Why You May Not Be Eligible for LASIK

You Have Unstable Vision
While your ophthalmologist would need to consider the root of your fluctuating vision to make a final determination about your eligibility, most surgeons believe that vision should be relatively stable for at least one year for LASIK to be indicated. Trying to operate on eyes with unstable vision is like trying to hit a moving target. Most doctors would consider a change of one diopter (1D) or more in 12 months significant.

You Are Pregnant or Nursing
Most doctors will not perform surgery on a woman while she is pregnant or nursing because the hormones produced during those time periods could cause temporary instability of the eye's refraction.

You Have Unstable or Uncontrolled Diabetes
LASIK is not recommended for those whose blood sugar levels are still fluctuating, as the fluctuation will affect the cornea's refraction. This makes achieving an accurate correction difficult. In addition, diabetics generally have a slower wound healing response than most patients do which condition could adversely affect healing post-operatively. Also, if there are any retinal tears or lesions resulting from diabetes, LASIK may not be indicated.

You Have an Autoimmune Disease, Collagen-Vascular Disease, or Take Drugs that Suppress the Immune System
Doctors debate the efficacy of performing LASIK on patients whose autoimmune system is compromised, either by a disease or by medications. Generally speaking, most surgeons are extremely cautious about performing refractive surgical procedures on those with such a history since it could affect the corneal healing process.

Your Eyes Are Amblyopic
Some doctors consider even mild cases of amblyopia, exotropia or strabismus in either eye a contra-indication to LASIK. Others will carefully evaluate the particular situation and patient's needs prior to scheduling surgery. Patients with amblyopia need to understand that since LASIK is a surgical procedure, there is a risk of losing vision. If you suffer from amblyopia, were a complication to occur in either eye, you could be without use of both. You should also be aware that LASIK could not correct you to better than your vision as it is correctable with lenses.

You Have Keratoconus
Patients who suffer from keratoconus have thinner corneas than normal. For these patients, removing corneal tissue has the potential to produce unpredictable results and post-surgical irregular astigmatism.

You Have Glaucoma
Glaucoma is a complicating factor that doctors must evaluate on a case-by-case basis. Some refractive surgeons will perform LASIK on patients whose condition is well-controlled by medications. Others deem a history of glaucoma a contraindication to surgery. Glaucoma patients considering LASIK should be sure to speak with the doctor who is treating their condition prior to making any decision about the procedure.

You Are Under 18 Years of Age
Children's eyes are constantly changing, and the vast majority of surgeons believe that vision should be relatively stable for at least one year for LASIK. Most doctors would consider a change of one diopter (1D) or more in 12 months significant. Sometimes, even when a person turns 18, the major changes to the eyes have not finished taking place. Such people may not be deemed eligible for LASIK until their refraction has stabilized.

"Things to Discuss with Your Doctor"

While none of the conditions below absolutely contraindicate surgery, we will need to carefully evaluate your case prior to making a decision about surgery. If you have any of the below, you may wish to discuss this with the Yavitz Eye Center staff in detail.

You Are Nursing or Expecting to Become Pregnant within Six Months after Having Had LASIK
Doctors debate how the hormonal changes caused by nursing affect the eye's refraction. Consequently, doctors take very different approaches to operating on women who are still lactating, and consensus has not been achieved regarding this issue. Essentially, ophthalmologists do not want to operate on eyes with an unstable refraction, as doing so makes performing an accurate correction difficult. Some ophthalmologists, therefore, take a conservative approach and consider nursing a contraindication to LASIK. Many will require that patients have several eye exams after patients have stopped nursing to indicate stable refraction. Only then will they recommend LASIK. Others maintain that, as long as refraction was stable during pregnancy and remains stable postpartum, stable refraction has been achieved. Therefore, LASIK is indicated.

It is generally not recommended that a woman become pregnant immediately after LASIK. It can take final vision several months to settle in post-operatively, and as a result, it can be difficult for your doctor to determine where your final refraction truly settled, were you to be pregnant in the first few months post-operatively. Moreover, it would be impossible to perform an enhancement procedure, should one be necessary.

You Have a History of Excessive Scarring with Injuries or Other Surgeries
Excessive scarring, even ocular scarring, in and of itself is not a contraindication to LASIK. It is not the scarring, but the origin of the scarring is what concerns ophthalmologists. This is because some types of severe scarring are associated with medical conditions that cause ocular surfaces to be highly unstable. There is an increased incidence of regression (vision returning to pre-operative levels) or overcorrection associated with unstable ocular surfaces in general. Other risks may be higher as well, depending upon the specific medical condition that causes the scarring.

The best way to determine if these conditions characterize your eyes is to undergo a full ocular examination by an ophthalmologist. Be sure to discuss your history of scarring after other surgeries with our staff and to ask how this history could affect the outcome.

You Have Chronic Ocular Herpes Infections or Connective Tissue Disorders
The concern about herpes relates to a history of herpes keratitis in the eye. Several studies demonstrate that stresses including surgery, topical steroid medication, and exposure to ultraviolet light can reactivate the herpes simplex virus in the eye, thereby threatening vision. However, a number of cases have been documented in which patients with a history of herpes keratitis in the eye suffered no complications.

Some connective tissue disorders are associated with unpredictable or poor healing responses. Therefore, patients with such conditions need to tell their ophthalmologist of their medical history so that a full evaluation can be completed and discussed.

You Have Severe Dry Eye
Patients need to be aware that it is not uncommon to experience some symptoms of dry eyes post-operatively, especially in the first few weeks as the majority of corneal healing takes place. Those patients who have a pre-existing dry eye condition need to be especially aware of the potential risks regarding LASIK and dry eyes.

Your Pupils Dilate Larger at Night than the Treatment Zone Available to You
Many doctors believe that there may be a correlation between wide pupils and the experience of decreased night or low light vision, particularly in cases where treatment of high myopia or high hyperopia is concerned. Some researchers contend that patients who have wide pupils may be more likely to experience decreased night vision following LASIK than the general population. Patients should talk with their doctor if this is an important consideration.

You Have Myopia Greater than -12D or You Have Hyperopia Greater than +5D
Although FDA-approved lasers are available to treat each of the three major types of refractive error (myopia, hyperopia and astigmatism) current FDA-approved indications define appropriate candidates as those with myopia up to -12 D, astigmatism up to 6 D and hyperopia up to +6 D. However, laser eye surgery technology is evolving rapidly, and doctors may be able to treat more severe errors in the future.

You Are Taking Medications Regularly
Certain medications can possibly affect the outcome of the surgery. Examples include Accutane, Amiodarone, Imitrex and tricyclic medications. Therefore it is important that patients provide their ophthalmologists with an accurate listing of all medications they are taking regularly during their consultation.