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“Do Not Have LASIK if…”

By Craig S. Bindi, MD

All conservative doctors agree that the best surgeons not only know how to operate well, but also know when to not operate at all.  While it is true that great surgeons must utilize great technology and meticulous surgical technique, an untold key to achieving great results relies on careful patient selection.  This is why it is so essential that I personally meet and evaluate every patient before surgery to determine candidacy.

Do not have LASIK if you have…

1. Very thin corneas.  Average corneal thickness pachymetry measurements range between 500-550 microns thick.  Depending on one’s prescription, for patients with thinner corneas I may recommend PRK or Visian ICL
2. Abnormal corneal shape.  If the testing detects underlying keratoconus, pellucid marginal degeneration, or asymmetric corneal shape, I may recommend Intacs, Visian ICL or C3-R therapy or no surgery. the Pentacam's Belin Ambrosio detection software is currently the most advanced method of determining if LASIK is safe or not.
   
3. Unstable refraction or changing prescription. Since the results of LASIK are not permanent, if your refraction continues to have significant yearly shifts, I prefer that you wait until your measurements stabilize so the results will last longer.  Slight variances in refraction ±0.5D are common and not clinically significant.
4. Younger than 18 years old.  LASIK is FDA-approved for individuals who are 21 or older.  However, it may be performed at age 18-21 if the prescription is stable (though it is an "off-label" treatment for certain laser manufacturers).
5. Severe dry eyes. The most common side effect of LASIK is Dry eye.  If you are currently are bothered by very dry eyes, I may recommend PRK or Visian ICL.  Read about Optimizing Eye Comfort & Alleviating Dry Eye
6. Extreme nearsightedness.  For extremely large amounts of nearsightedness (especially over -12D), the results of LASIK usually are not as good as with the Visian ICL lens implant.
7. Extreme astigmatism. Over 6D of astigmatism is not approved by the FDA and cannot be fully treated by current laser technology
8. Unrealistic expectations.  After meeting with you, I may conclude that I cannot fulfill your expectations, I may recommend that you continue with glasses or contacts
9. Very flat corneas (if nearsighted) Since the lasers remove nearsightedness by flattening the cornea, if your corneas are already naturally very flat, LASIK can make the cornea too flat, in which the optics of the eye are not ideal.  In this situation, I recommend Visian ICL, which does not alter the corneal shape.
10. Very steep corneas (if farsighted) Since the lasers remove farsightedness by steepening the cornea, if your corneas are already naturally very steep, LASIK can make the cornea too steep, in which the optics of the eye are not ideal.  In this situation, I recommend considering Refractive Lens Exchange, which does not alter the corneal shape. 
11. Cataracts.  If the natural lens in your eye is becoming cloudy it is called a cataract and I may recommend considering cataract surgery
12. Monocular.  If only one of your eyes can see, the standard of care is to NOT perform a laser vision correction procedure, but instead to wear safety glasses for protection.
13. Any untreated medical eye disease: Uncontrolled glaucoma, diabetic retinopathy, and retinal tears should be addressed first, and then LASIK can be considered.
14. Previous radial keratotomy (RK) or other corneal surgery is a potential risk factor for a flap problem.  PRK/Epi-LASIK is a better choice after RK
15. Too small refraction.  If the amount of prescription in your glasses is too small, you may want to consider no surgery (or waiting so it will be more beneficial).
16. Corneal Epithelial Dystrophy and certain corneal surface disorders, such as epithelial basement membrane dystrophy, can be cured by PRK/Epi-LASIK.
17. Strabismus/Prism in glasses or double vision without prismatic glasses: LASIK will not reduce the need for prism prescription.  As a rule of thumb, if you can’t tolerate contact lenses because of double vision, LASIK is not recommended.  It is usually preferable to continue with prismatic glasses or strabismus surgery.
18. Untreated Blepharitis or eyelid infections.  I treat any underlying disorder prior to surgery to reduce any likelihood of a problem after surgery.

Luckily, only about 20% of Americans have one of these conditions, making the other 80% of Americans potentially good candidates for LASIK.  A careful and observant eye surgeon can identify if these conditions are present and determine if you are indeed a good candidate for LASIK or not.  Often, an alternative type of surgery is preferable to LASIK when one or more of these conditions are present.  Or sometimes no surgery is the best option.

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