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
Can Your Vision Be Too Bad for LASIK?
Conditions That May Rule Out LASIK
Even when a prescription falls within approved ranges, certain eye conditions or health factors can make LASIK unsafe. Our LASIK Surgeons screen for each of these during your evaluation to protect your long-term vision.
Corneas that are naturally thin or have an irregular shape may not be suitable for LASIK. Keratoconus, a condition where the cornea gradually thins and takes on a cone-like shape, is a contraindication to LASIK. Performing LASIK on a weakened cornea could lead to serious and potentially irreversible complications.
We also screen for early or subtle forms of corneal irregularity, including changes in the back surface of the cornea, that can signal an elevated risk of post-surgical ectasia (a rare but serious weakening and bulging of the cornea after surgery). Advanced imaging helps us detect these issues before any decision is made.
Your prescription should be stable for at least one to two years before LASIK is considered. If your vision is still changing, any correction made today may not remain accurate over time.
- Most LASIK Surgeons prefer patients to be at least 18, and often 21 or older
- We review your prescription history over the past several years
- Significant recent changes may mean waiting before surgery
- Surgery is generally deferred during pregnancy and for a period after breastfeeding, until vision and tear film have stabilized
- Once your prescription has stabilized, you may become a candidate
LASIK can temporarily worsen dry eye symptoms, and patients with significant dry eye before surgery may experience prolonged discomfort afterward. We evaluate your tear production and ocular surface health as part of every evaluation. If dry eye is a concern, we may recommend treating it first or considering a different procedure.
Autoimmune conditions such as rheumatoid arthritis, lupus, or Sjogren syndrome are relative contraindications to LASIK. Stable disease, a careful medication review, and coordination with your other physicians help us determine whether surgical candidacy is appropriate.
A personal history of herpes simplex or herpes zoster keratitis (a viral infection affecting the cornea) increases the risk of reactivation after corneal surgery. We review your history carefully, and in some cases may advise against laser surgery or recommend antiviral medication as a precaution.
This careful approach is intended to protect your healing and preserve the best possible visual outcome after any procedure.
Patients with naturally large pupils, particularly in low-light conditions, may notice more glare, halos, or starbursts after LASIK. This is more likely when a high prescription limits the treatment zone size. We measure your pupil diameter in different lighting levels to assess this risk and balance the optical zone size with safe tissue levels.
Higher-order aberrations are complex focusing errors that go beyond standard nearsightedness, farsightedness, and astigmatism. Modern wavefront-guided LASIK, which we offer using the iDESIGN Refractive Studio system, can address many of these issues, but severe higher-order aberrations may increase the chance of a less satisfying visual outcome.
If you are in your mid-40s or older, you may be developing presbyopia, the natural age-related loss of near focusing ability. LASIK corrects distance vision but does not prevent or reverse presbyopia. Some patients choose monovision LASIK, where one eye is corrected for distance and the other for near, but this approach does not suit everyone.
Early cataract formation can also affect LASIK candidacy. When lens changes are present, our LASIK Surgeons may recommend addressing both your refractive error and the developing cataract together through lens-based surgery rather than proceeding with LASIK alone.
Risks and Safety Considerations
Every surgical procedure carries risks, and LASIK is no exception. Our LASIK Surgeons review all risks with you in detail before surgery so that you can make a fully informed decision.
While serious complications from LASIK are uncommon, they are possible. Understanding them is an important part of your decision-making process.
- Dry eye symptoms that may persist for several months after surgery
- Night vision disturbances such as glare, halos, and starbursts
- Under-correction, over-correction, or regression of results over time
- Flap-related issues including wrinkles in the flap, displacement, or epithelial ingrowth
- Inflammatory conditions such as diffuse lamellar keratitis
- Corneal ectasia, a rare but serious structural weakening of the cornea
- Infection or corneal haze, which is more common after surface procedures like PRK
- Neuropathic corneal pain in a small subset of patients
- Rare complications that could reduce your best-corrected vision
Enhancement surgery is not always possible if insufficient corneal tissue remains, so results cannot be guaranteed for every patient.
