Am I a Candidate for LASIK?


Contraindications are conditions listed in the FDA labeling as reasons why a potential patient absolutely should not have surgery.

Pregnancy and nursing: Pregnancy commonly causes fluctuating vision. Therefore, measurements taken during pregnancy may not lead to a stable, accurate correction, once the baby is born. The same is true for nursing. Furthermore, laser vision correction necessitates the use of antibiotic and steroid eye drops, both of which should be avoided by pregnant and nursing women for fear of harming the baby. Consequently, laser vision correction can only be performed after the baby is born, nursing has stopped, and regular menstrual cycles have resumed.

Immune deficiency: Diseases that decrease the body's immune status, such as HIV, increase the risk of unpredictable healing and infection.

Collagen vascular diseases: Rheumatoid arthritis, scleroderma, psoriatic arthritis, dermatomyositis, ankylosing spondylitis, Bechet's disease and systemic lupus erythematosis are on the list of disqualifying medical conditions. Nonetheless, some surgeons are willing to treat patients whose disease is "mild and well-controlled".

The exact level of risk in treating this group of patients is unknown. A pilot study published in the November 2005 issue of Ophthalmology found no vision-threatening complications in a group of 22 eyes, but the study was too small to make definitive conclusions.

While patients are often disappointed when laser vision correction is not recommended, the potential complications related to collagen vascular disease should not be taken lightly. The most feared complication, known as a corneal melt, is potentially sight threatening.

Keratoconus is a progressive, degenerative disorder in which a region of the cornea thins and bulges forward, leading to a conical shape, as opposed to the normal roundness. Mild keratoconus causes visual distortion that can still be corrected with glasses. With moderate disease, gas permeable or hard contact lenses are necessary to mask the distortion, and advanced cases are treated with corneal transplantation.

Laser vision correction removes corneal tissue, so it also thins the cornea. In patients with keratoconus, laser induced thinning could conceivably accelerate cone formation and distortion, so surgery is inadvisable.

Keratoconus is diagnosed by mapping the contour of the cornea with a corneal topographer. Advanced cases are easy to identify, but mild cases sometimes present surgeons with the dilemma of an inconclusive test.

Some surgeons perform flap procedures, such as LASIK and IntraLASIK, when the corneal topography is only mildly suspicious, but flapless procedures are often preferred because they thin the cornea less. However, a large number of surgeons avoid these cases entirely for fear of being blamed for future degenerative changes that may well have occurred anyway.

A handful of medications: Accutane, an oral anti-acne drug, causes an unacceptably high risk of corneal scarring and dry-eye related complications, so patients must be off of Accutane for a minimum of six months before surgery.

Amiodarone, a medication used to control irregular heart rhythms, forms deposits within the cornea that may affect the accuracy and healing of laser vision correction, so amiodarone users must avoid surgery.

Migraine headache medications of the triptan family, such as Imitrex, are often listed as a contraindication to surgery. However, there is no unanimous consensus on how to handle recent triptan use. Some surgeons won't operate at all until the patient has been off triptans for a certain time, while others follow a "use it as little as possible and not right before surgery" philosophy.

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