There are many reasons that a person may be told that they are not a good candidate for a vision correction procedure, including LASIK. In our experience, many of them may not end up being true. Each year, we see dozens of patients that have been told this and then have subsequently had successful treatment with us using LASIK, refractive lens exchange or one of several other available procedures.
Here are some of the more common reasons that an eyecare provider may tell you that you are not a candidate:
Your correction is too high, or you have too much astigmatism.
This was true for many first generation lasers that date back to the 1990’s. Advanced LASIK technique with modern technology is able to treat massive amounts of nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. Topography-guided treatment using Contoura Vision technology is able to accurately sculpt precise amounts of astigmatism that naturally occur on the cornea. Only your refractive surgeon that takes the required measurements and assesses them with their surgeon-specific formulas and nomograms can make the determination as to whether or not your amount of refractive error can be fully corrected. Many eyecare professionals that do not perform refractive surgery are not aware of the new technological advances and capabilities of the modern laser platforms that we use. In our practice, it only occurs at most once or twice a year at most where we discover a healthy patient that otherwise qualifies for LASIK that cannot have a full correction. In these atypical scenarios, we usually have other vision correction options to consider.
Your eyes and the refractive measurements are not stable.
It is normal for the refractive measurements to have small variations/fluctuations each and every time that you get your eyes checked. This is why often times your eyecare professional will make minor adjustments to glasses and contact lenses each time that they check you. Only if there are very large changes over time is it recommended to wait on laser vision correction until more stability is achieved. Almost everyone’s eyes are fully developed by age 18 with only a few exceptions. Our Comprehensive Ocular Health Analysis will help make this determination as to whether or not the measurements for your eyes are stable enough to allow for surgery.
You are too young for LASIK.
We will treat patients as young 18 years old given that their measurements have shown stability. The Comprehensive Ocular Health Analysis will help us make this determination.
You are too old for LASIK.
Our recommended age limits for LASIK vary from person to person depending upon your exact circumstances. If you do not qualify for LASIK, you may instead benefit from other vision correction procedures with Refractive Lens Exchange: Ages 50 to 59 or Advanced Cataract Surgery: Ages 60+.
You have cataract.
Visually significant cataract has to be addressed in order to optimize your vision. Glasses and contact lenses cannot treat or correct cataract. You will likely benefit from Advanced Cataract Surgery: Ages 60+. New lens implant technology with PanOptix Intraocular Lens Implant, Toric Intraocular Lens Implant, and Vivity Lenses can reduce your dependency on glasses.
You have keratoconus, irregular astigmatism or other corneal disorder.
LASIK alone should not be done in the setting of keratoconus. You should have an evaluation with a corneal specialist immediately to determine if you will benefit from corneal collagen cross-linking. Early intervention can prevent permanent damage of the cornea and future vision loss. We have access to advanced corneal cross-linking techniques that may even improve the vision.
You have corneal scarring.
There are many patients that have had trouble with contact lenses causing pink eye, dry eye, recurrent ulcers and infections which has resulted in corneal scarring. When scarring is mild, we have shown that innovative LASIK techniques using the femtosecond laser are still able to safely create flaps and perform the procedure. In more advanced cases of scarring, you may benefit from another procedure call phototherapeutic keratectomy (PTK) that uses the same advanced excimer laser technology used in advanced LASIK procedures in order to polish off the scarring while simultaneously treating your refractive error. We have pioneered these techniques with cutting-edge technology that we have published in scientific research articles.
Your eyes are too dry.
Dry eye can be an important factor that will affect your ability to be able to comfortably tolerate both contact lenses and LASIK. It is important to know that LASIK does not usually cause dry eye over the long term but does have potential to upset an existing dry eye disease condition. Recent studies have actually shown that, on average, dryness is likely to be worse on those that continue to wear contact lenses versus those that receive LASIK. Tear film analysis to detect dry eye is considered by your surgeon when determining the most appropriate vision correction procedure for you.
You are not alone. Over 50% of contact lens wearers experience symptoms of dryness, which may include pink eye, infections or ulcers. Some people will discover that “allergies” or other factors may develop over time that will negatively affect their ability to tolerate the contacts, even while rotating and experimenting with various contact lens brands and materials. Many of these cases occur even when meticulous hygiene and precautions are taken to safeguard against contact lens-related complications.
