LASIK: 7 reasons it might not be for you, plus 3 alternative procedures

If you use eyeglasses, you know what a nuisance they can be. They’re never where they’re supposed to be and just when you get attached to a favorite pair, they break, you lose them or your eyes have changed and you need a new pair.

That’s why many people have turned to LASIK (laser-assisted in-situ keratomileusis) surgery, the most commonly performed elective surgical procedure in all of medicine.

While LASIK surgery is very successful, not everyone may be a candidate.

“When it comes to determining who will get the most benefit from LASIK surgery, the secret is in the evaluation process,” says Ronald Krueger, MD, Nebraska Medicine ophthalmologist. “Some people may elect to have LASIK surgery when, in fact, they may have been better candidates for a different procedure, which could provide them better or safer results.”

Dr. Krueger has been performing LASIK surgery for more than 24 years and has been involved in laser vision correction research for more than 35 years. He also performs a more advanced form of customized LASIK surgery called topography guided LASIK, which is more personalized and precise in treating both the overall eye’s shape, as well as the surface texture of the cornea, enhancing the sharpness and clarity of vision compared to standard LASIK surgery. 

If you have any of these 7 issues, LASIK may not be a good fit: 

1. Nearsightedness that is progressing at a steady rate
2. Abnormalities in the shape of your eye
3. Insufficient tear film
4. A thin cornea
5. Eye infection or injury
6. Eye diseases such as keratoconus, glaucoma, cataracts, corneal disease, and certain retinal and optic nerve diseases, and eye conditions such as herpes simplex and herpes zosters
7. Eye problems such as lazy eye, strabismus (muscle imbalance) or any recurrent eye conditions could impact healing and should be discussed with your doctor

3 LASIK alternatives:

1. PRK (photorefractive keratectomy) surface laser procedure
This procedure is an option for individuals with a thin cornea. PRK works by using an excimer laser to reshape the corneal surface, thereby allowing light entering the eye to properly focus onto the retina. During LASIK, a thin flap is created and lifted to allow access to the inside layers of the cornea. The flap is then positioned back into place after the cornea is reshaped. In PRK, an outer layer of surface cells is completely removed to treat the corneal surface with the laser and then allowed to grow back after surgery. While the visual recovery maybe longer, the procedure may be safer in certain eyes.

2. Implantable Collamer lens (ICL)
This procedure is best for individuals who require a high degree of correction. It involves implanting a lens inside the eye beneath the iris to correct vision. 

3. Small incision lenticule extraction (SMILE)
This procedure is a solution for people with a tendency for dry eyes. It involves using a femtosecond laser to create an internal correction within the cornea and a small incision on the corneal surface. A small piece of tissue called the lenticule is then removed through the incision. This alters the shape of the cornea, which can correct nearsightedness and astigmatism. The small incision heals quickly within a few days.

“A comprehensive evaluation needs to occur to determine which solution is best for you,” says Dr. Krueger. “Do your homework first and ask lots of questions to ensure you have all of the information you need to make the best decision.”