The most common refractive surgery in the United States is LASIK (laser-assisted in-situ keratomileusis), which is also referred to as laser vision correction.
To date, approximately 12 million people have had this procedure. The surgery involves reshaping the cornea, the clear outer layer of the eye, to improve visual acuity and provide an alternative to eyeglasses or contact lenses. Although it is rare to develop glaucoma as a result of LASIK, individuals who are at risk of developing glaucoma or already have glaucoma require special considerations before, during, and after surgery.
Considerations before Surgery
LASIK is usually performed for correcting nearsightedness (myopia), which is a risk factor for developing glaucoma. In addition, those individuals with nearsightedness are more likely to have an increase in eye pressure (IOP) with steroids, which are routinely used after eye surgery. Also, a family history of glaucoma increases the risk of developing glaucoma. Therefore, it is important to report any family history of glaucoma to the eye surgeon so that a thorough baseline glaucoma evaluation can be done and the best refractive procedure can be chosen.
Considerations during Surgery
During LASIK surgery, 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 eye pressure is increased significantly during the formation of the corneal flap. This pressure elevation is temporary and may vary depending on the technique of the individual surgeon. Since high pressure may not be well tolerated when you have glaucoma or are at risk of developing glaucoma, this should be discussed with your doctor.
Considerations after Surgery
Steroid eye drops are commonly used after LASIK to reduce inflammation. Steroids can increase eye pressure which may lead to glaucoma; therefore, it is critical to monitor eye pressure carefully after surgery. However, this is not as straightforward as one might think. Laser vision correction for nearsightedness thins the cornea, which leads to underestimation of eye pressure with the current standard measuring tool.
At present, there are no approved formulas or methods to correct for this change. Also, in the early post-surgery period, elevated eye pressure due to steroids may be masked by measurement artifact due to a thinner cornea. Because of these difficulties in obtaining accurate IOP measurements, monitoring the optic nerve and peripheral vision testing become even more critical. 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 or glaucoma patients. With multiple choices now available for refractive correction, both patients and physicians have more options. However, a thorough baseline evaluation is needed before surgery and careful monitoring for changes in eye pressure is critical after surgery.
With vigilant screening, detailed informed consent, realistic expectations, and careful follow-up, negative effects can be avoided or minimized, and you are more likely to enjoy the benefits of this advancing technology.
First posted on May 15, 2015; Reviewed on April 19, 2022
Sarwat Salim, MD, FACS
Dr. Sarwat Salim is Professor of Ophthalmology, Vice-Chair of Clinical and Academic Affairs, and the Director of Glaucoma Service at New England Eye Center, Tufts University School of Medicine.