LASIK is an amazing surgery. It has helped over 30 million patients see clearly without the hassles of contacts and glasses. LASIK has even been described as the safest and most accurate surgery in the history of humanity. That’s quite a statement! But it bares truth. Few other procedures are as reproducible, precise, and safe as LASIK.
LASIK is an elective procedure; like all surgeries, it is not 100% risk-free. Luckily, surgeons can minimize and mitigate risk with a thorough screening process.
Is your cornea too thin or too irregular? Is your prescription stable? Do you have severe dry eye, glaucoma, or uncontrolled diabetes? Are you pregnant or nursing? Are you willing and able to take your medicated drops and attend your follow-up appointments after surgery?
These are just a handful of questions that surgeons consider before deciding on a patient’s candidacy for LASIK.
You could teach a monkey how to do surgery, whether an appendectomy, a knee replacement, or LASIK. The trait that separates good surgeons from great ones is the ability to determine who should get surgery and who should not. This is especially true for elective surgery like LASIK.
So, let’s say you have been told you are not a good candidate for LASIK. What are your potential options?
1. PRK (photorefractive keratectomy): PRK treats nearsightedness, farsightedness, and astigmatism without creating a LASIK flap. The top layer of the eye (the corneal epithelium) is removed with a brush or alcohol, then the SAME LASER that performs LASIK reshapes your cornea to correct your refractive error. Instead of replacing a flap, your surgeon will place a contact lens on your eye as your epithelium heals.
Because PRK does not involve the creation of a flap, it leaves more of your cornea untouched, which can be the difference maker in someone with a thin cornea before surgery. PRK is also popular for patients with corneal scars who may not be suited for a LASIK flap. PRK has a longer healing time than LASIK, with most patients returning to normal activities in one week.
2. SMILE (small incision lenticular extraction): SMILE is another flapless alternative to LASIK. Unlike PRK, SMILE heals quickly and painlessly, with most patients back to normal activities in 24 hours. SMILE is the latest development in laser eye surgery and is a popular option for patients with thinner corneas.
3. ICL (implantable collamer lens): Some patients’ corneas are too thin or irregular to qualify for LASIK, SMILE, or PRK. ICL is a popular option for these patients because it completely BYPASSES the cornea. Instead, your surgeon places a small lens (like a glasses lens) INSIDE your eye. Joe Jonas of the Jonas Brothers famously underwent ICL surgery to great success.
4. RLE (refractive lens exchange): Consider RLE as the alternative to ICL for patients over 40. Once you are 40 years old, removing your natural lens (which eventually turns into a cataract) and replacing it with an artificial lens may make sense. Multifocal lenses can be implanted to allow both near and distance vision in each eye.
5. Cataract Surgery: This is not your grandma’s cataract surgery! The average age of cataract surgery in the United States is about 70, but many patients are undergoing cataract surgery earlier and earlier these days. Why? Because of improvements in surgical skill and technology, specifically the types of multifocal lenses available. If you have been told you can’t have LASIK because you have a “baby” cataract that isn’t yet affecting your distance vision, don’t rule out cataract surgery as a life-changing option.
6. Remain in contacts and glasses: Glasses are a safe and effective vision correction tool. So are contact lenses if you use them safely (no sleeping in your lenses, no overwearing them, etc.). Many patients who are not candidates for LASIK continue wearing contacts and glasses until it is time for cataract surgery.
7. Seek a second opinion: Second opinions are worthwhile to give you confidence in your elective medical decision. If multiple surgeons recommend against LASIK, they are probably on to something. But perhaps an eye care provider told you outdated information, such as “LASIK won’t treat your astigmatism” or “You’re too young to get LASIK.” In fact, LASIK, SMILE, and PRK all accurately treat astigmatism and are approved for patients 18 years and older. Speak with a trusted LASIK surgeon to get the most accurate information and learn if you are a candidate.
Laser eye surgery is a decision that should not be taken lightly by either the surgeon or the patient. Although LASIK is historically safe and effective, it is not for everyone. Luckily, there are plenty of options for patients who are told they are not ideal LASIK candidates. Find out YOUR candidacy by scheduling a free, no-hassle consultation at Corsini Laser Eye Center.
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Thank you for your trust!
Jonathan Corsini, MD