Can I go for LASIK if I have high eye pressure, and what are the implications and considerations?
Elevated intraocular pressures maybe an artefact of the testing method (air-puff versus contact methods including the Goldmann applanation tonometer, or digital tonometer).
It is important to ascertain whether your eye pressures are truly high on applanation, as non-contact air-puff tonometers are notorious for giving falsely elevated readings.
Secondly, in the context of elevated IOP, you also need to know the corneal thickness as this will determine whether the reading is elevated due to a thicker cornea. This would imply that the real eye pressure is lower than is recorded.
Thirdly, a comprehensive evaluation of your optic disc is required to determine whether any structural or functional damage to the nerve has occurred (glaucoma evaluation).
It is important to consider all these parameters before deciding on whether to proceed with your refractive surgery.
Significantly elevated eye pressures will also affect the refractive result of LASIK surgery, as it will cause the cornea to bow forward and induce myopia in the post-surgery eye.
You should consult your attending ophthalmologist for specific advice as to how this question relates to you, as high pressures alone (if this is a true reading) may not be a disqualifying factor for refractive surgery.
Best of luck in your refractive surgery journey!
When a patient presents with high eye pressure, what we are usually concerned about is the risk of glaucoma. Glaucoma is an eye condition that causes damage to the nerve at the back of the eye, it is usually associated with but not limited to high eye pressure. If left untreated, it can lead to permanent loss of vision or blindness.
Before any laser vision correction (such as PRK, LASIK, ReLEx SMILE), a thorough pre-laser evaluation will usually be done to ascertain your suitability for surgery, and at the same time, to pick up or rule out any existing eye conditions. Some of these eye conditions will have to be treated or managed before any form of lasers are to be carried out. This is to optimise your surgical outcome post-surgery.
It is best to discuss and weigh the risks vs benefits of the surgery with your eye surgeon before proceeding.
LASIK, or any other laser refractive surgery such as PRK/SMILE etc, makes the cornea thinner in certain areas. This can potentially cause an underestimation in the real eye pressure whenever this is measured after the surgery.
As such, there is theoretical concern that people who develop glaucoma (which is usually associated with high eye pressures), may be diagnosed late because their eye pressures seem normal after LASIK when they actually are high. In other words, an eye with an actual high eye pressure may be measured to be at normal levels after laser refractive surgery is done.
Having said that, the underestimation caused by laser refractive surgery is usually on the order of a few mmHg. In reality, if a doctor is careful and looks at factors beyond pressure such as optic disc appearance, retinal nerve fiber layer thickness and visual fields, he or she will not miss a glaucoma condition regardless of whether LASIK had been done or not.
Whether a person with high eye pressure can have LASIK depends on several things. First, is it really high? Some instruments may not be very accurate in measuring this, such as the airpuff tonometer, so the 'high' pressure may need to be rechecked with a different instrument. Second, how high is high? eg 22mmHg vs 30mmHg or 40mmHg? A 'borderline' high pressure with a thick cornea may be considered 'normal' and LASIK may be possible as long as all other parameters are normal. On the other hand, an established case of glaucoma with high pressure and visual field changes is not considered a good candidate for LASIK because of various reasons, such as possible effects on vision from both glaucoma and LASIK adding up, or the possibility of needing glaucoma surgery in the future (which may affect the refractive state of the eye), or the effects of high pressure on refractive measurements, etc.
So to sum up, each case needs to be considered on its own merits. Ultimately, the suitability or otherwise for refractive surgery can only be determined after a full check up and taking into consideration the results of the various tests as mentioned above.
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