Diabetes is a common disease in the United States. Because of this, there are many diabetics who may want to get LASIK, even though there are higher risks for this group. (Learn More) Changes to tissue in the cornea and damage to the retina are risks associated with diabetes, which mean LASIK could make your vision worse, rather than better. (Learn More)

Some medical research suggests that people with controlled diabetes are acceptable candidates for LASIK, so guidelines around this cosmetic procedure may change. (Learn More)

Ultimately, a management plan works best to preserve eye health if you have diabetes. Control your diabetes with proper blood sugar management, work with your physician to manage your overall health, and get regular eye exams from an optometrist to keep your eyes healthy. (Learn More)

Diabetes & LASIK

Diabetes mellitus, or type 2 diabetes, is a common disease in the United States, with about 8 percent of the adult population developing it. More people are expected to be diagnosed with diabetes, as increasing numbers of people are overweight or obese. This means that more people who either have diabetes or are at risk of this condition will be interested in LASIK to improve their vision.

The United States Food and Drug Administration (FDA) does not recommend LASIK for people who have diabetes, either type 1 or type 2, because of hormone fluctuations. As time progresses, LASIK procedures are becoming safer and more effective. Some doctors are revising their standards about who can safely undergo LASIK and who should avoid it.

Complications From Diabetes & LASIKlaser eye surgery

The FDA does not recommend LASIK for people who have diabetes because this chronic condition can affect how well wounds heal. Undergoing surgery as a diabetic requires more planning and preparation for healing time. Since LASIK is a cosmetic procedure, it is often not recommended if you have diabetes. If your corneas do not heal properly after LASIK, you will not get improved vision.

There are many potential complications aside from wound healing that support the recommendation against people who have diabetes getting LASIK. Some of these include:

  • Corneal complications. Many parts in and around the cornea change because of diabetes. Since LASIK removes some tissue from the cornea to adjust how light is refracted onto the retina, these changes can make healing complicated, or they can cause the cornea to develop scar tissue after the surgery, making eyesight worse.

    Complications in the cornea include:

    • Epithelial changes, including thickening of this tissue, and abnormalities of the membrane.
    • Diabetic corneal neuropathy, which is associated with losing sensation as well as nerve death from diabetic neuropathy. This makes healing times longer.
    • Endothelial changes, which may allow excess fluid to leak into the corneal stroma.
  • Retinal complications. Diabetic retinopathy is damage to the retina due to blood flow changes from complications associated with diabetes. Sometimes, the cause of blurry vision or changing visual acuity is related to this type of retinal damage and not due to a refractive error like nearsightedness or farsightedness. It is vital to get regular eye exams if you have diabetes, to ensure that any changes in your eyesight are not due to damage to your retina.
  • Surgical site infection. People who struggle with diabetes are more likely to experience infections at surgical sites regardless of the type of surgery. Infections in the eye can lead to vision loss and even blindness.

People who have diabetes are also at higher risk for:

  • Glaucoma.
  • Cataracts.
  • Diabetic macular edema.

Symptoms of these conditions include:eye floaters

  • Blurry vision.
  • Reduced color vision.
  • Vision that fluctuates frequently, including from day to day.
  • Dark areas in the visual field or vision loss.
  • Floaters, spots, or dark strings.
  • Light flashes.

Some of these symptoms are similar to refractive errors light nearsightedness, farsightedness, and astigmatism. You may want LASIK to get rid of a perceived refractive error. Eye surgeons will conduct a thorough eye exam to check for signs of other eye diseases, including those associated with diabetes. It may be that your perceived refractive error is actually a symptom of a diabetes-related eye condition.

Medical Research on LASIK Outcomes

Although these issues are documented, medical studies vary on how serious or frequent these complications are. One study found that about 47 percent of people with diabetes who underwent LASIK experienced complications afterward compared to 6.9 percent in the control population. However, the study did not report postoperative infections. Those complications involved endothelial and epithelial cells causing defects.

A different study reported that complication rates among diabetic patients after LASIK averaged 6.5 percent, as long as they controlled their blood sugar, had no systemic complications, and had minimal retinopathy. A second study found a similarly low rate of complications among people with controlled diabetes — 9.1 percent, which was not considered significantly different from the general population. Reported complications included postoperative keratopathy and mild epithelial changes, which resolved.

 

Keep Your Eyes Healthy if You Have Diabetes

If you have diabetes, it is important to maintain your overall health, whether you want LASIK or not. Controlling your blood sugar and blood pressure is vital to keeping your body healthy in general and keeping your vision healthy in particular.

Having a full, dilated eye exam once per year is a good way to ensure your vision is stable, and you do not develop eye diseases. If your vision is changing quickly because of diabetes, your optometrist or ophthalmologist may recommend getting an eye exam more frequently than once a year. If you experience a sudden change in vision, see a doctor immediately.

You may need special eye drops or laser surgery to manage vision problems from diabetes. This includes anti-VEGF drugs and laser surgeries that destroy unhealthy blood vessels around the retina, to keep this part of your eye healthy. If you develop too many floaters, you may need vitrectomy, which removes the aqueous humor and replaces it.

At some point, you may need assistance from a low vision and rehabilitation clinic. Professionals at these centers can help you manage vision loss that cannot be corrected with glasses, medicine, or necessary surgery.

Ultimately, the best way to ensure you have healthy eyes is to maintain your blood sugar and blood pressure as directed by your physician. If you want LASIK, you can ask your optometrist or ophthalmologist about this, and they may evaluate your potential as a candidate for this surgery.

It’s important that you understand the potential risks and complications, acknowledging that as a diabetic, you are at higher risk than the general population. Studies show that you may need longer to heal after the operation, and you may need more frequent eye exams to ensure your eyes heal well.

Ultimately, type 1 and type 2 diabetics may be able to get LASIK in some situations, but this is determined on a case-by-case basis.

 

References

LASIK in Patients With Diabetes Mellitus. (January 2015). American Academy of Ophthalmology (AAO). When Is LASIK Not for Me? (July 2018). United States Food and Drug Administration (FDA).

Diabetic Eye Disease. (May 2017). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).