When is LASIK not for me?

You are probably NOT a good candidate for refractive surgery if:

• You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.

• It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.

• Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.

• You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability. Patients who are:

• In their early 20s or younger, 
• Whose hormones are fluctuating due to disease such as diabetes,
• Who are pregnant or breastfeeding, or 
• Who are taking medications such as steroids that cause fluctuations in vision, 

are more likely to have refractive instability and probably should not have a refractive procedure.

• You have a disease (e.g. lupus, rheumatoid arthritis) or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases and immunodeficiency states, and some medications, such as retinoic acid and steroids, may prevent proper healing after a procedure.

• You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.

• You are not an adult.  Currently, no lasers are approved for LASIK on persons under the age of 18.

Contraindications
The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Do NOT have LASIK surgery if you have a history of any of the following:

• Herpes simplex or Herpes zoster (shingles) involving the eye area.

• Glaucoma, glaucoma suspect, or ocular hypertension.

• Eye diseases, such as uveitis/iritis (inflammations of the eye) and blepharitis (inflammation of the eyelids with crusting of the eyelashes). 

• Eye injuries or previous eye surgeries.

• Keratoconus

• Large pupils. Make sure this evaluation is done in a dark room. Younger patients and patients on certain medications may be prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and ghost images (double vision) after surgery. In some patients these symptoms may be debilitating. For example, a patient may no longer be able to drive a car at night or in certain weather conditions, such as fog. New software now available has reduced but not eliminated this risk.

• Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue).  Performing a refractive procedure on a cornea that is too thin or has too few cells lining the back surface (endothelial cells) may result in blinding complications. 

• Previous refractive surgery (e.g. RK, PRK, LASIK).  Additional refractive surgery may not be recommended.  The decision to have additional refractive surgery must be made in consultation with your doctor after careful consideration of your unique situation.

• Dry Eyes New therapies now allow better results in patients with dry eyes. Discuss puntal occlussion with your surgeon.