You're Unsuitable for LASIK. Now What?

I’ve Just Been Told I’m Unsuitable For LASIK Laser Eye Surgery. Now What?

You’ve finally saved up those dollars, mentally prepared yourself for the idea of undergoing an eye operation, told all your friends now is the time, and advised work you’re going to need some time off. Then you march into the ophthalmologist’s office armed with your questions about how long the LASIK procedure will take, how long until you can drive again… and, after all that you’re told you can’t have LASIK.

Seven (7) Reasons Why You May Not Be a Candidate for LASIK Laser Eye Surgery

There can be several reasons why your ophthalmologist may have steered you away from LASIK (laser assisted in situ keratomileusis) laser eye surgery. In fact, if your ophthalmologist has advised you against this procedure, think of this as a good thing. They have your best interests (and vision) at heart and are not simply looking to grab at your hard-earned dollars. Here are some reasons that may exclude people from being suitable for LASIK.

1.     Your corneas are too thin. This is not something you’d bring up on a first date but when it comes to LASIK eye surgery, it can be a dealbreaker. During the LASIK procedure, the surgeon creates a hinged flap out of the top layers of your corneal tissue. By lifting this flap to the side, the deeper corneal layers can be exposed for the laser to vaporize the necessary areas and correct your vision. However, a minimum amount of corneal tissue needs to be available without compromising the structural integrity of your eyes post-surgery. The creation of the corneal flap already takes up some of this tissue, leaving even less behind for vaporization.

2.     Your prescription is still unstable. What would be an even bigger bummer than being told you can’t have LASIK? Having LASIK and then your script changes and you end up in glasses again, that’s what. For this reason, your ophthalmologist will want to see that your prescription has been stable for at least the last year or two. This typically means patients younger than 18 years old, those pregnant or breastfeeding, those on certain medications which may cause variability in vision, or people with a condition which can affect your prescription, such as diabetes, are not suitable candidates.

3.     You’re getting on in years. Agist, you cry! But remember what would be an even bigger bummer than being told you can’t have LASIK? Unfortunately, older age can make LASIK not your best option simply because of the development of presbyopia as you approach your mid-40s. Presbyopia is the age-related decline of your near vision, resulting in the need for reading glasses. If you’re pinning all your glasses-free hopes on LASIK, you’re going to be in for some disappointment if you notice presbyopia creeping in only a few years after you had LASIK surgery.

4.     You are slow to heal wounds. And we don’t mean after a breakup. Medications, such as steroids, and medical conditions, such as HIV or lupus, can delay proper wound healing. Although it’s a controlled procedure, technically LASIK eye surgery results in a wound that needs to heal. If your body is unable to heal properly, it can put you at risk of prolonged suboptimal vision and eye infections.

5.     Your hobbies or vocations exclude you. Although overall LASIK is considered a highly safe and successful eye procedure, the necessity of a corneal flap does make it liable for flap-related complications. Trauma to the head or face may cause the flap to dislodge or dislocate (sounds nasty, doesn’t it), or very dirty environments can result in debris getting caught underneath the flap. Professional or amateur boxers, martial artists, or those who regularly play other contact sports may want to avoid LASIK.

6.     You have another eye condition. Some people mistakenly believe that LASIK will magically correct their vision to be even better than what they could achieve with glasses or contact lenses. Unfortunately, this is not the case. It is unable to restore vision limited by other eye diseases, such as a retinal detachment or a macula condition. Some specific eye diseases may also be exacerbated by LASIK, such as keratoconus, a herpes eye infection, or dry eye syndrome. If you have any of these eye conditions, your eye specialist can advise you on your individual circumstances.

7.     Your prescription is outside the treatable range. Modern day LASIK can cover an impressive range of prescriptions from short-sightedness to long-sightedness to astigmatism. However, your prescription must be taken into account alongside your corneal thickness. You may have a script that’s technically within range but if you don’t have enough corneal tissue for the laser to work on, that’s still a no-go.

If the aforementioned list of LASIK ineligibility criteria has you feeling a little down, keep your head up. All is not lost.


Alternatives to LASIK

Yes, there is such a thing! While many people equate laser eye correction to LASIK, there are, in fact, several other surgical procedures that can still achieve that greatly longed-for freedom from glasses and contact lenses. Though some people may just be entirely unsuitable for any sort of refractive procedure, here are some other options you may want to explore with your eye specialist.


Photorefractive Keratectomy (PRK)

PRK has a long track record in the military, mainly because it eliminates the risk of the flap-related complications that come with LASIK. Although military service no longer automatically disqualifies you from undergoing LASIK, you may still prefer PRK for the peace of mind. During PRK, the superficial layers of epithelial cells are removed rather than creating a flap. This leaves more corneal tissue for vaporization, making PRK a more suitable option for patients with thinner corneas.


Implantable Collamer Lens/Intraocular Contact Lens (ICL)

As the name suggests, an ICL is basically a contact lens implanted into the cornea, entirely eliminating the need for a minimum corneal thickness. This also means an ICL is able to correct prescriptions that fall outside the typical LASIK treatable range, and can be a good option for dry eyes. This procedure is also entirely reversible.


Small Incision Lenticule Extraction (SMILE)

SMILE eye surgery is a newer refractive technique. Using a laser, a small disc-like sliver of tissue is created in the deeper layers of the cornea without needing to remove the layers on top. This sliver is then removed through a keyhole incision, reshaping the cornea from the inside and correcting your vision. Because of this minimally invasive method, patients with dry eyes or those who are exposed to a risk of head trauma may prefer SMILE over LASIK. One downside of SMILE is that it is currently only suitable for treating short-sightedness.



Epi-LASIK is very similar to regular LASIK with the exception of the corneal flap being much thinner and involving only the epithelial layers. Once this flap is lifted away, the laser has more corneal tissue to work with compared to regular LASIK, making epi-LASIK more suitable for those thin corneas. The corneal flap created in epi-LASIK also carries no risk of becoming dislodged, an advantage for those boxers, wrestlers, and special ops soldiers.


Refractive Lens Exchange (RLE)

Here’s one for the presbyopes. RLE involves removing your natural lens inside the eye and replacing it with an implant that corrects for your prescription. It is very similar to a cataract procedure, minus the cataract. Because your natural lens is responsible for the ability to shift your focus to near objects (a process called accommodation), RLE is, in fact, only recommended for those who have already gone through presbyopia, as the procedure will remove your accommodative ability. RLE is great for high prescriptions or for those whose corneas exclude them from LASIK.

As with any medical procedure, the best person to discuss your vision with is your attending eye specialist or ophthalmologist. By conducting a thorough eye examination and understanding your medical history, they will be able to advise you on your best options when it comes to surgical vision correction.