Unsuitability for Laser Eye Surgery

Unfortunately, laser eye surgery is not suitable for everyone. In medical terms, if someone is unsuitable for a treatment, it is known as a contraindication. Broadly speaking, there are two main types. A complete contraindication is where the operation or treatment in question cannot be done, whereas a relative contraindication means that extra care is required before, during or after the procedure.

There are many complete contraindications to laser eye surgery. These are:

Pregnancy and breast feeding

During pregnancy, your body undergoes a series of changes, both hormonal and physiological. In both pregnancy and breast-feeding you may notice a slight change in your vision, which can be due to increased pressure within the eye or a host of other reasons. Due to this, any measurements of your visual acuity and prescription may be wrong, leading to an inadequate correction in surgery. It is therefore recommended that you put off having surgery until after you have given birth and stopped breast-feeding. Another reason to wait until after birth is the drugs you are given following the laser surgery. These are usually steroids and antibiotics and can seriously harm your baby when you are pregnant.

Immunodeficiency

Your bodies immune system fights off bacteria that can cause infection everyday, by using special cells in our blood. Some people have conditions that prevent their immune system from functioning correctly, such as AIDS, meaning they can get infections very easily, which can be very serious.

In such circumstances when the cornea is cut, bacteria can get into the eye and cause an infection. In a healthy person with a functioning immune system the infection is stopped, however in immuno-deficient people this infection can spread, leading to blindness and even more serious consequences. It is for this reason why laser surgery is not available for such patients.

Some vascular diseases

Some conditions, such as systemic lupus erythrematosus, lead to blood vessels becoming damaged and blocked. In laser eye surgery these conditions can lead to blood not flowing to your eye as it should, causing problems with vision. For more information on these conditions please contact your local laser eye surgery clinic or your GP.

Glaucoma

Glaucoma is a condition whereby the pressure inside the eyeball rises gradually over time. During laser eye surgery, your cornea is re-shaped by removing part of it to help you regain your vision. This often results in your cornea being thinner than before the surgery started. If you have glaucoma, the raised pressure in your eye can then lead to the cornea bulging outwards, having a negative effect on your vision. It is therefore important that your glaucoma is treated before you have laser eye surgery.

Cataracts

A cataract is when the lens within your eye becomes cloudy over a period of time. The condition is progressive, eventually preventing you from seeing much through your affected eye. This lens must be removed and replaced with a new synthetic IOL (intraocular lens) implant to correct your vision. In most cases this will restore your vision back to normal and you will not require laser eye surgery.

Relative contraindications are somewhat milder and may just require extra care and attention during the procedure. These are –

Diabetes

To be able to recover properly following laser eye surgery it is important that you are healthy and your blood sugar is normal. If you are diabetic and your blood sugar is not well controlled, it can prevent your eye from healing as well as it should. To allow your eye to heal as well as possible, before you have surgery your blood sugar should be under good control.

Another problem associated with diabetes is diabetic retinopathy. This can adversely affect your vision, usually causing blurring and clouding. As the problem is due to new blood vessels growing in the retina, procedures such as LASIK cannot correct your poor vision. If following treatment for diabetic retinopathy your vision is still poor, you may then be a candidate for laser eye surgery.

Dry eye

Procedures such as LASIK require that your tear production is OK, so that following surgery your eye will be well lubricated and continue to heal well. If you don’t produce tears very well, it can prevent your eye from healing as well as possible and this is known as dry eye. This can be treated to an extent with artificial tears and antibiotic drops to prevent any infections.

Keratoconus

Keratoconus is a progressive condition that causes the cornea to bulge outwards leading to blurred, cloudy vision. If you suffer from this, it is likely that you will be unsuitable for procedures that involve the use of a flap, as it thins the cornea and can make the condition worse. Instead, procedures such as INTACS insertion are often used.

Visual stability

If you wish to undergo laser eye surgery, it is advised that you do so only if your prescription has remained unchanged for a period of greater than a year. This is to make sure that your eye is not likely to change after surgery, ensuring that laser eye surgery will give you the best possible results. Also, most clinics will not treat anyone under the age of 21 years as eyes can still be developing until this age.

Some medications

Some drugs used for a variety of conditions can cause problems, both during and after surgery. Some drugs used to treat acne, such as Accutane can lead to scarring around the corneal flap, so should be discontinued for longer than half a year before surgery. A drug called Amiodarone, which is used for heart problems, can give deposits in the cornea. These can affect laser eye surgery procedures and as a precaution should not be used together. If you suffer from migraines and regularly take any of the triptan family of drugs, such as sumatriptan, you should let your ophthalmologist know as the too can lead to problems with surgery.

Recently research has shown that drugs to treat prostate problems, specifically Flomax, can give rise to problems during surgery. It is important that you tell your ophthalmologist of any drugs you are taking in your initial consultation.

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