Posted on December 20, 2017
Diabetes is a common metabolic disease and its incidence is increasing with the increase in global obesity. Because of this reason, the number of patients with diabetes who need laser vision correction, or LASIK, is also increasing.
The guidelines of the US FDA regarding diabetes label it a relative contraindication for the following reasons:
- Unstable and fluctuating power of glasses, due to fluctuating blood sugar levels (remember your power of glasses should be stable for a year before surgery).
- Decreased immunity.
- Delayed or poor healing.
- Potentially increased risk of operative and post-operative complications and infections.
With increasing data on the safety and effectiveness of LASIK in these patients, these recommendations have been modified in clinical practice. Now, there is sufficient evidence to say that LASIK is safe and efficacious consistently, in diabetic patients with good blood sugar control and no systemic or ocular complications.
It is recommended that special attention be given to certain factors, in addition to the standard LASIK pre-operative evaluation, when performing LASIK in patients with diabetes, and your operating surgeon will discuss them with you in great detail.
- Good blood sugar control: Normal blood sugar levels for a few days before surgery are not sufficient for LASIK, and your doctor will want to check your blood glucose levels over at least two to three months. This is best evaluated using a test called glycosylated hemoglobin or HbA1c levels. The risks involved in undergoing the LASIK surgery are more than the potential benefits if the patient’s HbA1c result is in excess of 7%. Even though recommendations allow for LASIK with HBA1c levels less than nine, most eye surgeons will insist on levels around or less than seven. Your eye surgeon may also want a letter of clearance from your treating diabetologist stating that the diabetes is under control and being monitored
- Systemic Complications of Diabetes: Patients with evidence of systemic complications of diabetes, such as peripheral neuropathy or nephropathy, should not be considered as suitable candidates for LASIK.
- Eye related complications of Diabetes: Patients with diabetic retinopathy, that is, diabetic eye disease that affects the light sensitive portion of the eye called the retina, are usually not considered suitable for LASIK. Patients with mild diabetic retinopathy may be considered for the surgery, but LASIK is contraindicated in more severe forms of the disease. Similarly, LASIK is not recommended in patients with maculopathy, ischemia, cataracts or glaucoma.
- Stability of refractive power of the eye: In case the power of your glasses is fluctuating, because of fluctuating blood sugars or otherwise, your eye doctor will ask you to wait until it has been stable for at least six months to a year. If your blood sugar isn’t controlled over the long term, the varying blood sugar levels can result in change in the prescription of glasses. Because of this, your eye doctor will not be able to ensure optimal long term results with LASIK.
That said, you must know that diabetics are routinely undergoing LASIK, all over the world. And in the hands of a trained, experienced surgeon, the surgery remains safe and effective. It must however be kept in mind that you must be very particular about your diabetic medication, diet and exercise to ensure a proper blood sugar control.
Once your blood sugar is adequately controlled, your eye surgeon will work with you on a thorough and detailed analysis of the potential risks and consequent benefits of LASIK.
Diabetes is no longer considered a contraindication for LASIK, and neither is it true that people with diabetes will invariably have complications after undergoing LASIK surgery. In fact, if you have no diabetic retinopathy and your blood sugars are well controlled, you will probably be eligible for a refractive surgery. The only way for you to know if you are suitable for LASIK or not is by undergoing a complete eye evaluation with a competent eye surgeon. If your blood sugar levels are kept consistently under control through medication and sustained lifestyle changes, LASIK is as safe for diabetics, as for the general population.