Here are some statistics about contact lens wear: Nine out of ten people wearing contact lenses state that it is for the purpose of glasses-free vision correction. There are approximately 40 million contact lens wearers in the United States at any given time. Each year, 5 million of them are new or returning to contact lenses, and 5 million of them are discontinuing contact lenses (as either a new dropout that failed to tolerate them or as a long term wearer that decided to stop). For those 5 million that are discontinuing contact lenses for any reason, one million of them stop after initial failure within the first month of trying them, and another one million of them stop after trying contact lenses for one year. Of those that stop after one year, 50% of them say that it is because of poor vision and 33% say that it is because of poor comfort, described as dryness most of the time. Two-thirds of people that present to an eye surgeon for laser vision correction are experiencing some element of dryness or irritation with their contact lenses.
Both contact lenses and LASIK are safe vision correction options, but both also entail some degree of risk. Furthermore, not everyone can comfortably and safely tolerate the contacts. Contact lenses have potential to damage the surface of the eye and cause corneal scarring which must be treated with laser procedures other than LASIK. Contact lenses should not be worn in the setting of recurrent corneal infections or ulcers.
Many patients may be fearful simply because they do not know what to expect. You should be assured that it is normal to experience some degree of apprehension regarding medical procedures of any kind, including eye surgery. Some people know that they would be more “squeamish” depending upon which body part is being treated, for example, an eye procedure versus a dental treatment versus another procedure. Regardless of your expectations prior to the surgery, most people are surprised to discover the simplicity and ease with which the LASIK procedure is performed.
Here’s Exactly What to Expect with LASIK:
The LASIK procedure does not cause intense pain. We try not to overwhelm you with too many intricate details regarding the process up front because it is too much to remember and most of it is irrelevant to your experience during treatment. You should know that there is nothing special required on your part to make the procedure go well. It will be smooth and efficient when you simply listen to the instructions as we coach you through the entire process.
You will be given a relaxing medicine by mouth approximately 30 minutes prior to the treatment. Numbing eye drops are then used to anesthetize the cornea on the surface of the eye. Within the first few seconds of positioning you under the lasers, we use an eyelid speculum which is a spring that holds the eyelids open during the procedure, that way you don’t have to worry about holding them open on your own. Initially it feels like mild tension on the eyelids without pain which tends to fade almost immediately. It’s good to know that this is usually the most discomfort that you will experience the entire process, and it comes and goes within seconds before the procedure has actually begun. That way you will feel confident through the remainder of the treatment knowing the worst is over so quickly, and it wasn’t near as bad as you imagined it might be. Throughout the course of the procedure, you will notice a little bit of pressure sensation, light touch and cool fluid coming off and on. You will spend approximately 15 minutes in the procedure suite for which most of the time spent is setting things up, not undergoing surgery. The actual time during which the laser is treating is approximately 10 seconds for the femtosecond laser portion that cuts the flap and usually 10-20 seconds for the excimer laser portion that sculpts the cornea, depending upon how large the treatment is.
Afterwards, we place protective plastic shields over the eyes to prevent accidental bumping/rubbing of the eyes. Many patients will notice almost immediate improvement in the vision through the plastic shields within minutes from completion of the treatment, even as you walk out the front door of the building. The shields are removed 24 hours after the treatment during our first post-operative visit the next morning. You will use antibiotic and anti-inflammatory eye drops three times daily for a total of three days. It is common to have burning, irritation and light sensitivity immediately following the procedure which usually wears off within the first two or three hours. Artificial tears are used as needed to help with mild dryness and scratchiness that occasionally occurs during the post-operative healing period. Tylenol or other over-the-counter pain medications can be used for minor headaches or soreness. All of the instructions will be written down for you. It usually takes up to two weeks to get your maximum vision as the healing process is accomplished, but it is typical to have vision of 20/20 or better the very next day after surgery!
We will perform your surgery toward the end of week so as to bookend it with a long weekend and minimize your down time from work. We ask that you lay low during the first couple days following the surgery without doing any overly strenuous activity. Most people are ready to resume their normal activities and return to work by Monday. The next post-operative visit occurs 2 weeks from the time of surgery. In this way, we are diligent to ensure that your eyes are healing up perfectly fine from the procedure. We are determined to make sure that you are well-pleased with your outcome and your new vision.
Here are other common concerns that patients will sometimes have regarding the LASIK procedure:
What happens if I move or blink during the surgery?
It is normal for everyone to always have small eye movements, especially when viewing your eyes through the very high magnification of an operating microscope as in the setting of a laser procedure. The laser has a tracking device that engages your pupil which is able to follow your eye quicker than you can move it. In the event of a large movement, the laser is able to stop while we reposition you. It will resume treatment where it left off.
Can I dislodge the flap?
