Who is Right for Laser Eye Surgery?
While many individuals are considered good candidates for LASIK, there are some who do not meet the generally accepted medical criteria to ensure a successful laser vision procedure. Individuals that are not deemed good candidates given today’s technology may be able to have the surgery in the future, as technology advances and new techniques are refined. Anyone considering laser eye surgery must have a thorough examination by an ophthalmologist that will help determine, in consultation with the patient, whether or not the LASIK proce-dure is right for them. Based on various conditions and circumstances, all LASIK candidates will fall into one of the following three broad categories.
The Ideal LASIK Candidate
The ideal candidate includes those who:
- Are over 18 years of age and have had a stable glasses or contact lens prescription for at least two years.
- Have sufficient corneal thickness (the cornea is the trans-parent front part of the eye). A LASIK patient should have a cornea that is thick enough to allow the surgeon to safe-ly create a clean corneal flap of appropriate depth.
- Are affected by one of the common types of vision prob-lems or refractive error – myopia (nearsightedness), astig-matism (blurred vision caused by an irregular shaped cornea), hyperopia (farsightedness), or a combination thereof (e.g., myopia with astigmatism). Several lasers are now approved by the U.S. Food and Drug Administration (FDA) as safe and effective for use in LASIK, but the scope of each laser’s approved indication and treatment range is limited to specified degrees of refractive error.
- Do not suffer from any disease, vision-related or oth-erwise, that may reduce the effectiveness of the surgery or the patient’s ability to heal properly and quickly.
- Are adequately informed about the benefits and risks of the procedure. Candidates should thoroughly discuss the procedure with their physicians and understand that for most people, the goal of refractive surgery should be the reduction of dependency on glasses and contact lens-es, not their complete elimination.
The ‘Less Than Ideal’ LASIK
Candidate Sometimes, factors exist that preclude a candidate from being ideal for LASIK surgery. In many cases, a surgeon may still be able to perform the procedure safely, given that the candidate and physician have adequately dis-cussed the benefits and risks, and set realistic expecta-tions for the results. Candidates in this category include those who:
- Have a history of dry eyes, as they may find that the con-dition worsens following surgery.
- Are being treated with medications such as steroids or immunosuppressants, which can prevent healing, or are suffering from diseases that slow healing, such as autoim-mune disorders.
- Have scarring of the cornea.
More often, factors exist that may keep an individual from being a candidate immediately, but do not preclude the individual from being a candidate entirely. Candidates in this category include those who:
- Are under age 18.
- Have unstable vision, which usually occurs in young people. Doctors recommend that, prior to undergoing LASIK, candidates’ vision has stabilized with a consis-tent glasses or contact lens prescription for at least two years.
- Are pregnant or nursing.
- Have a history of ocular herpes within one year prior to having the surgery. Once a year has passed from initial diagnosis of the disease, surgery can be considered.
- Have refractive errors too severe for treatment with current technology. Although FDA-approved lasers are available to treat each of the three major types of refrac-tive error – myopia, hyperopia and astigmatism – cur-rent FDA-approved indications define appropriate candidates as those with myopia up to -12 D, astigma-tism 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. The Non-LASIK Candidate Certain conditions and circumstances completely pre-clude individuals from being candidates for LASIK surgery.
Non-candidates include individuals who:
- Have diseases such as cataracts, advanced glaucoma, corneal diseases, corneal thinning disorders (keratoconus or pellucid marginal degeneration), or certain other pre-existing eye diseases that affect or threaten vision.
- Do not give informed consent. It is absolutely necessary that candidates adequately discuss the procedure and its benefits and risks with their surgeon, and provide the appropriate consent prior to undergoing the surgery.
- Have unrealistic expectations. It is critical for candidates to understand that laser eye surgery, as all surgical procedures, involves some risk. In addition, both the final outcome of surgery and the rate of healing vary from person to person and even from eye to eye in each individual.
(c) Eye Surgery Education Council (ESEC)