Most post-surgical discomfort is mild and expected, but certain symptoms require prompt attention. Contact us right away if you experience any of the following after surgery.
- Severe eye pain, a sudden decrease in vision, or marked sensitivity to light
- Increasing redness or discharge from the eye
- Any trauma to the eye or concern that the corneal flap may have shifted
How We Evaluate LASIK Candidacy
Your LASIK evaluation is a thorough, multi-step process that goes well beyond a routine eye exam. We gather detailed measurements and a complete health history to determine whether LASIK is the safest and most effective option for your eyes.
Plan for your evaluation to take one to two hours. Several specialized tests are performed, and your eyes will be dilated, which can temporarily blur your vision. A few preparation steps will help ensure the most accurate results.
- Bring a complete list of current medications and medical conditions
- Stop wearing soft contact lenses for approximately one week before your exam, or longer if instructed
- If you wear rigid gas permeable or scleral lenses, plan for a longer contact lens break and repeat corneal mapping until measurements are stable
- Arrange for someone to drive you home after your appointment
- Write down any questions you want to ask during your visit
We use corneal tomography and topography to map both the front and back surfaces of your cornea, including its curvature, shape, and thickness at thousands of points. This detailed map allows us to detect early keratoconus, subtle irregularities, and other factors that affect candidacy.
Pachymetry, a test that precisely measures corneal thickness, is performed alongside this mapping. Together, these measurements allow our LASIK Surgeons to calculate a safe treatment plan tailored to your specific anatomy and prescription.
We measure your pupil size in both bright and dim lighting. Larger pupils may require a wider optical treatment zone to reduce the risk of nighttime glare or halos after surgery. Our LASIK Surgeons will discuss how your pupil size and prescription together influence your individual risk profile.
Your refractive error is measured using both computerized instruments and a careful manual refraction. After your contact lens break, repeat measurements help confirm that no prescription warping from lens wear has affected the readings. Accurate and stable measurements are essential to programming the laser for the best possible outcome.
We examine your entire eye, not just the cornea. This includes checking the retina, assessing for glaucoma, evaluating the lens for early cataract changes, and looking for any signs of eye disease that could affect healing or outcomes.
Your general health matters equally. We ask about autoimmune conditions, diabetes, current medications, and whether you are pregnant or nursing. We also review any history of herpetic eye disease, a tendency toward keloid scarring, and use of medications such as isotretinoin or systemic steroids that can affect surgical healing.
Alternatives When LASIK Is Not the Right Fit
Not qualifying for LASIK does not mean you cannot achieve significantly better vision without glasses. Several effective alternatives exist, and our LASIK Surgeons will help identify the approach that offers the safest and most meaningful improvement for your eyes.
PRK, or photorefractive keratectomy, is an excellent laser option for patients with thinner corneas or other factors that rule out LASIK. Rather than creating a corneal flap, PRK gently removes the surface cell layer and reshapes the cornea directly. Those cells regenerate naturally over a few days.
Because no flap is created, PRK preserves more of the cornea's overall structural integrity, which can make it a safer choice for certain prescriptions or corneal profiles. Recovery involves several days of discomfort and temporarily blurred vision, but long-term visual outcomes are comparable to LASIK. We also offer EpiLase, an advanced surface ablation approach, and apply mitomycin C during higher-prescription treatments to reduce the risk of corneal haze.
For prescriptions that exceed the safe limits of laser vision correction, an implantable collamer lens (ICL) may be an option worth discussing. An ICL is a small lens placed inside the eye between the iris and the natural lens. It can correct higher degrees of nearsightedness and astigmatism without removing corneal tissue.
- ICLs do not alter the structure of the cornea
- The procedure may be reversible if circumstances change
- Vision recovery is often rapid
- Candidates must have adequate internal eye dimensions and healthy corneal cell counts
- Potential risks include elevated eye pressure, inflammation, and cataract formation
Refractive lens exchange involves removing your natural lens and replacing it with a precisely selected artificial intraocular lens (IOL). This is the same procedure used in cataract surgery but performed before a cataract has fully developed. It can address very high prescriptions that are beyond the reach of laser correction.
