You are looking for freedom from your eyeglasses or contact lenses and wonder if refractive surgery is right for you? iLASIK and PRK are good options, and many people are satisfied with the results. However, not everyone is a candidate.

If you decide to go ahead with refractive surgery, you will need an initial or baseline evaluation by your optometrist. Your optometrist should perform a thorough eye exam and discuss what makes a good candidate, ask about your expectations and explain the benefits, risks or alternatives to the surgery are. Your lifestyle may play a part in your candidacy, so discuss your hobbies and interests, too.

Are You a Good Candidate for Refractive Surgery?

  Yes No
Do you have a strong desire to be free of glasses?    
Do your glasses interfere with your job, sports or daily activities?    
Do you clearly understand and accept the risks of surgery?    
Do you clearly understand that the effects of refractive surgery are permanent and that the effects do not wear off?    
Do you understand that refractive procedures require follow-up examinations at very specific intervals?    
Do you have time to attend these examinations?    
Are your expectations of refractive surgery realistic?    
Would you still be OK with wearing thinner glasses under some conditions, such as driving at night?    

*If you answered 'no' to any of the above, you should have a detailed discussion with your optometrist regarding the surgery and your expectations.

Cause for Pause

The safety and effectiveness of refractive surgery has not been fully determined in patients with some conditions and expectations. The criteria that Horizon uses to determine eligibility in these cases vary. The following questionnaire is designed to alert us to conditions that Horizon will evaluate on a case-by case basis.

  Yes No
Are you nursing or expecting to become pregnant within the six months following the LASIK procedure?    
Do you have a history of excessive scarring with injuries or other surgeries?    
Do you suffer from chronic ocular herpes infections or connective tissue disorders?    
Do you have severe dry eye?    
Do you have high myopia (more than -12 diopters) or high hyperopia (more than +5 diopters)?    
Are you taking any medications regularly?    

While none of the conditions below are absolute contra-indications to surgery, your doctor will need to carefully evaluate your case prior to making a decision about surgery. If you answered yes to any of the above, you may be cautioned against having surgery at this time.

If You Are Nursing or plan to become pregnant within 6 months of Refractive Surgery.

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, surgeons do not want to operate on eyes with an unstable refraction, as doing so makes performing an accurate correction difficult. Some doctors, therefore, take a conservative approach and consider nursing a contraindication to refractive surgery. Many will require that patients have several eye exams after patients have stopped nursing to indicate stable refraction. Only then will they recommend refractive surgery. Others maintain that, as long as refraction was stable during pregnancy and remains stable postpartum, stable refraction has been achieved. Therefore, treatment may be indicated.

It is generally not recommended that a woman become pregnant immediately after refractive surgery. 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.

If You Have a History of Excessive Scarring following Injury or Other Surgeries

Excessive scarring, even ocular scarring, in and of itself is not a contraindication to refractive surgery. It is not the scarring, but the origin of the scarring that concerns the doctor. 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 or over correction 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 examination by an your optometrist. Be sure to discuss your history of scarring after other surgeries with your doctor and to ask how this history could affect outcomes.

If 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 doctor of their medical history so that a full evaluation can be completed and discussed.

If 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 doctor with an accurate listing of all medications they are taking regularly during their consultation.

NOTE: If you cannot stare at a fixed object for at least 60 seconds, you may not be a good candidate for this surgery.

The decision to have refractive surgery can have possible impact the careers of those who are in the military and commercial pilots. We provide detailed information for anyone who is in either field or has plans to enter in either field.

Why You May Not Be Eligible for Refractive Surgery:

Certain conditions may be a contra-indication to refractive surgery. These include:

  • under 18 years of age
  • unstable vision
  • pregnant
  • uncontrolled or unstable diabetes
  • autoimmune disease or collagen-vascular disease
  • certain drugs that suppress the immune system
  • amblyopia
  • keratoconus
  • glaucoma
  • other eye diseases