The flap heals up amazingly quick. It is exceedingly rare to dislocate a LASIK flap even in the setting of eye rubbing or accidental trauma. Of course, we don’t ever recommend deep eye rubbing for anyone, whether you have had LASIK or not. The type of mishap that would be capable of dislocating a flap is sufficient and likely to cause significant ocular injury, even in a healthy eye that does not have a LASIK flap. Severe trauma to the eye is always a concern for everyone, but LASIK has even been shown to be safe for active duty military, including navy top-gun pilots.
Wearing contact lenses or having eye surgery of any kind, including LASIK, always entails some degree of risk. It you ever meet an eye surgeon that says otherwise, they are either not being truthful or have not done very many surgeries. While LASIK is safe and effective on a massive scale, especially with regards to surgeries in all other medical fields, no procedure has a 100% success rate. Most complications that could potentially occur are mild and can be easily corrected with further treatment. Dr. Rush will take time to answer any particular questions or concerns that you may have regarding the specific risks related to LASIK.
By “going blind”, most people are talking about vision that is measured as 20/200 or worse which meets that the standard of legal blindness in the state of Texas. Blindness from corneal damage may occur from complications related to both contact lenses and LASIK. This type of blindness may result in need for a more invasive corneal transplant surgery. Our research has shown that you are twice as likely to require a corneal transplant to correct legal blindness from a complication related to contact lenses versus a complication from LASIK. Furthermore, advances with technology including innovative pre-operative imaging modalities and corneal collagen cross-linking have dramatically reduced the likelihood of having a complication from LASIK that results in becoming legally blind.
Some cynics have falsely claimed that LASIK is a procedure that the surgeon knows is dangerous. However, it is very revealing that many refractive surgeons, including Dr. Rush, have had LASIK themselves. In fact, scientific research has shown that LASIK surgeons are 5 times more likely to have laser vision correction on themselves compared to the general population, and more than 90% of refractive surgeons have recommended it for an immediate family member. We certainly would not knowingly recommend any procedure for you that we know is not advisable in our medical opinion, as your safety and visual well-being is our top priority.
Yes! Over 40 million people worldwide between 2000 to 2020 have experienced the benefit of a glasses and contact lens-free lifestyle because of LASIK. There are currently over 700,000 cases done in the United States each year. LASIK is a procedure where scientific studies have repeatedly shown that greater than 90% of patients undergoing treatment achieve vision 20/20 or better without glasses and contact lenses.
In our own experience and in studies conducted across the United States, we often discover that patients will have vision better than 20/20 and even better vision after the surgery than what they had beforehand with glasses and contact lenses. The final vision outcome varies from person to person and will ultimately depend on a variety of factors, including the health of the eyes at baseline prior the treatment.
LASIK cannot cure disease of the eye or other pre-existing ocular conditions. We do not guarantee any particular vision outcome for anyone because, like anyone and everyone, we are not capable of predicting the future with absolute certainty. Furthermore, each person has an exclusive set of circumstances that apply only to them and no one else, whether it be preexisting ocular disease or other unique scenarios. For this reason, many people will have a similar, but never identical, experience with their eye surgery and outcomes. This is also why we take the extra time to customize the most appropriate treatment plan that is designed specifically with you in mind. The guarantee that we will make is that we will give you our very best effort to allow for your optimal results, regardless of what it takes.
No. With a successful procedure, the cornea has been permanently sculpted to correct your refractive error, a sculpting that always remains and does not spontaneously disappear. In the event of an over-treatment or under-treatment, this is usually detected early on within the first several months. This scenario can almost always be corrected with an enhancement where the existing flap is lifted, and the residual error is retreated. Our experience shows that the likelihood of an enhancement occurs in approximately 1% of the cases. In addition, some people’s vision may shift in small amounts over time whether they have had LASIK or not, just as it would when you get new glasses or contact lens prescriptions with minor adjustments each year. That is why it is important to confirm stable and consistent measurements prior to the procedure in order to ensure that we are not chasing a moving target with the laser. In the less common situation where there are larger shifts, it is usually possible to lift the old flap or even create a new flap to retreat again. Furthermore, eye disease such as cataract can develop that is unrelated to the LASIK procedure that will negatively affect your vision or require later use of glasses to optimize your vision.
Presbyopia also universally occurs in all people: As we approach age 50, we naturally lose our ability to accommodate or see up close. This requires reading glasses even if your distance vision is fully functional. LASIK does not cause presbyopia; collecting birthdays does. There are several solutions for mitigating the effects of presbyopia.