Limitations of LASIK

Refractive surgeries like LASIK and PRK can be quite successful for the right patient. I performed this type of surgery for 15 years and had excellent results. I stopped only when there was no longer a laser available in Boulder. But part of my success was limiting my surgical patients to those who were exceptionally good candidates.

First, LASIK and PRK are elective surgeries. They don’t make the vision any better than contacts or glasses do. And, there are risks inherent in any surgery. So the surgery shouldn’t be done unless there is an excellent chance of a great outcome. I have seen many patients who had procedures done (by other surgeons) who may never have clear vision again. They wish they had never had their surgeries. If you’re not a perfect candidate, don’t take the risk of doing surgery. It’s that simple.

So, what makes a good candidate for LASIK and why did I turn away more than 3/4 of the patients who asked me about having the surgery done?

Stable vision is a must. If your glasses prescription is changing – you’re needing to get new lenses each year to keep your vision crisp – then LASIK won’t stop that change. You should have a stable prescription for at least a year before having refractive surgery. If you don’t, you might be back in glasses within a year or two.

Small pupils work well for LASIK. But if you have large pupils or ones that dilate a lot in the dark, this can cause a lot of glare after LASIK or PRK. This has to do with the specific way the laser shapes the cornea. But the bottom line is don’t have the surgery if you have big pupils.

Not so near-sighted folks have the best result from LASIK. The procedure works best if we don’t have to correct a lot of near-sightedness. And the results are better for near-sighted patients than for far-sighted ones. The thickness of the cornea is one limitation to how much correction can be achieved.

Younger patients can enjoy the most years from a successful surgery. But LASIK can’t get rid of glasses forever. As the lens inside the eye (behind the pupil) ages, it limits the ability to read up close. Even if you have a perfect outcome from LASIK, you will need reading glasses in your early 40s. While there are some options for older patients like correcting one eye for far vision and the other for near, this isn’t optimal for most people. If you’re already over 40, you can still have a very successful surgery, but you must understand that you’ll need glasses to see things up close.

No presence of eye disease is an absolute must for a LASIK candidate. LASIK can make dry eyes much worse, for example. Irregularly shaped corneas can lead to very poor and unstable vision after surgery. So careful screening by an ophthalmologist is crucial before considering refractive surgery.

Finally, if you have had a complete eye exam with your ophthalmologist and you find that you are a good potential candidate for LASIK, carefully consider which eye surgeon will do your surgery. I recommend finding someone with a lot of experience, someone whose income does not depend solely on doing more LASIK cases (avoid the big discount LASIK centers), and someone who will spend time with you personally and do most of the critical pre-operative measurements and post-operative follow-up themselves (instead of technicians).

-Donald McCormack, MD

If you would like to schedule an eye exam with Dr. McCormack, please call (303) 440-3049.