LASIK is a very popular and very successful type of refractive surgery. As the surgical method has progressed over time, the procedure itself has been expanded to treat a wider variety of patients. Patients need to be adults, to have had stable vision for one year and to have sufficient corneal thickness to undergo the surgery. However, there are some patients who should not have LASIK surgery for various reasons. The eye surgeon will carefully evaluate the patient during the LASIK screening exams to make sure that none of the conditions are present.
Pregnancy and Nursing
Pregnancy and nursing are absolute contraindications to LASIK surgery because vision often fluctuates during these times. It would be difficult to accurately correct the refractive error during pregnancy and while nursing. Also, the medications that need to be taken after the procedure--such as antibiotics and anti-inflammatory drops--are not recommended for pregnant or nursing women due to concerns about harming the fetus. Pregnant women often have symptoms of dry eye which would also eliminate them as candidates. After the hormonal changes even out, these patients may become candidates for LASIK again a few months after pregnancy or nursing.
Autoimmune Diseases
People with autoimmune diseases often have difficulties healing after an injury or surgery. For these people, an elective refractive surgery may not be a good idea because the cornea may not heal properly. Among eye surgeons there are differing opinions about different diseases being absolute disqualifiers for LASIK. Diseases that fall into this category include type 1 diabetes, HIV and rheumatoid arthritis.
Collagen Vascular Diseases
Patients with collagen vascular diseases such as Sjogren's syndrome, systemic lupus erythematosis and scleroderma are generally disqualified from LASIK surgery as well. Although the scientific reason for the poor outcome for these patients after LASIK is not fully understood, the presence of dry eye syndrome in many patients with collagen vascular diseases may play a role. Also, these patients may be more susceptible to poor corneal healing and may even develop what is known as corneal melt. However, some surgeons will perform the surgery on patients whose condition is well controlled.
Corneal Conditions
Several issues involving the cornea can eliminate a person from consideration for LASIK surgery. The condition keratoconus, which is a disease where the cornea thins and becomes abnormally shaped, is a contraindication because LASIK surgery also removes tissue from the cornea and could worsen the disease. It is sometimes challenging for eye surgeons when a patient has a thin cornea because the surgeon has to make the decision about whether LASIK is appropriate. Patients with excessive scarring of the cornea should not undergo LASIK surgery; patients with dry eyes often are precluded from surgery because dry eye tends to get worse after LASIK.
Certain Medications
Some medications create difficulties with healing or dry eyes, and being on one of these medications would prevent a patient from undergoing LASIK. Steroid or immunosuppressant medications can impair wound healing, which could cause problems after LASIK surgery. Accutane causes dry eye and can cause scarring after surgery; patients need to be off this medication for six months before having LASIK. Other medications, such as anthistamines, beta blockers and diurectics, can cause dry eyes; however, some of the medications can not be just stopped for an elective procedure so these may be contraindications too.
Eye Disease
Several systemic diseases have been noted as contraindications for LASIK. Corneal conditions such as dry eye syndrome have been mentioned as eye conditions that preclude LASIK surgery; however, there are other conditions, including cataracts, eye infections (conjunctivitis) and uncontrolled glaucoma, that would exclude the patient from the LASIK procedure. Having had ocular herpes during the year prior would eliminate a patient from consideration; if the condition has not been present in over a year, the patient can be considered again for the procedure.
