Are my eyes too dry for LASIK?

I have dry eyes, can I still have LASIK? This is a question I’ve been asked quite often as an eye care professional.  I myself have dry eyes, but I also have had refractive surgery. The key to having a successful refractive surgery is knowing that you have dry eyes ahead of the surgery.

 

 

The word refraction refers to the fact that you need to wear a prescription to see your best, 20/20.  Refractive surgery then refers to any surgery which helps you to achieve better vision without wearing an external vision correction like glasses or contact lenses.  

 

RK or radial keratotomy is a refractive surgery that was once popular but is no longer being performed.  RK does not offer results as stable as LASIK and is no longer being performed.

 

PRK (Photorefractive Keratectomy) was the first laser vision correction surgery available.  It came before LASIK, but it is still being performed today.  Unlike LASIK, PRK does not involve making a flap on the cornea first.  It does utilize a laser to make the vision correction possible. 

 

 

LASIK surgery is considered to be a refractive surgery.  To perform this surgery, a flap is made on the cornea and laser is applied to the cornea to make the vision correction.  Then, the flap is placed back done and allowed to heal.  

 

LASIK is famous for quick recovery time and excellent visual results.  Most patients will see very close to 20/20 within the first week.  And, there is very little discomfort involved in the healing process.

 

The problem with LASIK surgery and dry eye sufferers is that dryness increases temporarily until the flap is completely healed.  The eye does not produce the same amount of tears and can increase dryness symptoms.  

 

1) Talk to your surgeon about your concerns ahead of time.  Your LASIK surgeon will be doing a battery of dry eye test to rule out whether or not you have dry eye symptoms before your LASIK surgery.

 

2) If you test positive for dry eye symptoms, pre-treat your symptoms aggressively prior to your surgery. Once your symptoms are under control it will be up to your surgeon to determine whether or not your eyes the front surface of your eye is stable enough for surgery.  Some patients need a few weeks of treatment before their eyes are ready to proceed with surgery.

 

In more moderate cases, patients need to be on therapy for several months before thinking about proceeding with surgery.  Or, another surgery like PRK, ICL, or refractive lens exchange may be a better option.

 

3) Follow all of your post-operative instructions very carefully.  It is likely that you will need more lubrication than the average patient.  You may also need to adjust the treatment plan you were on prior to surgery.  

 

Your surgeon may also want to follow your healing more closely than a non-dry eye sufferer.  So, plan to attend all post-operative appointments even if you feel your eyes aren't dry. 

 

Remember when the flap is formed during surgery, the sensations of the front surface of the eye is diminished.  So, your eyes may not feel dry even when they are.  One common recommendation for patients is to use a preservative-free artificial tear to supplement the tears.  Download your guide to artificial tears here.

 

 

If your surgeon tells you that your eyes are too dry for LASIK.  You may be a candidate for another type of reflective surgery.  About a month ago,  I had Visian ICL surgery.  In a future blog, I will walk through the ICL or implantable contact lens surgery with you.

 

Also, there are always new treatments on the horizon for both dry eyes and refractive surgery.  As research brings new treatments, there may be a procedure available for your eyes in the future.