Who Should Not Have Laser Eye Surgery?

10 Reasons LASIK May Not Be Right for You

Not everyone is a good candidate for LASIK eye surgery, also known as laser eye surgery or laser vision correction. Several conditions may disqualify you from the procedure, such as having an autoimmune disorder that causes dry eyes or having degenerative eye disease. Other chronic conditions like diabetes can affect LASIK results as well.

This article describes the top 10 reasons why LASIK eye surgery may not be right for you.


You Are Younger Than 18 Years Old

patient and doctor Preparing for LASIK eye surgery
Sean Locke/Photographer's Choice/Getty Images

A person's eye can change physically throughout their life. This is especially true during adolescence when the eyes will gradually increase in size, eventually measuring between 21 and 27 millimeters by early adulthood.

Because LASIK surgery is permanent, you need to wait until your eyes are completely grown before submitting them to irreversible changes. For this reason alone, LASIK is not recommended for anyone under 18.


You Have Dry Eye Syndrome

Having dry eye syndrome (keratoconjunctivitis sicca) is usually a disqualifier for LASIK. A person with dry eyes has an increased risk for postoperative pain and a worsening of dry eye symptoms. Having dry eyes can also delay healing by reducing the lubrication needed to stabilize the reshaped cornea.

This is not to say that a person with dry eyes cannot have LASIK. Your ophthalmologist will examine you to help make the decision. Certain procedures, such as ​punctal occlusion, can be performed to unblock tear ducts and make LASIK surgery safer.


You Are Pregnant or Nursing

Having LASIK surgery during pregnancy is generally discouraged. Hormone fluctuations and fluid retention can cause short-term vision changes that tend to resolve once breastfeeding has ceased.

It is not uncommon for a person with pregnancy to become nearsighted or develop short-term astigmatism. Hormone changes during breastfeeding can also lead to dry eyes that can delay healing.

While pregnancy is not a contraindication for laser eye surgery, most ophthalmologists recommend delaying the procedure until after you have finished breastfeeding (or until you've at least had your first period after giving birth).


You Are Taking Certain Drugs

Certain prescription drugs can cause changes in the eyes that can lead to complications from LASIK surgery.

For example, corticosteroid (steroid) drugs like prednisone work by suppressing the immune system and can significantly delay healing. People on chronic (long-term) steroids may also experience changes in their vision that can make LASIK less successful.

Other drugs like latanoprost, cyclosporine, bimatoprost, moxifloxacin, travoprost, brimonidine, and olopatadine can lead to dry eyes which can affect healing and lead to corneal scarring.

The risk needs to be assessed on an individual basis. It is important that your ophthalmologist knows about all the medications you take so that an informed choice can be made.


You Have an Autoimmune Disease

People with certain autoimmune diseases are not good candidates for LASIK surgery. These are conditions in which the immune system attacks its own cells and tissues.

Autoimmune diseases like lupus and Sjogren's syndrome are associated with vision changes as the immune system directly attacks tissues and nerves of the eyes. People with psoriasis and rheumatoid arthritis can also develop eye problems as a result of autoimmune inflammation.

On the flip side, biologic drugs like Enbrel (etanercept) and Humira (adalimumab) used to treat autoimmune diseases can impair the immune system and may interfere with healing after LASIK surgery.


You Have Diabetes

Having diabetes is a relative contraindication for LASIK surgery, meaning that it is generally not advised but may be performed in certain instances.

Diabetes causes high blood sugar that damages blood vessels, including those of the eyes. Over time, this can cause diabetic retinopathy, an eye disease that can progress if blood sugar is not controlled.

LASIK surgery may be considered if a person's blood sugar has been consistently controlled and their vision is persistently stable. If not (or a person has diabetic retinopathy), LASIK surgery should not be pursued.


Your Vision Is Fluctuating

You are not a good LASIK candidate if your contact lens or glasses prescription is fluctuating. Most ophthalmologists prefer that your prescription be stable for a minimum of one year before considering laser eye surgery.

Prescriptions can fluctuate for a variety of reasons, including dry eye syndrome, uncontrolled diabetes, and uncontrolled high blood pressure. Because LASIK is a permanent procedure, it makes sense that your prescription is stable before having it done.


Your Pupils Dilate Excessively in the Dark

During standard LASIK surgery, the area of the eye that will be lasered is usually around 6 millimeters in diameter. Ideally, the size of your pupil when dilated (narrowed) should be 6 mm or less. If it dilates to 7 mm or 8 mm, you will likely have unwanted glare, halos, or starbursts around lights at nighttime.

Newer lasers used for LASIK surgery can accommodate pupil dilation larger than 7 mm. But you need to be doubly sure of this before undergoing the procedure.

If considering LASIK surgery, don't be afraid to ask:

  • What is the size of my dilated pupil?
  • What is the diameter of the beam generated by your laser device?

You Have Severe Vision Problems

If you have serious eye or vision problems, LASIK surgery may not provide you with the results you hope for. In some cases, it may do more harm than good.

While people with mild nearsightedness (myopia) generally respond well to laser eye surgery, the results are more unpredictable in those with extreme nearsightedness (presbyopia). This is when your negative vision scale is less than 5.25.

People with corneal thinning (keratoconus) are also not good candidates for LASIK surgery as it can compromise the integrity of already-unstable tissues.

People with blepharitis (eyelid inflammation) should also delay LASIK surgery until the underlying condition is resolved. If not, the condition can lead to eye infection or inflammation and permanent corneal scarring.


You Have Unrealistic Expectations

You should not expect perfect vision following LASIK surgery. Many LASIK advertisements are misleading, promising an immediate "end" to glasses or contact lenses.

While most people who undergo LASIK have excellent results, you should not expect perfect 20/20 vision. Every person heals differently, and there is a possibility you will need reading glasses or corrective lenses for at least some activities, especially at night.

If you decide to pursue LASIK, go in fully understanding the potential benefits and risks of the procedure.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Bekerman I, Gottlieb P, Vaiman M. Variations in eyeball diameters of the healthy adults. J Ophthalmol. 2014;2014:503645. doi:10.1155/2014/503645

  3. American Academy of Ophthalmology. Considerations for lacrimal occlusion in the moderate dry eye patient.

  4. Naderan M. Ocular changes during pregnancy. J Curr Ophthalmol. 2018;30(3):202-210. doi:10.1016/j.joco.2017.11.012

  5. Moshirfar M, Rosen DB, Helland MB, Ronquillo YC, Hoopes PC. Should I get LASIK if I’m breastfeeding? Ophthalmol Ther. 2019 Sep;8(3):349–52. doi:10.1007/s40123-019-0195-5

  6. Sahay P, Bafna RK, Reddy JC, Vajpayee RB, Sharma N. Complications of laser-assisted in situ keratomileusis. Indian J Ophthalmol. 2021 Jul;69(7):1658–69. doi:10.4103/ijo.IJO_1872_20

  7. Fraunfelder FT, Sciubba JJ, Mathers WD. The role of medications in causing dry eye. J Ophthalmol. 2012;2012:285851. doi:10.1155/2012/285851

  8. AlKharashi M, Bower KS, Stark WJ, Daoud YJ. Refractive surgery in systemic and autoimmune disease. Middle East Afr J Ophthalmol. 2014 Jan-Mar;21(1):18–24. doi:10.4103/0974-9233.124082

  9. American Academy of Ophthalmology. LASIK in patients With diabetes mellitus.

  10. American Academy of Ophthalmology. Surface ablation: photorefractive keratectomy, LASEK, Epi-LASIK, and Epi-LASEK.

By Troy Bedinghaus, OD
Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.