Is LASIK Right for You? How I Decide

Offering patients the chance to live independently of glasses and contact lenses is the most rewarding part of my work. Getting you there takes some planning, and it starts with a consultation.

If you are considering LASIK, you have probably run into PRK, SMILE, and implantable lenses along the way. There is no shortage of articles comparing them against one another, but very few explain how a surgeon actually arrives at a recommendation for one particular patient.

The answer comes from the measurements of your eyes, not from whichever procedure happens to be newest. Usually those numbers point toward LASIK, and when they don’t, that is where the consultation gets interesting.

A Versatile Procedure

Where LASIK Fits Best

It covers a wide range of prescriptions. LASIK can correct astigmatism, myopia, and hyperopia, and that last one matters more than people expect. SMILE, the procedure most often compared with LASIK, is FDA-approved for myopia with or without astigmatism, for sphere from -1.00 to -10.00 diopters and cylinder from -0.75 to -3.00, in patients 22 and older. Within that range it performs well, but farsightedness falls outside it entirely.

It heals faster than surface procedures. PRK arrives at a similar destination. One clinical review notes that “visual acuity is comparable between procedures once it is stable,” and that patients usually prefer LASIK “due to its rapid recovery time, faster visual improvement, and reduced postoperative discomfort.” I perform both procedures. If PRK turns out to be the better fit for your eyes, I will say so, but you should go in knowing what those first two weeks feel like.

The results hold up. More than 90% of patients achieve 20/20 vision or better after laser surgery, and LASIK carries a complication rate of less than 1%. A systematic review published in Ophthalmology, covering 2,198 patients, found satisfaction of 95.4%.

For most eyes that qualify, that combination is where I start.

The other half of the conversation

When I Don’t Recommend It

A quick overview first, and then I will walk through the reasoning behind each one.

When there is not enough corneal tissue

LASIK requires creating a tissue flap on the corneal surface. Without sufficient thickness, I recommend an alternative treatment. Published guidance puts appropriate candidates above 500 µm and favors PRK below that, because PRK “has a lower risk profile because it involves no LASIK flap creation.” The American Academy of Ophthalmology puts it simply: if you have thin corneas and want refractive surgery, PRK may be a good choice. Because I perform PRK myself, being told LASIK is not an option does not mean leaving without a plan.

When your life involves getting hit in the face

From 2010 to 2013, I served as Chief of Ophthalmology at Reynolds Army Community Hospital at Fort Sill. Clinical guidance recommends PRK for “patients who play contact sports or those in the military or police because such patients are more prone to eye trauma.” If you box, wrestle, or work a job with real impact exposure, that belongs in the conversation.

When the nearsightedness is extreme

A very strong prescription can rule out LASIK, though it rarely rules out a good result. An implantable collamer lens is FDA-approved to correct myopia with a spherical equivalent from -3.00 to -15.00 diopters, and to reduce it from greater than -15.00 up to -20.00, in both cases with no more than 2.5 diopters of astigmatism. It goes inside the eye rather than removing corneal tissue, and Visian ICL implantation is part of my practice.

When the lens, not the cornea, is the real problem

The ideal age range for LASIK is 28 to 60. Patients older than 60 without cataracts may still be candidates, but in most cases cataract surgery is the better option, because it addresses the lens itself instead of working around it. Refractive lens exchange follows the same logic before cataracts arrive.

When the eye is not ready yet

Your vision needs to have been stable for at least two years, and several of the conditions listed above can rule you out for now. Worth knowing: most of them rule out the newer procedures for the same reasons. SMILE’s own FDA labeling lists keratoconus, severe dry eye, active autoimmune disease, and uncontrolled diabetes or glaucoma among the reasons not to proceed. Hearing that LASIK is not an option does not automatically clear you for the alternatives.

How the decision gets made

Why The Answer Comes From The Measurements

None of this can be settled from a website, mine included. It comes down to your corneal thickness, your topography, the stability of your prescription, the health of your ocular surface, and a conversation about your lifestyle and goals. Custom wavefront mapping is part of how I get there, creating a precise map of your eye that can help correct the aberrations unique to your cornea. Our Aurora office has ophthalmologists and an optometrist on staff, so the call is made by someone who has actually examined your eyes.

Come in and let’s talk it through. If LASIK is the right fit for your eyes, I will explain why, and if something else suits you better, I will tell you that just as plainly.