Excellent practice! Dr. Griffiths and her staff are top-notch. Thorough eye exams, ample time spent explaining everything, and answers to all questions. Highly recommend NewView Eye Center!
Linda Cummings
LASIK Eye Surgery: Who Is a Good Candidate?
Eye Health Factors That Affect Your Candidacy
Beyond your prescription, the overall health of your eyes plays a major role in determining whether LASIK is safe for you. Certain eye conditions can make the procedure inadvisable or require treatment before surgery is considered.
A healthy cornea has a smooth, evenly curved surface. Keratoconus is a progressive condition in which the cornea gradually thins and bulges forward into a cone shape. Performing LASIK on a keratoconic cornea can accelerate this dangerous weakening, which is why thorough corneal mapping is one of the most critical parts of your evaluation.
- Even mild or suspected keratoconus disqualifies most patients from LASIK
- Early keratoconus can sometimes only be detected on detailed tomography scans rather than standard surface mapping
- Other irregular astigmatism patterns may also raise concerns about corneal stability
- Corneal cross-linking or specialty contact lenses may be recommended as alternatives in these cases
We rely on corneal tomography, which maps both the front and back surfaces of your cornea, because early disease can be hidden when only the front surface is examined.
Healthy tear production is essential for a smooth LASIK recovery. The procedure temporarily reduces natural tear production by affecting corneal nerves, which can worsen existing dryness and slow the healing process.
We evaluate the quality and quantity of your tears before recommending surgery. Mild dry eye can often be managed with lubricating drops and punctal plugs (tiny inserts placed in your tear ducts to slow drainage) before and after LASIK. Moderate to severe dry eye may need to be treated first, and candidacy is reassessed once the tear film improves. Severe cases may be better suited to a procedure that does not disrupt the corneal surface in the same way.
Several eye diseases can make LASIK unsafe or significantly less effective. Active infections, cataracts, severe glaucoma (a condition involving damage to the optic nerve), and unstable retinal disease are among the conditions that typically prevent safe LASIK surgery.
- Cataracts cloud the natural lens inside the eye, and cataract surgery is a better solution than surface laser treatment in those cases
- Mild, well-controlled glaucoma is not always an absolute disqualifier, but it requires careful evaluation and monitoring
- Retinal conditions such as macular degeneration or diabetic retinopathy must be stable before any elective vision correction is considered
- A history of herpes simplex or herpes zoster in the eye raises the risk of reactivation and is generally a contraindication unless the condition has been long-term quiescent and a careful plan is in place
A history of eye surgery or trauma does not automatically rule out LASIK, but we must carefully evaluate how those events affected your corneal structure and healing capacity. Previous radial keratotomy (an older form of refractive surgery that makes small incisions in the cornea) can make LASIK outcomes less predictable due to the pattern of corneal scarring left behind.
Significant eye trauma that caused scarring or irregular healing may prevent safe laser treatment. We review your complete ocular history and examine your corneas closely to determine whether residual changes are compatible with LASIK or whether another approach would serve you better.
Overall Health and Lifestyle Considerations
Your general health can influence how well your eyes heal after surgery and how stable your results will be over time. Certain systemic conditions and medications require careful discussion before LASIK is considered.
Conditions such as rheumatoid arthritis, lupus, and Sjogren syndrome can interfere with normal wound healing after LASIK and may significantly worsen dry eye. These diseases cause the immune system to attack the body's own tissues, which can lead to unpredictable or delayed corneal recovery.
We evaluate the type and severity of your autoimmune condition, how well controlled it is, and whether it affects your eyes directly. Some patients with mild, stable autoimmune conditions may still qualify, while active disease typically makes elective eye surgery inadvisable. Sjogren syndrome in particular often causes severe dry eye and may point toward a non-corneal option.
Diabetes affects wound healing and can cause fluctuations in vision, making it an important factor in LASIK candidacy. Poorly controlled blood sugar raises the risks of infection, delayed healing, and unstable visual results.
