Who Is A Good Candidate For Laser Vision Correction?
In general terms, any individual with a refractive error correctable by the excimer laser should be a candidate for Laser Vision correction (PRK or LASIK). However, our 16 year experience as laser refractive surgeons has made indications for surgery much more focused and refined. Clinical experience has perfected our approach as it has become apparent that excimer laser vision correction is not without limitations and that all patients are not appropriate candidates for laser surgery.
Excimer laser vision correction is best performed when a patient’s refractive error has stabilized. We know that younger individuals may be subject to instability of prescription and that, as a result, surgery might be best postponed until the age of 21. Obviously, the selection of that specific age for candidacy is quite arbitrary in that even after the age of 21 a prospective patient may be subject to refractive instability. We therefore need to document stability of prescription for at least six months prior to surgery in order to assure treatment accuracy. While there is no intrinsic danger in performing surgery for younger patients (even under the age of 21), such individuals may have a greater risk of needing enhancement treatments which are normally requested by 2-3% of our patients. While requiring an enhancement treatment does not represent a complication, it is always desirable to avoid added surgery whenever possible. There is no upper age limitation on laser vision correction. In fact, excimer laser procedures have become a welcomed and safe method of visual improvement for patients following cataract surgery providing excellent uncorrected visual acuity following these procedures.
Patients with a history of auto immune collagen diseases are poor candidates for laser treatment. Therefore those with illnesses such as Rheumatoid arthritis or Lupus would be better treated using an ICL implant which can safely correct vision for such individuals. Pregnant women or nursing mothers are best not treated with LVC until at least six months after delivery and nursing to assure predictable accuracy of the procedures.
Dr. Fox on Whether You Are A Candidate
Excimer laser vision correction works best when it is used to treat near sightedness with or without astigmatism. Prescriptions ranging from -1.00 to -9.00 will qualify for surgery if pre-operative evaluation indicate no contraindication. Standard of care in laser vision correction dictates use of sophisticated wave front custom laser treatments. Each calculated wavefront treatment is specific for the eye under consideration and no two are alike.
Such treatments will assure the very best in accuracy and provide excellence in visual outcomes. Levels of astigmatism up to -3.50 can be treated with custom wavefront technology, and for those with higher degrees of astigmatism other methods of treatment can be performed to bring astigmatic errors into treatment range. For individuals with myopic prescriptions outside the safe range of excimer laser treatment, ICL (intra ocular contact lens) implantation can provide an excellent alternative for vision correction.
In myopia, the excimer laser works to reduce optical power by essentially flattening the cornea. With far sighted or hyperopic prescriptions, the excimer laser treatment is designed to increase the power of the cornea by steepening it. Experience has taught us that, because of this fundamental difference in treatment pattern, the level of treatment for hyperopia results in best outcomes when prescriptions are +2.00 or under. Hyperopic treatments have a tendency to lose their effectiveness in almost 30% of treated patients, especially those with higher prescriptions. We are therefore very cautious in counseling our hyperopic candidates for treatment.
The excimer laser will not correct for the need of reading glasses. New technology is approaching FDA approval and we plan to offer these treatments as soon as they become available. In the interim, mono vision or blended excimer laser treatments can provide for a very satisfactory approach for those seeking correction of both distance and reading vision.