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Characteristics of a Good Candidate for Laser Vision Correction
A good candidate for Laser Vision Correction should have a thorough discussion
with the operating surgeon about the surgery itself and the goals of the
surgery. Potential risks, side effects, and alternative treatments should be
discussed. The prospective candidate for surgery should understand that while
the results of Laser Vision Correction have been excellent, every individual
eye may heal differently from another, sometimes with unexpected results. Thus,
there may be a need for retreatment after an initial healing period. The patient
should understand his motives for desiring Laser Vision Correction.
Some specific details about indications and contra-indications for treatment
include:
Indications for Laser Vision Correction (good characteristics):
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The patient should be 21 years of age or older.
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The VISX excimer laser is FDA approved to treat up to 14 diopters of
myopia, 5 diopters of astigmatism, and 6 diopters of hyperopia
(farsightedness). However, not everyone within this range will be a
candidate for the procedure, due to other anatomical factors of the eye and
cornea.
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There is no treatment to restore the focusing ability to read at near that
is lost by age 50. However, a "monovision" effect can be achieved
by attempting to leave one eye intentionally nearsighted for reading.
Similar to what is done with contact lenses, one eye (non-dominant) is
corrected for reading at near, and the other eye is corrected for distance.
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The eyes should have had a stable refraction over the past year.
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The patient should be able to cooperate during the procedure and be able
to maintain fixation upon the fixation light of the laser during the
procedure. Some people have a significant squeezing response to anything
near to their eyes or to bright lights, and they may not be able to have the
procedure reliably performed.
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There should be no contra-indication for surgery, as described below.
Negative Indications for Laser
Vision Correction (bad characteristics):
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The patient is under 21 years of age.
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The patient has unrealistic expectations about the outcome of the surgery.
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The eye should have no other disorder that limits its best corrected
vision, such as retinal disorders, severe glaucoma, cataract, etc. If one of
these disorders is present, the patient should understand that the best
corrected visual acuity will not be improved by Laser Vision Correction,
only that their dependence on glasses and contact lenses to achieve this
vision will be improved. In the case of cataract, placing an intraocular
lens implant can achieve refractive results itself, and cataract extraction
with lens implantation is an option to Laser Vision Correction that is
usually covered by insurance. Also, it may be difficult to accurately
predict the necessary lens implant power after corneal refractive surgery
has been performed.
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The eye should have a stable
refraction over the prior year. Otherwise, the prescription may continue to
change after
Laser Vision Correction, leading
to a worsening result as time passes.
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If a person wears contact lenses, these should be removed for at least 1
to 2 weeks prior to surgery in the case of soft lenses, and at least 2 weeks
with gas permeable or hard lenses. The refraction should be demonstrated to
be stable after the lenses have been out for that time period, otherwise,
more time have have to pass to allow the cornea to stabilize.
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There should not be an eye condition that could lead to changes in the
corneal shape, such as keratoconus or corneal warpage syndrome from hard
contact lens wear. There should be no corneal scars, or prior corneal
infection with herpes simplex or zoster (shingles).
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There may be healing problems in certain individuals with autoimmune
disorders such as rheumatoid arthritis, lupus, Sjogren's syndrome, and other
"collagen vascular diseases", in people who are immunocompromised,
and in people with hypertrophic scar formation (keloid). Also, caution should be taken in
people with other medical problems such as diabetes mellitus, due to
abnormal healing responses.
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Laser Vision Correction should not be performed
during pregnancy, or in patients with uncontrolled medical problems.
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There may be a problem in patients with a dry eye problem becoming worse
after LASIK. This may need to be treated before surgery.
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Patients with very large pupils at night may be at higher risk of
developing glare and halos at night after Laser Vision Correction.
A Discussion of the Risks
and Complications of Laser Vision Correction is available for review. |
