Medical Conditions That May Prevent You From Getting Laser Eye Surgery

Laser eye surgery offers a life-changing opportunity to reduce dependence on glasses or contact lenses. Millions of people have improved their vision through procedures like LASIK or PRK. Yet, not everyone qualifies for this surgery. Certain medical conditions can increase risks or reduce the effectiveness of laser eye surgery, making it unsafe or inadvisable. Understanding these conditions helps you make informed decisions and discuss options with your eye care professional.

This article explores the key medical conditions that may prevent you from getting laser eye surgery. It explains why these conditions matter and what alternatives might be available.

Eye with corneal topography scan showing detailed corneal shape

Eye-level view of an eye undergoing corneal topography to assess suitability for laser eye surgery

Corneal Diseases and Abnormalities

The cornea is the clear, dome-shaped surface covering the front of the eye. Laser eye surgery reshapes the cornea to correct vision problems. If the cornea is unhealthy or irregular, surgery may cause complications or poor results.

Keratoconus

Keratoconus is a progressive thinning and bulging of the cornea into a cone shape. This condition weakens the cornea’s structure and causes distorted vision. Laser surgery can worsen the corneal shape and lead to serious vision loss.

Eye surgeons typically exclude patients with keratoconus from laser eye surgery. Instead, treatments like corneal cross-linking or specialized contact lenses may be recommended.

Corneal Scarring or Opacities

Scars or clouding on the cornea from injury, infection, or previous surgery can interfere with laser treatment. The laser needs a clear, smooth surface to reshape the cornea accurately. Scarring can cause unpredictable healing and poor visual outcomes.

Thin Corneas

Laser eye surgery removes corneal tissue to reshape the eye. If the cornea is too thin, removing tissue can weaken it excessively. This increases the risk of corneal ectasia, a serious condition where the cornea bulges and vision deteriorates.

Eye doctors measure corneal thickness during pre-surgery screening. Patients with thin corneas often cannot safely undergo laser surgery.

Autoimmune and Inflammatory Disorders

Autoimmune diseases cause the immune system to attack the body’s own tissues. Inflammation and poor healing are common in these conditions, raising risks after surgery.

Rheumatoid Arthritis and Lupus

These autoimmune diseases can cause chronic inflammation affecting the eyes and other organs. Healing after laser surgery may be slower or complicated by flare-ups. There is also a higher risk of infection or dry eye syndrome.

Surgeons usually advise against laser eye surgery for patients with active autoimmune disease or poorly controlled symptoms.

Sjögren’s Syndrome

Sjögren’s syndrome causes severe dry eyes due to immune system damage to tear glands. Dry eyes can worsen after laser surgery, causing discomfort and delayed healing. This condition often disqualifies patients from laser eye surgery.

Diabetes and Blood Sugar Control

Diabetes affects blood vessels and healing throughout the body, including the eyes. Poor blood sugar control increases the risk of complications after laser eye surgery.

Diabetic Retinopathy

This diabetes-related eye disease damages the retina and can cause vision loss. Laser eye surgery does not treat diabetic retinopathy and may worsen eye health if the disease is advanced.

Delayed Healing and Infection Risk

High blood sugar slows wound healing and increases infection risk. Patients with uncontrolled diabetes are usually advised to stabilize their condition before considering laser surgery.

Eye Conditions That Affect Surgery Outcomes

Certain eye diseases or abnormalities can reduce the safety and success of laser eye surgery.

Severe Dry Eye Syndrome

Dry eye syndrome causes irritation, redness, and fluctuating vision. Laser surgery can exacerbate dry eyes by affecting corneal nerves. Patients with severe dry eye often experience prolonged discomfort and poor visual results.

Glaucoma

Glaucoma damages the optic nerve and can cause vision loss. Some glaucoma treatments affect eye pressure and corneal health. Laser eye surgery may not be recommended if glaucoma is uncontrolled or advanced.

Cataracts

Cataracts cloud the eye’s natural lens and reduce vision. Laser eye surgery reshapes the cornea but does not treat cataracts. Patients with significant cataracts usually benefit more from lens replacement surgery.

Other Health Factors That Matter

Beyond eye-specific conditions, some general health issues can affect laser eye surgery candidacy.

Pregnancy and Nursing

Hormonal changes during pregnancy and breastfeeding can alter vision and corneal shape temporarily. Surgeons recommend waiting until after this period to ensure stable vision.

Age Restrictions

Most surgeons require patients to be at least 18 years old, with stable vision for at least one year. Older adults may face other risks depending on overall eye health.

Medications

Certain medications, such as isotretinoin (used for acne) or immunosuppressants, can impair healing or increase infection risk. Disclose all medications to your surgeon during evaluation.

What to Expect During the Screening Process

A thorough pre-surgery evaluation identifies contraindications and ensures safety. This includes:

• Measuring corneal thickness and shape with topography

• Checking eye pressure and retinal health

• Reviewing medical history and current health conditions

• Assessing tear production and dry eye symptoms

• Discussing medications and lifestyle factors

  
  

If any contraindications are found, your surgeon will explain why laser surgery is not recommended and discuss alternative treatments.

Alternatives When Laser Surgery Is Not an Option

If you cannot undergo laser eye surgery, other options may improve vision:

• Phakic intraocular lenses (IOLs): Implantable lenses that correct vision without removing corneal tissue

• Refractive lens exchange: Replacing the eye’s natural lens, similar to cataract surgery

• Specialized contact lenses: Including scleral lenses for irregular corneas

• Corneal cross-linking: To strengthen weakened corneas in keratoconus

  
  

Your eye doctor can help determine the best approach based on your condition.

Laser eye surgery can dramatically improve quality of life, but it is not suitable for everyone. Medical conditions affecting the cornea, immune system, blood sugar control, or overall eye health may prevent safe surgery. A careful evaluation by an experienced eye surgeon is essential to identify risks and find the best vision correction method for you.