Who Should Not Have Laser Eye Surgery: Important Considerations Before You Decide

Laser eye surgery has transformed the lives of millions by reducing or eliminating the need for glasses or contact lenses. Procedures like LASIK, PRK, and refractive lens exchange offer fast results and long-lasting improvements in vision. However, laser vision correction is not right for everyone. While it is FDA-approved and widely considered safe, certain health conditions, eye characteristics, and lifestyle factors can make it risky or less effective.

If you are considering LASIK surgery or another form of refractive surgery, understanding who should not have laser eye surgery is essential. Here we explore the situations, conditions, and factors that may mean you are not an ideal candidate, along with alternative vision correction options that may be better suited for your needs.

Understanding Laser Eye Surgery and How It Works

Laser eye surgery, including LASIK, PRK, and other refractive surgery techniques, reshapes the cornea to correct refractive errors like myopia, hyperopia, and astigmatism. The goal is to improve the way light focuses on the retina, leading to clearer vision without the constant use of corrective eyewear.

LASIK eye surgery involves creating a thin corneal flap, reshaping the underlying corneal tissue with a laser, and then repositioning the flap. PRK surgery, on the other hand, reshapes the surface of the cornea without creating a flap. While both are highly effective for many patients, the procedure requires healthy corneal tissue, a stable prescription, and good overall eye health for proper healing.

When Laser Eye Surgery May Not Be the Right Choice

1. Unstable Vision or Frequent Prescription Changes

A stable prescription is crucial for LASIK eligibility. If your glasses prescription changes frequently, laser vision correction results may not last long. Vision changes can occur due to age-related vision changes, hormonal fluctuations, or underlying eye diseases.

If your vision is still changing, your eye doctor will likely advise you to wait until your prescription has been stable for at least 12 months. Performing surgery on unstable vision can lead to the need for additional corrective eyewear sooner than expected.

2. Thin or Irregular Cornea

The thickness and shape of your cornea determine whether laser eye surgery can be performed safely. A thin or irregular cornea increases the risk of complications such as corneal ectasia, where the cornea becomes weakened and bulges over time.

Your eye surgeon will measure your corneal thickness during your consultation. If you have corneal scarring, irregular cornea shapes, or reduced corneal tissue, you may not be a good candidate for LASIK, but you could explore PRK surgery or other alternative procedures.

3. Autoimmune Diseases and Healing Disorders

Conditions like rheumatoid arthritis, lupus, and other autoimmune diseases can interfere with your body’s ability to heal properly. A healthy healing process is essential for laser vision correction to be successful. Autoimmune disease patients may face higher risks of infection, inflammation, or delayed healing.

Certain prescription drugs, including some acne medications and steroids, can also delay healing or increase complications. If you are taking medication that affects the body’s ability to recover, your eye doctor will likely recommend postponing or avoiding refractive surgery altogether.

4. Severe Dry Eye Symptoms

Dry eye syndrome is a common condition that can be worsened by laser eye surgery. Because the procedure temporarily affects corneal nerves, it can lead to reduced tear production and increased discomfort.

Patients with severe dry eyes may experience prolonged irritation, blurred vision, and delayed healing after LASIK surgery. In such cases, your eye doctor may first treat and manage dry eye symptoms before considering surgery or suggest alternative vision correction options.

5. Uncontrolled Diabetes or Poor General Health

Uncontrolled diabetes can damage blood vessels throughout the body, including those in the eyes, and can slow down the healing process after surgery. Poorly managed diabetes also increases the risk of eye infections and vision problems after laser-assisted procedures.

Your overall health impacts your ability to recover from surgery. Chronic illnesses, especially those that compromise immune function, can make healing more challenging and outcomes less predictable.

6. Eye Diseases That Affect the Cornea or Retina

Eye diseases such as keratoconus, advanced glaucoma, severe cataracts, or significant retinal disorders can make refractive surgery unsafe or ineffective. The presence of these conditions often requires other forms of treatment before vision correction can be considered.

