LASIK Eye Surgery Candidacy
Is Laser Eye Surgery right for you? 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 eye doctor that will help determine, in consultation with the patient, whether or not the LASIK procedure 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

  • Is over 18 years of age and has had a stable glasses or contact lens prescription for at least two years.

  • Has 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 safely create a corneal flap of appropriate depth, and perform the necessary treatment on the tissue underneath.

  • Is affected by one of the common types of vision problems or refractive error myopia (nearsightedness), astigmatism (blurred vision caused by an irregular shaped cornea), hyperopia (farsightedness), or a combination thereof (e.g., myopia with astigmatism).

  • Does not suffer from any disease, vision-related or otherwise, that may reduce the effectiveness of the surgery or the patient's ability to heal properly and quickly.

  • Is adequately informed about the benefits and risks of the procedure. Candidates should thoroughly discuss the procedure with their eye doctor and understand that for most people, the goal of refractive surgery should be the reduction of dependency on glasses and contact lenses, not their complete elimination.

The Less Than Ideal LASIK Candidate
Sometimes factors exist that prevent a candidate from being an ideal candidate for LASIK surgery but a surgeon may still be able to perform the procedure safely, given that the candidate and physician have adequately discussed the benefits and risks, and set realistic expectations for the results.  Candidates in this category include those who:

  • Have a history of dry eyes, as they may find that the condition 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 autoimmune 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 consistent glasses or contact lens correction 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 refractive error – myopia, hyperopia and astigmatism – current FDA-approved indications define appropriate candidates as those with myopia up to -10 D, astigmatism up to 4 D and hyperopia up to +3 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 preclude 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.

*Based on the LASIK Patient Screening Guideline For Patients from The Eye Surgery Education Council Medical Advisory Board of the American Society for Cataract and Refractive Surgery.

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Copyright © 2009 Robert C. Arffa, M.D., 1370 Washington Pike, Bridgeville, PA 15017