticule inside the cornea, which is then removed through a small incision. This procedure is primarily used for myopia (nearsightedness).

    SMILE (Small Incision Lenticule Extraction)

Now, let’s explore who should not consider these procedures:

Who should avoid laser eye surgery?

1. Individuals with Unrealistic Expectations:

Laser eye surgery can significantly improve your vision, but it may not guarantee perfect vision or eliminate the need for glasses or contacts entirely. If you have unrealistic expectations, thinking you’ll achieve 20/20 vision without the need for corrective eyewear, you might be disappointed. It’s essential to have a thorough discussion with your eye surgeon about the expected outcomes before undergoing the procedure.

2. Pregnant or nursing women:

Pregnant or nursing women should avoid laser eye surgery. Hormonal changes during pregnancy and lactation can affect vision stability, making it challenging to determine the most accurate prescription for surgery. It’s recommended to wait until several months after giving birth or finishing breastfeeding before considering the procedure.

3. Individuals under 18:

Laser eye surgery is typically not recommended for individuals under the age of 18 because their eyes are still developing. Vision changes during adolescence are common, and it’s important to wait until your prescription stabilizes, which usually occurs in early adulthood.

4. People with Unstable Vision:

Patients with unstable vision should avoid laser eye surgery. This includes individuals whose prescription has changed significantly in the past year. Stable vision is crucial for accurate preoperative assessments and achieving optimal results.

5. Those with Certain Eye Conditions:

Certain eye conditions may disqualify you from laser eye surgery, including:

  • Keratoconus: This progressive thinning and bulging of the cornea can make LASIK and PRK risky. Other vision correction options may be more suitable.
  • Glaucoma: Individuals with glaucoma have increased eye pressure, which can worsen with refractive eye surgery. It’s essential to manage glaucoma before considering any refractive procedure.
  • Cataracts: Laser eye surgery is not a treatment for cataracts. If you have cataracts, you should discuss cataract surgery with an ophthalmologist instead.
  • Corneal Diseases: Conditions like severe dry eye syndrome, corneal dystrophies, and corneal scarring may make you ineligible for laser eye surgery.

6. People with Systemic Health Issues:

Certain systemic health conditions and medications can impact your eligibility for refractive eye surgery. These include:

  • Autoimmune Diseases: Conditions like lupus and rheumatoid arthritis may affect the healing process and increase the risk of complications.
  • Diabetes: Diabetes can slow down the healing process and increase the risk of postoperative complications.
  • Immunosuppressive Medications: Medications that suppress the immune system may hinder the healing process.
  • Pregnancy or Nursing: As mentioned earlier, hormonal changes during pregnancy and lactation can affect vision stability.

7. Individuals with Thin Corneas:

Adequate corneal thickness is essential for LASIK and PRK. If your corneas are too thin, these procedures may not be suitable. In such cases, alternative procedures like implantable contact lenses (ICL) may be considered.

8. People with high refractive errors:

Extreme refractive errors (very high degrees of nearsightedness, farsightedness, or astigmatism) may not be fully correctable with refractive eye surgery alone. In such cases, a combination of procedures or other options may be recommended.

9. Individuals with Insufficient Tear Production:

If you have chronic dry eyes or insufficient tear production, Lasik eye surgery can exacerbate the condition. It’s essential to manage dry eye symptoms before considering refractive surgery.

Conclusion

Laser eye surgery can significantly improve your vision, but it may not guarantee perfect vision or eliminate the need for glasses or contacts entirely for each and every patient, although this holds true for most of the patients. It’s essential to have a thorough discussion with your eye surgeon about the expected outcomes before undergoing the procedure.

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Written and Verified by:

DR. AKASH YADAV

DR. AKASH YADAV

MBBS, DNB, FSSN (SRI SANKARADEVA NETHRALAYA) & FICO (U.K.)

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