Pupillary Pathways

Is Your Patient a Good Candidate for LASIK Surgery?

Posted by Amanda Dexter on Mar 10, 2016 9:00:00 AM
Amanda Dexter
Dr. Amanda K. Dexter received her optometric training at Southern California College of Optometry in Fullerton, California, where she was Class of 2010 Valedictorian. She also completed a residency in Primary Care and Ocular Disease at the Veteran's Affairs Hospital in San Diego, California. Dr. Dexter is the Manager and Program Coordinator for OptoPrep, the premiere online study resource for the NBEO Part I & II.
LASIK.jpg

With the continued growing popularity for surgical options to correct one’s refractive error, you are likely to encounter patients that will ask you if LASIK surgery is a good option for them on a daily basis.

In order to properly answer this question, careful patient history, evaluation, and discussion are essential pieces of determining a patient’s candidacy for LASIK surgery.

Most of the time you will be screening these patients first before referring them to a refractive surgery center for a comprehensive LASIK evaluation.  It is only after a full work-up is completed, including corneal topography, pachymetry, manifest and cycloplegic refraction, and a dilated fundus examination that candidacy can be fully determined.

In this blog post, I will review the most important things you should look for and discuss with your patients in order to begin the process of answering this popular question and determining if they are a good candidate for LASIK. 

The Ideal LASIK Candidate

  • Age: The FDA states that candidates should be at least 18 years of age to be considered for LASIK surgery. With that being said, I don’t typically recommend LASIK surgery until at least the mid- to late-twenties due to the fact that a person’s refractive error is often unstable in late-teens and early-twenties. It is also important to think about an upper age limit for LASIK surgery. Although there is no specific age cut-off here, an important factor to note is that LASIK is not a great option for patients who show the early signs of cataracts. 
  • General Health: Patients considering LASIK surgery must be in good general health, and should not have certain health conditions, such as uncontrolled diabetes. Patients should also be able to lie down and remain still during the procedure, so patients with certain health problems that could prevent this from occurring could be considered a non-candidate for LASIK (claustrophobia, back problems, excessive coughing, severe anxiety, etc). 
  • Eye Health: Good candidates for LASIK surgery are those patients who are free from ocular diseases and certain eye problems. Patients with a recent history of herpes keratitis or other ocular infections are not good candidates due to the possibility of recurrence. LASIK is absolutely contraindicated on anyone who has a history of keratoconus or pellucid marginal degeneration. Other conditions that should be carefully evaluated include strabismus, amblyopia, and a history of keloid scarring. Patients with prior history of corneal ulcers or corneal injuries that have resulted in scarring may not be good candidates for LASIK depending on the depth and density of the scar, as it may cause problems when creating the LASIK flap. 
  • Dry Eye Syndrome: Patients who continually suffer from dry eye syndrome are not good candidates for LASIK surgery as dry eye symptoms commonly increase after LASIK due to damage to the corneal nerves. It is very important to control the dry eye signs and symptoms before recommending LASIK. I will often start my patients on artificial tears, lid hygiene, and omega 3s prior to LASIK. In some patients, depending on the severity of dryness, I will also consider adding Restasis drops or even punctal plugs to the regimen. Controlling dryness first will result in better a better outcome and fewer dry eye symptoms post surgery. 
  • Stable Refractive Error: LASIK surgery is not recommended for patients with fluctuating or changing refractive error. Good candidates will show a stable prescription for at least one year prior to surgery. 
  • Adequate Corneal Thickness: For a patient to be considered a good candidate for LASIK surgery, corneal pachymetry measurements must be taken. Most surgeons prefer a LASIK patient to have a corneal thickness of at least 500 microns to begin with, and prefer to leave the patient with a residual bed of at least 300 microns (this varies a bit surgeon to surgeon). Corneal thickness measurements are often taken at the refractive surgery center after you have referred a patient out for a consultation, but can be taken in your office as a screener if you have access to a pachymeter. 
  • Normal Corneal Topography: This is another piece of information that is often collected at the surgery center, but again if you have access to a corneal topographer, you may perform this test on patients who are interested in LASIK as another screener. Surgeons will be looking for any signs of keratoconus, pellucid marginal degeneration, inferior steepening, irregular astigmatism, etc. 
  • Nursing/Pregnancy: Hormones during pregnancy and nursing may affect the stability of the patient’s refractive error; therefore, most LASIK surgeons recommend waiting until after a mother is finished nursing before considering LASIK surgery. On the other hand, some surgeons believe that if the refractive error is stable, LASIK surgery can be an option for nursing mothers, but with careful consideration to medications used pre and post-operatively. 
  • Realistic Patient Expectations: This is an extremely important factor to consider in determining candidacy for LASIK surgery. It is important for patients to understand that laser eye surgery, as with any surgical procedure, involves some risk. Additionally, the final outcome of surgery and the rate of healing can vary from person to person, and even from eye to eye in each individual. Patients should fully understand that for most people, the goal of refractive surgery is to be able to reduce reliance on glasses and contacts, and if complete elimination occurs, that is a plus!

Reviewing each of these points will help you determine if your patient is a good candidate for LASIK. If all of these issues are evaluated and discussed, the next step is to refer the patient to a refractive surgery center for a full comprehensive LASIK evaluation to confirm their candidacy for LASIK! 

-Dr. Dexter 

The Top 15 Tips and Tricks for Studying for Part I of NBEO®

 

We’ve put together a ton of great tips and tricks for studying for Part I of NBEO along with two tailored study programs that will help you thoroughly prepare for the big day. Remember, you’ve made it this far and you can totally do this!

Some of the Top 15 Tips include:

  • Familiarize Yourself with the Test Format
  • Tackle the Weak Subjects Early
  • Start Sooner and Ease Into It
  • ...and 12 more!

 

Topics: LASIK