If you have eye infections, corneal ectasia, or a history of eye injuries, your eye surgeon may determine that laser vision correction carries more risks than benefits.

7. Pregnancy and Hormone Fluctuations

Hormonal changes during pregnancy and breastfeeding can cause temporary changes in your vision and corneal shape. Undergoing LASIK eye surgery during this time is not recommended, as the results may be unpredictable and vision changes may reverse once hormone levels return to normal.

Your eye doctor will typically advise waiting several months after pregnancy or breastfeeding before considering surgery to ensure stable vision and proper healing.

8. Younger Than Recommended Age or Age-Related Vision Changes

Most eye doctors recommend that patients be at least 18 years old with a stable prescription for one year before undergoing laser eye surgery. Younger individuals may still be experiencing changes in their vision, making results less permanent.

Similarly, older adults may experience age related vision changes such as presbyopia, which affects close up vision and may still require reading glasses after LASIK. In such cases, a refractive lens exchange or other corrective options may be more appropriate.

Prescription Drugs That May Interfere With Healing

Some prescription medications, such as isotretinoin for acne or certain anti-inflammatory drugs, can affect the body’s ability to heal corneal tissue. These drugs may increase the risk of scarring, infection, or poor visual outcomes.

If you are taking medications that can delay healing, it is important to inform your eye surgeon. They may recommend postponing the surgery until you can safely discontinue the medication.

The Importance of a Comprehensive Eye Examination

Before pursuing LASIK surgery or any form of refractive surgery, a comprehensive eye examination is essential. Your eye surgeon will assess your corneal thickness, refractive errors, eye health, and overall medical history to determine if you are a good candidate.

The goal is to ensure that the procedure will safely improve your vision without increasing your risk of complications or causing vision loss.

Exploring Alternative Vision Correction Options

If you are not eligible for laser eye surgery, there are still several ways to achieve improved vision without relying solely on glasses or contact lenses. These include:

• PRK surgery – Suitable for patients with thin corneas, as it reshapes the cornea without creating a flap.
• Refractive lens exchange – Replaces your natural lens with an artificial one, ideal for certain refractive errors and age related vision changes.
• Implantable contact lenses – A surgical option where a lens is placed inside the eye to correct vision.
• Updated glasses or contact lenses – The safest and most accessible option for many people.

Your eye doctor can help you decide which alternative is best based on your specific refractive error, lifestyle, and eye health.

Making the Decision with Careful Consideration

Not everyone is a good candidate for LASIK or other laser vision procedures. Factors like unstable vision, thin or irregular cornea, autoimmune diseases, uncontrolled diabetes, eye diseases, and certain prescription drugs can affect eligibility.

Choosing to have laser eye surgery is a major decision that should be made with careful consideration. Work closely with a qualified eye surgeon to discuss your vision problems, review your medical history, and explore both surgical and non-surgical solutions.

Final Thoughts

Laser eye surgery has helped countless people achieve clear vision and freedom from corrective eyewear, but it is not a one-size-fits-all solution. Understanding who should not have laser eye surgery is the first step toward making a safe and informed decision.

If you have conditions that make LASIK surgery risky, remember that alternative vision correction options can still help you enjoy better sight without compromising your eye health. Always seek professional advice from an experienced eye doctor or surgeon who can guide you toward the safest and most effective solution for your needs.

References:

https://www.fda.gov/medical-devices/lasik/when-lasik-not-me

https://www.mayoclinic.org/tests-procedures/lasik-eye-surgery/in-depth/lasik-surgery/art-20045751

https://www.verywellhealth.com/should-you-have-lasik-3421961

https://www.michiganmedicine.org/health-lab/pros-and-cons-lasik-are-risks-worth-cost

https://www.mayoclinic.org/tests-procedures/lasik-eye-surgery/about/pac-20384774

https://www.medicalnewstoday.com/articles/laser-eye-surgery

https://www.healthdirect.gov.au/laser-eye-surgery

https://www.aao.org/eye-health/treatments/lasik