Who is NOT suitable for laser eye surgery?
Laser eye surgery in its different forms – LASIK, PRK, Transepi PRK, LASEK, SMILE, Lenticular Extraction (LEX) has transformed the lives of millions, providing clear vision without the need for optical crutches – glasses and contact lenses.
The procedure has transformed the lives of patients and more than 100 million procedures have been performed since its introduction in the early 1990’s Laser eye surgery is safe and effective however patients need a thorough evaluation and consultation as there are some who are not suitable. What makes some individuals unsuitable?
1. Unstable glasses prescription
It is important that those considering laser eye surgery have a stable prescription with less than 0.5D change in the preceding year. Those in their early 20’s may well find that their prescription is changing and they really should wait for this to stabilise before undergoing the procedure.
2. Thin or irregular shaped corneas
The procedure involves changing the shape of the cornea and sculpting essentially an optical correction. To accomplish this safely and successfully the cornea must be thick enough. It must also be strong enough to undergo the procedure. Tell-tale signs that the cornea is not stable is if it is irregular in shape. More definitive methods to test biomechanical strength (Ocular Response Analyzer – ORA and Corvis) are very helpful and should be used by the evaluating clinic and eye surgeon.
3. Significant Dry eye
Those who have significant and severe dry eye will not be suitable. However there are treatment options available in advance of surgery. A good laser eye care provider will test for both evaporative and underproductive dry eye and treat the underlying cause and only consider treatment once the dry eye is better in terms of symptoms and measurement.
4. Underlying Eye Conditions
There are a number of eye conditions that makes a person unsuitable for laser eye surgery. Conditions like Keratoconus, Cataract, Glaucoma and Retinal conditions for instance Diabetic retinopathy or macular degeneration may make a person unsuitable.
5. Underlying Autoimmune diseases
There are some conditions that if active are “relative” contraindications – meaning they are not always contraindicated. Some like Rheumatoid arthritis are associated with severe dry eye and prone to corneal inflammation. Laser eye surgery may be best avoided in this group. Other conditions like Lupus can also affect wound healing and result in less than ideal outcomes. Fibromyalgia, while not an autoimmune condition is often found in association with autoimmune conditions. This condition where a person is more sensitive to pain is a contraindication to laser eye surgery. It makes sense that individuals considering laser eye surgery be evaluated by consultants well versed with the speciality of cornea to ensure surgery is safe. A consultant at a good centre well versed with the cornea, should be able to decide who might or might not be suitable.
6. Inherited and other conditions
Some conditions like Ehlers Danlos syndrome causes hyper-elasticity of joints and ligaments. The same applies to the cornea with some sub-types of the condition. Marfan’s syndrome is another condition where laser eye surgery is best avoided.
7. Pregnant or Nursing mothers
High circulating hormonal levels and glucose instability can lead to changes in eye prescription. It is best to wait for at least 3 months after cessation of breast feeding to be considered for laser eye surgery.
8. Unrealistic expectations
While laser eye surgery improves vision and transforms lives, it is important that anyone embarking on the procedure does their homework well and understand what the procedure is about, what is involved and understand its limitations. For instance some may need reading glasses as they age due to a condition called presbyopia where the focussing lens inside the eye becomes harder over time and cannot focus on near objects. It is equally important to select a well-established laser eye clinic with a long track record and a good reputation who will ensure patients understand what to expect.
Other Vision correction options for those unsuitable for laser eye surgery
All is not lost if you are not suitable for laser eye surgery. There are several other options depending on your age, prescription and overall eye health. Implantable contact (Collamer) Lenses, Lens Replacement surgery with high performance lenses are also good options.
Final Thoughts
Laser eye surgery can be life-changing but not for everyone. Suitability is best determined by a thorough evaluation with considerable variety of diagnostic tests. This best performed by a fellowship trained corneal and refractive surgeon who can ensure you are a good candidate for the procedure and if not consider other options for vision correction.
Should you have any questions about your suitability for laser vision correction please do not hesitate to contact us at the Centre for Sight