LASIK is seen by many as the ultimate get-out-of-jail-free card—no more glasses slipping down your nose in the monsoon, no more fiddling with contact lenses when dry eyes strike at the end of a long day of work and no more stress about getting new glasses or contact lenses. Waking up in the morning with perfect vision sounds like a dream come true. It is no surprise then that LASIK is one of the most popular eye surgeries in India and the rest of the world.
LASIK is commonly a quick, safe procedure with minimal risks that treats refractive errors in the eyes. However, here is where the catch is, one that is not always emphasized: not everybody is a candidate for LASIK, and sometimes your physician might recommend against it for your own well-being.
Although it sounds glamorous and appealing, one crucial aspect to LASIK surgery is whether or not your eyes are well-suited. Pre-LASIK screening is not a secondary consideration; it is the key to ensuring that the surgery safely and successfully works for you.
Understanding LASIK
The cornea, the clear front of the eye, is the focus of LASIK. The procedure restructures the cornea with laser technology so that light can focus properly on the retina. But for this to be performed without risking your vision, your cornea should be healthy and have an adequate amount of thickness. Where the cornea is thin, irregular, or there is an undiagnosed condition such as keratoconus (an eye condition where the cornea thins and bulges), LASIK can further thin it and lead to severe complications, including blindness. This is one of the top reasons why physicians tend to say no to LASIK for certain patients.
Age is another factor. While it might sound odd to say someone is too young for perfect vision, individuals below 18, and sometimes even those in their early 20s, are discouraged from LASIK. This is because their eye power may not yet have stabilized. If the vision is still changing, performing LASIK is like trying to build a house on shifting sand—it simply will not hold. Similarly, those above 40 may need to consider that LASIK does not prevent age related near vision difficulties (presbyopia). So, while distance vision might improve, reading glasses could still be needed later on.
Pre-existing eye disease may also be grounds for exclusion. Individuals with inflammatory or scarring eye disease, such as severe dry eye, uncontrolled diabetes, glaucoma, or retinal disease, are usually discouraged from having LASIK. Dry eye, in fact, is an underappreciated cause for which LASIK may be unsafe. As LASIK alters the eye’s normal tear film temporarily, those who already have difficulty with dryness can find their discomfort worsened following surgery.
Systemic medical conditions also have an important part to play. LASIK is a surgery that, due to certain medical complications such as untreated diabetes mellitus, becomes particularly risky. The same goes for quite a few medical conditions such as autoimmune diseases, thyroidism, and longstanding use of medications that include steroids. Thyroid disorders and steroid use may alter the body’s ability to heal the cornea post-surgery. Even pregnancy and breastfeeding can be reasons to delay LASIK due to shifting hormonal levels that may cause unsatisfactory vision correction.
Managing expectations
Other times, the problem is not with the eyes but with what people expect. Some individuals envision that LASIK provides them with superhero vision or releases them from having to wear glasses again for the rest of their life. While LASIK does provide clear eyesight to most, minor corrections may still be necessary down the road as the eye changes naturally with age. Unrealistic expectations are an important reason why a good doctor may hold back and recommend alternatives.
Lifestyle and profession also matter. For instance, those in jobs with high risk of eye trauma such as boxers, wrestlers, or military personnel may not be the best candidates. A LASIK flap, even though healed, can be vulnerable to dislodgement with severe impact.
Alternative options
Does that mean rejection after screening is the end of the dream? Not necessarily. Alternatives such as ICL (Implantable Collamer Lens) may be better suited for some eyes. In fact, these newer procedures are equally effective and are designed for cases where LASIK is not ideal. Patients and even doctors need to keep in mind that safe, long-term vision should be the main goal, and LASIK should not be pursued if it poses long term risks to one’s eyesight and health.
The fact is, LASIK is among the most successful eye operations of the day, yet it’s not for everyone. The secret here is realising that sometimes the best medical advice is no, and the key lies in accepting this. After all, our vision is not something to gamble with.
The lesson is simple: do not self-diagnose or fall for glossy advertisements. Trust the screening process, have an open discussion with your ophthalmologist, and remember—sometimes the wisest answer for your eyes is “not now” or “not this method.” The dream of glasses-free vision may still possible, but only when the foundation, your eyes, are healthy enough to carry it.
(Dr. Prabhakar G.V. is a consultant, cataract cornea LASIK, Sankara Eye Hospital, Hyderabad. prabhakar@sankaraeye.com)
Published – August 27, 2025 04:00 pm IST
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