- Well-controlled diabetes with stable blood sugar levels may not disqualify you from LASIK
- Diabetic retinopathy (damage to the blood vessels in the retina) must be evaluated and confirmed stable before any elective procedure
- We may request recent hemoglobin A1c results to assess your glucose control
- Your diabetes management team should be informed of your plans for vision correction
Hormonal changes during pregnancy and breastfeeding can temporarily alter your corneal shape and prescription, making it difficult to achieve accurate, lasting results from LASIK. These shifts also tend to increase dry eye symptoms, which can slow healing after surgery.
We recommend waiting until at least three months after nursing has ended and your menstrual cycles have returned to their normal pattern. This period allows your prescription and tear film to stabilize so we can plan your treatment with confidence.
Certain medications can interfere with wound healing, affect corneal health, or cause vision changes that make LASIK inadvisable at the time of surgery. Isotretinoin (used for acne) can cause severe dry eye and impaired healing, and we typically require patients to be off this medication for at least six months before surgery. Oral corticosteroids can suppress immune response and delay recovery.
- Some anxiety or depression medications can affect pupil size or tear production
- Amiodarone (used for certain heart conditions) can cause corneal deposits and visual disturbances
- Topiramate (used for migraines or epilepsy) can temporarily shift refraction and requires timing and safety assessment
- Always bring a complete list of your current medications and supplements to your consultation
The LASIK Candidacy Evaluation Process
Your candidacy evaluation is a thorough appointment that goes well beyond a standard eye exam. We use advanced diagnostic technology to gather precise data about your eyes and review your health history in full before making any recommendations.
Contact lenses rest directly on your cornea and can temporarily reshape it, which affects the accuracy of our measurements. We ask patients to stop wearing soft contact lenses for at least one to two weeks before their evaluation. Toric or extended-wear lenses typically require a two-week break, and rigid gas permeable or hybrid lenses usually need three to four weeks or longer.
Wearing your glasses full time during this period allows your corneas to return to their natural shape. If your measurements appear inconsistent, we may ask you to extend this contact lens break and return for repeat testing before making a treatment plan.
Corneal topography and tomography create detailed maps of your corneal surface and internal structure, showing every curve, contour, and potential irregularity. These scans help us detect even subtle signs of keratoconus, irregular astigmatism, or asymmetry that could affect the safety of surgery.
- Pachymetry measures corneal thickness at multiple points across your entire cornea
- These measurements confirm you have adequate tissue for safe reshaping
- Both the front and back corneal surfaces are evaluated to catch early disease not visible from the front alone
- Epithelial thickness mapping may be used in select cases to provide additional detail
We perform detailed refraction testing to determine your exact prescription for nearsightedness, farsightedness, and astigmatism. This goes well beyond a routine eye exam, because the laser must be programmed with extremely precise measurements to deliver your correction accurately.
Wavefront analysis measures how light travels through your entire optical system and can detect subtle higher-order aberrations (tiny visual imperfections) beyond what standard prescription testing captures. Combined with your refraction data, wavefront information guides a more customized laser treatment for sharper, clearer vision.
Because LASIK temporarily affects tear production, we carefully evaluate your tear film before recommending surgery. This assessment helps us identify existing dryness, assess the health of your meibomian glands (the oil-producing glands along your eyelid margins), and determine whether pre-treatment is needed.
- Tear breakup time testing measures how long your tear film stays stable before it begins to break apart
- Schirmer testing gauges overall tear volume production
- Tear osmolarity testing measures the salt concentration in your tears as a marker of dry eye severity
- If dry eye is found, treatment may be started weeks or months before surgery to optimize your healing environment
We measure your pupil diameter in both bright and dim lighting conditions. Larger pupils can expand beyond the laser treatment zone in low light, increasing the likelihood of halos, glare, or starbursts around lights at night. This measurement, combined with your prescription and your lifestyle needs, helps guide treatment zone planning.
