LASIK Eye Surgery: Who Is a Good Candidate?

We carefully map your corneal shape using advanced tomography imaging because certain irregularities can make LASIK unsafe. Keratoconus is a progressive condition where the cornea thins and bulges forward into a cone shape. Performing LASIK on a keratoconic cornea can accelerate this dangerous weakening.

• Even mild or suspected keratoconus disqualifies most patients from LASIK
• Forme fruste keratoconus, an extremely early form, may only appear on detailed scans and not on routine topography
• Other irregular astigmatism patterns may also raise concerns
• Our LASIK Surgeons rely on tomography rather than topography alone to detect subtle early disease

For patients with keratoconus, our team offers corneal cross-linking, a treatment that strengthens and stabilizes the cornea. Dr. Elliot Perlman was the first LASIK Surgeon in Rhode Island to offer FDA-approved corneal cross-linking, and this may be a necessary first step before any refractive procedure is considered.

LASIK temporarily reduces tear production by affecting the corneal nerves that signal your glands to produce tears. If you already experience dry eye syndrome, the procedure may worsen your symptoms and slow healing.

We evaluate the quality and quantity of your tears before recommending surgery. Mild dry eye can often be managed with lubricating drops, prescription eye drops, or punctal plugs, which are tiny devices placed in the tear drainage canals. Moderate to severe dry eye may require treatment and reassessment before LASIK is considered.

Glaucoma is a condition that damages the optic nerve, often related to elevated eye pressure. Because LASIK changes corneal thickness, pressure readings taken after surgery must be interpreted with this change in mind. Mild, well-controlled glaucoma is not always an absolute disqualification, but it requires careful management and monitoring.

Cataracts, which cloud the natural lens inside your eye, are better addressed with cataract surgery than with surface laser treatment. Retinal conditions such as diabetic retinopathy, macular degeneration, or retinal tears must be stable and well-managed before any elective vision correction is considered. Patients with high myopia may require a preoperative retinal evaluation to ensure the retina is healthy.

A history of eye surgery or injury does not automatically disqualify you, but it does require a thorough review. Previous procedures such as radial keratotomy, an older form of refractive surgery, can make LASIK results less predictable because of the pattern of corneal scars left behind.

A history of herpetic keratitis, an eye infection caused by the herpes simplex virus, generally represents a contraindication to LASIK unless the condition has been long dormant and a perioperative antiviral plan is in place. We review your complete eye history and examine your corneas closely to determine whether the changes present are compatible with safe laser treatment.

We measure your pupil size in dim lighting because larger pupils can increase the risk of nighttime visual disturbances after LASIK. When your pupils dilate beyond the edge of the treatment zone, you may notice halos, glare, or starburst patterns around lights.

• Pupils larger than 7 millimeters in darkness may be associated with more optical side effects
• Modern laser platforms create larger treatment zones than older technology, reducing this risk
• We also consider optical zone size, blend zones, and higher-order aberrations alongside pupil size
• If you drive frequently at night or work in low-light environments, we discuss this factor carefully during your evaluation

In the days and weeks following LASIK, it is normal to experience some temporary changes in your vision and comfort. These effects are part of the healing process and typically improve over time.

• Dry eye symptoms that may last weeks to months and sometimes longer
• Glare, halos, and difficulty with night driving, which usually improve as healing progresses
• Fluctuating or blurry vision during the initial recovery period
• Mild irritation, tearing, and light sensitivity in the first hours and days

More serious complications are uncommon in carefully selected patients, but they are important to understand before consenting to surgery. Our LASIK Surgeons also have extensive experience in managing post-refractive surgery complications when they do occur.

• Undercorrection or overcorrection that may require glasses, contacts, or an enhancement procedure
• Infection or inflammation, including a condition called diffuse lamellar keratitis under the flap
• Epithelial ingrowth, where surface cells grow under the flap
• Flap-related issues such as wrinkles or displacement, particularly with trauma to the eye
• Corneal ectasia, a rare progressive weakening of the cornea that may require specialty contact lenses or cross-linking
• Steroid-related eye pressure rise in susceptible patients following post-operative drops
• Rare chronic pain or light sensitivity that may persist beyond the expected healing window

Mild nearsightedness often responds very well to LASIK, and many patients with lower prescriptions achieve excellent results. The key consideration is whether the inconvenience of glasses or contacts feels significant enough to justify a surgical procedure with its small but real risks. During your consultation, we help you weigh the personal benefit against those risks so you can make a confident decision.

Borderline cases require careful, individualized conversation rather than a simple yes or no. In some situations, optimizing factors like dry eye or waiting for further prescription stabilization can move you into a more favorable range. In others, an alternative procedure such as PRK or implantable collamer lenses may offer a better safety profile. Our goal is always to match you with the option that offers the best balance of safety and visual outcome for your specific eyes.

If you are over 40, LASIK corrects your distance vision but does not prevent or reverse presbyopia, the natural age-related loss of near-focusing ability. You may still need reading glasses for close tasks. A monovision approach, where one eye is corrected for distance and the other for near, is one option we discuss, and we typically recommend a contact lens trial beforehand so you can experience the effect before committing to it surgically.

Treating both eyes during the same session is standard practice and is safe for the vast majority of appropriately selected patients. This approach avoids a prolonged period of imbalanced vision between eyes and reduces the need for multiple procedure visits. In rare cases involving individual risk factors, we may recommend staging the procedures separately, and we discuss this openly if it applies to your situation.

Some patients may benefit from an enhancement procedure if a meaningful prescription remains after full healing. Candidacy for enhancement depends on how much corneal tissue remains, how stable your refraction is, and how much time has passed since your original surgery. Enhancement policies, timing, and associated costs are discussed openly during your initial consultation so there are no surprises later.

Previous eye surgery does not automatically disqualify you, but it does require a thorough evaluation of how that procedure affected your corneal structure, thickness, and healing capacity. Older procedures like radial keratotomy can make outcomes less predictable. Our LASIK Surgeons, including Dr. Elliot Perlman and Dr. Christopher Newton, have specialized experience in post-refractive surgery evaluation and complication management, and they will give you a clear and honest assessment of your options.