Can I Have Laser Vision Correction?

The most common refractive surgery in the United States is LASIK (laser-assisted in-situ keratomileusis). It involves reshaping the cornea, the clear outer layer of the eye, with a laser in order to improve visual acuity and provide an alternative to eyeglasses or contact lenses for vision correction.

LASIK is usually performed for correcting nearsightedness (myopia), which is a risk factor for developing glaucoma. In addition, individuals with myopia are more likely to have an increase in eye pressure (IOP) with steroids, which are routinely used after eye surgery. It is also important to report any family history of glaucoma to the eye surgeon to make sure  that a thorough baseline glaucoma evaluation can be done and the best refractive procedure can be chosen.

During LASIK, a partial-thickness corneal flap is created and laser energy is used to reshape the corneal tissue under this flap. In order to stabilize the eye, the IOP is increased significantly during the formation of the corneal flap. Although this increase in IOP is temporary, the potential impact on the optic nerve should be discussed with your doctor. In the presence of glaucoma, other options for laser vision correction, such as small-incision lenticule extraction (SMILE) or photorefractive keratectomy (PRK) which do not require flap formation may be considered.

Steroid eye drops are commonly used after laser vision correction to reduce inflammation, and the duration of steroid treatment is longer after PRK than LASIK. Steroids can increase IOP which may lead to glaucoma; therefore, it is critical to monitor IOP carefully after surgery. However, this is not as straightforward as one might think. Laser vision correction for myopia thins the cornea, which leads to underestimation of IOP with the commonly used measuring tools. This underestimation may mask steroid related IOP elevation and lead to delay in treatment.

Because of the difficulties in obtaining accurate IOP measurements, IOP should be measured using more than one instrument. In addition, monitoring the optic nerve and peripheral vision testing become even more critical in this setting. When establishing eye care with a new ophthalmologist, it is important to provide your history of laser vision correction and all the baseline tests and results you have to make follow-up care easier.

In summary, refractive surgery is not prohibited for glaucoma suspects and those with well controlled, early glaucoma. However, a thorough baseline evaluation is needed before surgery and careful monitoring for changes in eye pressure is critical after surgery.

Article by Sarwat Salim, MD, FACS. Last updated on May 1, 2025.