Posted on January 1, 2018
We have the follow up reports of approximately 12 million people have had LASIK, and in this population, and its safety and effectiveness have been proven without doubt. Glaucoma has been reported as a rare complication following LASIK. Glaucoma is a disease in which the optic nerve (the nerve that connects the eye to the brain, and enables us to see) is damaged due to high pressures inside the eye (called intraocular pressure, or IOP). That said, the relationship between glaucoma and LASIK is complex, and although there is no direct cause and effect relationship between the two, certain subgroups of patients undergoing LASIK may be at risk of glaucoma.
How can LASIK increase the risk of glaucoma?
Patients with high myopia are known to be at risk of glaucoma. It is this subgroup of patients that usually wants laser vision correction for better sight without glasses. They are naturally more susceptible to the disease. This group could have anyway developed glaucoma, and LASIK is actually incidental to the disease process.
The other risk factors of glaucoma are:
- Advanced age
- Corticosteroid use
- History of previous ocular trauma
- African origin
- ? Smoking
In patients who have vulnerable to glaucoma, that is, they have optic nerves which are more in danger of disease, LASIK can aggravate the situation. This is because LASIK requires the creation of a corneal flap, followed by remoulding of the residual cornea to correct the refractive power of the eye. In order to stabilize the eye during creation of the flap, the doctor uses a suction mechanism, which increases the eye pressure significantly. This pressure elevation is temporary and but may cause damage to an already vulnerable optic nerve, resulting in glaucoma.
After LASIK, all patients are routinely prescribed steroid eye drops. These eye drops can cause an elevation of eye pressure which can be transient and innocuous, or can cause lasting damage to the optic nerve. This may happen to any patient, whether their nerves have been diagnosed as being susceptible to glaucoma earlier, or not.
How can my doctor ensure I will not get glaucoma?
Glaucoma tends to run in families, so you must inform your eye surgeon about any family history of glaucoma. Your surgeon will perform a thorough eye evaluation to rule out any susceptibility to glaucoma. In case of any suspicion of disease or a positive family history, a thorough baseline glaucoma evaluation will be done so that the best refractive procedure can be chosen for you. In case, the risk of glaucoma is high, your doctor will suggest another refractive surgery to provide you better vision without spectacles.
LASIK for myopia makes the cornea thinner and the current gold standards for measuring eye pressure are not very accurate in post LASIK eyes. Therefore, your doctor will monitor the optic nerve and peripheral vision to ensure you don’t develop glaucoma.
Your doctor will also monitor you eye pressures during follow up to ensure that there is no increase in the eye pressures due to steroid use.
Can I have LASIK if I have glaucoma?
As LASIK gains more popularity and acceptance, there are many diagnosed glaucoma patients who want to undergo LASIK. LASIK is not recommended in any patient with moderate to advanced glaucoma due to the problems in measuring IOP which makes the monitoring and appropriate management of the glaucoma difficult. Also, LASIK may cause increased nerve fibre loss in this group of patients due to the suction required for creation of the corneal flap.
LASIK, however, may be considered, in mild forms of glaucoma patients who have well-controlled IOP and no field defects.
The most critical detail in LASIK evaluation is that refractive surgery is not contraindicated in patients at risk, or with glaucoma, but the individual’s glaucoma should be treated and stablized before any intervention.
Is there no option to remove glasses in patients with glaucoma, not eligible for LASIK?
There are many refractive surgeries that do not require the creation of a corneal flap. PRK, LASEK, CK, ICL, and RLE are all options that your doctor will discuss with you before choosing the surgery best suited to your eyes and needs.