A dilated eye exam allows us to thoroughly examine your retina, optic nerve, and internal eye structures. We check for any signs of disease or abnormality that could affect your candidacy or require attention before LASIK is considered. Baseline intraocular pressure is also documented at this stage.
Understanding what you hope to achieve helps us determine whether LASIK can realistically meet your needs. We ask about your lifestyle, occupation, hobbies, and visual demands so that our treatment plan fits your daily life.
Setting realistic expectations is a critical part of the evaluation. LASIK produces excellent results for most appropriately selected patients, but it cannot guarantee perfect vision for everyone. We explain likely outcomes based on your specific measurements, discuss potential side effects, and address any questions you have. If you are over 40 and considering monovision (where one eye is corrected for distance and the other for near), we typically recommend a contact lens trial first to confirm you can tolerate that type of correction before choosing it surgically.
Risks and Possible Complications
Like any surgical procedure, LASIK carries risks that you should understand fully before making your decision. Most side effects are temporary and improve during healing, but some may persist or require additional treatment. We discuss your individual risk factors in detail during your consultation.
In the days and weeks following LASIK, it is normal to experience some degree of visual fluctuation, dry eye symptoms, and sensitivity to light. These effects are part of the healing process and typically improve over time with proper care and follow-up.
- Dry eye symptoms that may last weeks to months, and rarely longer
- Glare, halos, and night driving difficulty that usually improve as healing progresses
- Fluctuating or temporarily blurry vision during the early recovery period
- Mild discomfort, tearing, or a feeling of scratchiness in the first day or two after surgery
While serious complications after LASIK are uncommon, it is important to be aware of them before proceeding. Our LASIK Surgeons take every precaution to minimize risk through careful patient selection and precise surgical technique.
- Undercorrection or overcorrection that may require glasses, contacts, or an enhancement procedure
- Infection or significant inflammation, including a condition called diffuse lamellar keratitis (DLK), which affects the tissue beneath the flap
- Epithelial ingrowth, where surface cells grow underneath the flap
- Flap-related complications such as wrinkling or displacement
- Corneal ectasia, a rare weakening of the cornea that may require specialty lenses or corneal cross-linking
- Steroid-related eye pressure rise in susceptible patients
- Rare cases of chronic pain or persistent light sensitivity
While most recovery is smooth, there are specific warning signs that require prompt attention. Sudden vision loss, severe pain that does not improve, or signs of infection such as increasing redness, discharge, or swelling should prompt an immediate call to our office.
- Flashes of light, new floaters, or a curtain-like shadow across your vision require urgent evaluation to rule out retinal problems
- A sudden increase in pain or blurry vision after an initial period of improvement could suggest a flap-related issue
- Foreign body sensation accompanied by reduced vision warrants prompt contact rather than waiting for your next scheduled appointment
Mild dryness, glare, and halos in the first days to weeks are normal and expected. We always encourage you to reach out with any concern rather than wait, because early attention leads to better outcomes.
Alternatives If LASIK Is Not Right for You
Not qualifying for LASIK does not mean you are out of options for vision correction. Several highly effective alternatives can deliver excellent results for patients who are not ideal LASIK candidates.
Photorefractive keratectomy, commonly called PRK, uses the same excimer laser as LASIK but does not require creating a corneal flap. Instead, the outer cell layer of the cornea is gently removed, and the laser reshapes the surface directly. This approach preserves more structural tissue and is an excellent choice for patients with thinner corneas.
PRK also eliminates the small risk of flap-related complications, making it a preferred option for patients in contact sports, military service, or other environments with a higher likelihood of eye trauma. Recovery takes longer than LASIK, with several days of discomfort and blurred vision, but final visual outcomes are generally comparable.
Implantable collamer lenses (ICLs) are tiny prescription lenses surgically placed inside the eye, in front of the natural lens, to correct vision without removing any corneal tissue. This option is well suited for patients with very high myopia or myopic astigmatism that falls outside the safe range for laser correction.