This option is often most appropriate for patients over 50 who have both extreme prescriptions and early changes in the natural lens. Premium IOLs, including extended-depth-of-focus and trifocal designs, can address both distance vision and presbyopia in a single procedure. Potential side effects include halos and glare, which we discuss in detail before you decide. In highly nearsighted patients, this approach also carries a somewhat higher risk of retinal detachment, and our LASIK Surgeons will counsel you carefully on that risk.
If an irregular or weakening cornea is the primary barrier to LASIK, corneal cross-linking (CXL) can stabilize the condition and prevent further structural change. CXL works by strengthening the bonds between collagen fibers within the cornea, helping it hold its shape over time.
Cross-linking does not correct refractive error on its own, but stabilizing the cornea may open the door to other vision correction approaches in the future. We offer corneal cross-linking as part of our corneal care services.
Some patients achieve their best results through a combination of procedures. For example, lens-based surgery might be followed by a laser enhancement to fine-tune the final prescription. Our LASIK Surgeons will design a personalized plan based on your unique anatomy, prescription, lifestyle, and visual goals.
We take the time to explain every option fully so you can make a confident, well-informed decision about the path that is right for your eyes.
Frequently Asked Questions
These answers address common questions we hear from patients who are unsure whether their prescription makes them a LASIK candidate.
Extremely high prescriptions do narrow the field of available options, but they rarely eliminate all possibilities. When laser surgery is not appropriate, lens-based approaches such as an ICL or refractive lens exchange can often provide meaningful vision improvement. Your overall eye health, corneal dimensions, and age all help determine which path, if any, is right for you. An evaluation is the only way to know for certain what is achievable.
Borderline cases require especially careful judgment. Our LASIK Surgeons may recommend additional testing, a more conservative treatment plan, or an alternative procedure to ensure both your safety and a satisfying outcome. Being at the edge of acceptable limits is not a reason to rush into surgery, and we will always prioritize your long-term eye health over performing a procedure just because it is technically possible.
Candidacy can change over time. If your prescription is still fluctuating, it may reach a stable point within a year or two. If a treatable condition like dry eye is the current barrier, addressing that first may open the door to surgery later. We encourage patients who are turned away to return for reevaluation when their circumstances have changed, because a previous disqualifying factor does not always remain one permanently.
LASIK corrects your distance prescription, but it does not slow the natural aging process that affects near vision after age 40. If you are already experiencing presbyopia, you will likely still need reading glasses after LASIK for close tasks. Your distance prescription strength does not determine your need for reading glasses. If monovision correction interests you, we recommend a contact lens trial before surgery to help you decide whether the visual tradeoff works for your daily life.
The contact lens break required before your evaluation depends on the type of lens you wear. Soft lenses are typically stopped about one week in advance, toric soft lenses for approximately two weeks, and rigid gas permeable or scleral lenses for several weeks, sometimes longer, with repeat corneal mapping performed until measurements confirm stability. Skipping this step can cause temporary changes in corneal shape that lead to inaccurate measurements and a less accurate prescription for your treatment plan.
No practice can guarantee a specific visual outcome, and we believe it is important to be transparent about that. Many patients achieve excellent unaided vision after LASIK, but results vary based on individual healing and the complexity of each prescription. In some cases, a follow-up enhancement can refine results, but enhancements are not always possible if insufficient corneal tissue remains. Our goal is to give you the best possible chance at clear, comfortable vision, with a thorough evaluation and an honest conversation about what to realistically expect.
Schedule Your LASIK Evaluation at NewView Eye Center
If you are wondering whether your prescription or eye health makes you a candidate for LASIK, the most important step is to schedule a comprehensive evaluation with our team. At NewView Eye Center, our LASIK Surgeons have the expertise, technology, and genuine commitment to guide you through every option available, whether that turns out to be LASIK, an advanced surface procedure, or a lens-based alternative. We look forward to helping you find the clearest, safest path forward for your vision.
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