LASIK Surgery - Are You a Candidate?

What to Expect   Are You a Candidate?    Risks    Consent Form

While most patients are eligible for LASIK, not everyone is. Some individuals who are not eligible for LASIK may be eligible for other forms of refractive surgery. Those who are deemed ineligible for LASIK may wish to discuss alternatives with their ophthalmologist.

Eligibility depends on the amount of refractive error, the curvature and thickness of the cornea and a number of other factors that an ophthalmologist must evaluate. The following questionnaire is designed to help you understand a few of the criteria your ophthalmologist will review and evaluate.

	Yes	No
Has your lens prescription changed significantly within the last year?
Are you pregnant or nursing?
Are you afflicted with unstable or uncontrolled diabetes?
Do you suffer from an autoimmune disease?
Do you take drugs or undergo therapy that suppresses your immune system?
Are you afflicted with a collagen-vascular disease?
Do you have medical problems related to your eyes, such as amblyopia (lazy eye), keratoconus, pellucid degeneration or glaucoma?
Are you under 18 years of age?

If you have said yes to any of the above, be sure to read Why You May Not Be a Candidate for LASIK eye surgery.

The criteria that surgeons use to determine eligibility vary. The following questionnaire is designed to alert patients to conditions that surgeons 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 your pupils dilate larger at night than the treatment zone that can be provided to you?
Do you have high myopia (more than -12 diopters) or high hyperopia (more than +5 diopters)?
Are you taking any medications regularly?

If you have said yes to any of the above, be sure to read about Cause for Pause.

Are You a Good Candidate for LASIK?

Not everyone who can have LASIK should. As we mentioned, people who are most satisfied with the results of laser correction possess realistic expectations of what their vision will be like after surgery and clearly understand the potential risks and side effects. The following questionnaire is designed to assist in determining if you are a good candidate for the LASIK procedure.

	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 LASIK are permanent and that the effects of LASIK 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?

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

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 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.

Cause for Pause

While none of the conditions below absolutely contraindicate surgery, your doctor 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 your doctor 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 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 ocular examination by an ophthalmologist. Be sure to discuss your history of scarring after other surgeries with your doctor and to ask how this history could affect outcomes.
• 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 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.

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