- The lenses can be removed or exchanged if your vision changes over time
- No corneal tissue is permanently altered, preserving future options
- Results are often excellent for patients who were told they were not LASIK candidates due to extreme prescriptions
- In the United States, current approvals cover myopia and myopic astigmatism
- Candidacy depends on the internal dimensions of your eye, including anterior chamber depth
Small incision lenticule extraction, known as SMILE, is a laser procedure that corrects nearsightedness and astigmatism through a tiny incision without creating a large corneal flap. Because no flap is made, SMILE may reduce dry eye symptoms and help preserve corneal strength for some patients.
SMILE currently treats a somewhat narrower range of prescriptions than LASIK and does not treat farsightedness. Treatable ranges and indications vary by laser platform and region. If you have borderline corneal thickness or concerns about dry eye, we can discuss whether SMILE is an appropriate option for your situation.
Refractive lens exchange (RLE) replaces your natural lens with an artificial intraocular lens that corrects your distance vision and may also address presbyopia. This approach works well for patients over 40 who have extreme prescriptions, early cataract formation, or who want to reduce their future need for cataract surgery.
The procedure is identical to cataract surgery and uses advanced multifocal or extended depth of focus lens implants to reduce dependence on both distance and reading glasses. Because your natural lens is removed, you will not develop cataracts in the future, making this a particularly practical option for patients in their mid-forties and beyond.
Frequently Asked Questions
These answers address common questions we hear from patients considering LASIK and offer guidance beyond what is covered in the sections above.
Borderline candidacy is actually quite common, and it does not automatically mean surgery is off the table. In some cases, optimizing a factor such as dry eye before surgery, or waiting a few more months for prescription stabilization, can shift you into a more favorable range. In other cases, a procedure like PRK or SMILE may offer a better safety profile for your specific measurements. We take the time to explore all of these pathways during your evaluation rather than simply saying no.
Mild nearsightedness often responds very well to LASIK, and patients with low prescriptions frequently achieve outstanding results. The key question is whether the inconvenience of glasses or contacts in your daily life outweighs the small risks that accompany any surgical procedure. That is a personal decision, and we help you weigh it thoughtfully during your consultation by reviewing your specific measurements and lifestyle needs together.
Treating both eyes during the same session is standard practice for the vast majority of appropriately selected LASIK candidates. This approach minimizes the period of imbalanced vision between your two eyes and reduces the number of appointments you need. In rare circumstances based on individual risk factors, we may recommend staging the procedures, and we will explain our reasoning clearly if that applies to you.
Enhancement procedures are possible when a meaningful prescription remains after healing and when your cornea retains enough thickness for a safe retreatment. Candidacy for an enhancement depends on how much time has passed since your original surgery, the stability of your refraction, and your overall corneal health at the time of evaluation. We discuss enhancement policies, timing, and associated costs as part of your initial consultation so there are no surprises later.
Yes, LASIK and other elective vision correction procedures are generally considered eligible expenses under flexible spending accounts (FSAs) and health savings accounts (HSAs). Most standard health insurance plans classify LASIK as an elective procedure and do not provide direct coverage, though some vision plans offer a discount benefit. We recommend checking with your benefits administrator, and our team can discuss available financing options during your consultation.
Many patients return to office-based or desk work within one to two days after LASIK, though your vision may still fluctuate slightly during that first week. Activities that involve water, dust, or direct eye contact require a longer break, and high-contact sports typically require at least four weeks with protective eyewear afterward. We provide a personalized recovery timeline based on your specific job and lifestyle so you can plan accordingly.
Schedule Your LASIK Consultation at NewView Eye Center
Taking the first step toward clearer vision starts with a thorough evaluation from our experienced team. NewView Eye Center brings advanced diagnostic technology and deeply personalized care to every patient across Northern Virginia, helping you understand whether LASIK or another vision correction procedure is the right fit for your eyes, your health, and your life. We would be honored to guide you through this decision with honesty, expertise, and genuine attention to your long-term vision health.
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