Before deciding to undergo laser eye surgery, discuss with a physician whether or not you are a good candidate for any of the available procedures. Surgery won’t help some types of vision problems and, as we have noted, some surgical options are inappropriate for some people.

During the initial consultation, the surgeon and his or her team should check your eyes and measure your eyesight, corneal thickness, corneal shape, pupil size, and other factors. Tell the surgeon if you take any medications, are allergic to any medications, or have any medical conditions. It is especially important to inform the surgeon if you are pregnant because visual acuity may change during pregnancy.

Your Age

Your age, and how long you are likely to be able to enjoy the full benefits of laser eye surgery, are major considerations.

First, you must be old enough for your eyes to have stabilized. People in their early 20s or younger often have significant “refractive instability,” which means corrections made by laser surgery might lose their effectiveness as their eyesight changes.

Second, people in their 20s, 30s, and early 40s need to be aware that the freedom from glasses and contacts that results from the most common laser surgery procedures is not likely to be permanent. As noted above, most people after age 40 or 45 find that their eyes begin to lose their flexibility. If they see well at a distance, possibly as a result of laser surgery, their eyes may not be able to adjust to focus well close up, and they may need reading glasses.

Surgery to make one eye farsighted and the other nearsighted could be a lasting solution for people whose brains can adjust to this setup, but some can’t.

Other Considerations

While problems can befall any patient, the risk is considerably higher for some than for others. If you have any of the following characteristics, you may not be a good candidate for laser eye surgery, or at least for some types of laser eye surgery—

  • If you currently need a large correction. If your vision is quite poor before surgery, laser surgery is less likely to allow you to go without glasses than for those who need small corrections. Also, you are slightly more likely than other patients to have post-surgery vision problems such as seeing glare or halos at night.
  • If you required a big change in your contact lens or glasses prescription in the past year. Such “refractive instability” is common not only in patients in their early 20s or younger, but for patients whose hormones are fluctuating due to a disease such as diabetes, who are pregnant or breastfeeding, or who are taking certain medications.
  • If you have a disease or are on medications that may affect wound healing. Diabetes, autoimmune diseases such as lupus and rheumatoid arthritis, and immunodeficiency conditions like HIV may prevent proper healing after the procedure. The same holds true of medications like retinoic acid and steroids.
  • If you work in an occupation or actively participate in contact sports in which blows to the face and eyes normally occur. LASIK surgery may not be an option for you, but you may still be a good candidate for PRK.
  • If you have a history of certain eye-related conditions or problems, including dry eyes, herpes involving the eye area, suspected or actual glaucoma, ocular hypertension, inflammations of the eye or eyelids or crusting of the eyelashes, eye injuries or previous eye surgeries, or keratoconus.
  • If your cornea is thin. Again, you may not be a good candidate for LASIK surgery, but your doctor may be able to perform an alternative procedure.
  • If you have retinal pathology. Have the ophthalmologist who is treating this condition assess whether you are a good candidate for laser surgery.