Laser eye surgery can benefit several eye conditions. However, not all people are viable candidates for this surgery. If you are not eligible for laser eye surgery, learning more about the possible alternatives is a good choice.

One procedure replaces the lens of the eye to improve vision issues associated with cataracts and refractive errors. (Learn More) Some procedures use a knife instead of a laser to treat issues, such as an abnormal cornea shape. (Learn More)

When your doctor talks to you about eye surgeries, get information about several options. They will go over your health history and the overall health of your eyes to see if laser surgery is a viable choice. (Learn More)

If it is not, explore non-laser options. Learn about the pros and cons, and how each procedure works, to make the best decision for your situation.

woman making no gesture

When to Avoid Laser Eye Surgery

 

Not all people are able to have laser eye surgery. Knowing the factors that might disqualify you can help you to make the right choice about your eye health. There are common factors that make people ineligible for laser eye surgery.

  • You should be at least 18 years old. When you are younger than this, your eyes are still changing so the surgery is not recommended. For some lasers, you might need to be at least 21 years old.
  • If you are nursing or pregnant, you usually need to wait for laser eye surgery. This is because your vision corrective prescription may change during pregnancy due to fluid retention and hormone fluctuations.
  • If you take certain medications, this could disqualify you from laser surgery. For example, some steroids may delay healing. Another example is acne treatment drugs causing dry eyes. If your eyes are dry, there is an increased risk of corneal scarring with laser surgery.
  • If you have certain eye conditions, laser surgery may not be ideal. For example, if you have glaucoma, laser surgery could potentially increase your eye pressure and worsen your condition.
  • Laser surgery is usually a permanent procedure. Because of this, you might not be a good candidate if your corrective lens prescription fluctuates.
  • If your pupils dilate more than 7 millimeters in the dark, you may not be a candidate. People with large pupils may experience debilitating symptoms, such as halos, ghost images, glare, and starbursts.

The following are other factors that could possibly disqualify you from laser eye surgery:

  • Your employer prohibits refractive procedures.
  • You are active in contact sports.
  • Your corneas are too thin.
  • You have eyelid inflammation.
  • You had refractive surgery in the past.

Clear Lens Extraction

 

If you have farsightedness, this procedure may be a better choice compared to laser and other refractive surgery types. The doctor will remove your natural lens and then put a new artificial one in its place.

Once the new lens is in place, it can provide sharper focus. It can also correct the refractive error you have. This can decrease your need for bifocals or reading glasses.

The procedure is like the surgery used to treat cataracts. There are three lens types doctors might put into the eye.

  • Multifocal: This lens allows for clear vision at several distances.
  • Monofocal fixed-focus: These might be used for astigmatism.
  • Accommodating: This type shifts its position to allow for greater focus at several distances.

Pros

  • This is a viable alternative for people who cannot have laser surgery.
  • This procedure prevents cataract formation.
  • This surgery can correct farsightedness and nearsightedness that laser surgery cannot treat.
  • The postoperative discomfort is typically minimal.

Cons

  • People may need glasses for close-up vision due to issues with accommodation.
  • Compared to laser surgery, clear lens extraction is more invasive.

Astigmatic Keratotomy

An opthamologist is listening to the patient in an exam room.

While LASIK has replaced this surgery for the most part, there are still instances where it is preferable over laser surgery. Doctors might recommend this procedure if you have astigmatism.

The doctor will find the cornea’s steepest part and make one to two incisions. This reduces astigmatism by creating a rounder shape of the cornea. For both eyes, it usually only takes about 10 minutes to complete this procedure.

Some people with astigmatism also have farsightedness or other vision issues. For a short while after this procedure, the other vision issues may get worse. If you want to stop wearing glasses, you might consider an additional procedure to correct your other vision issues if it is possible.

Pros

  • It is an effective astigmatism treatment.
  • You can use this procedure with other vision correction methods.

Cons

  • It is possible to experience some discomfort for up to two days.

Conductive Keratoplasty

 

This procedure is a type of refractive surgery. It is typically for people over age 40 who have farsightedness. Instead of a laser, the doctor will use low-level radiofrequency energy as the primary instrument.

The doctor will use this surgery to reshape the cornea by utilizing circular pattern on the outer elements of the cornea. The result of this is that the cornea will shrink in the small areas. By using a circular shrinkage pattern, the cornea experiences a band-like tightening. Overall, this increases the power and curvature of the cornea.

Following the surgery, you should be able to reduce your reliance on reading glasses. This is especially true for simple tasks, such as signing paperwork or reading a restaurant menu.

Pros

  • The postoperative discomfort is typically mild.
  • If retreatment is necessary, the risk is usually minimal.
  • This procedure has a strong safety profile.

Cons

Phakic Intraocular Lenses

intraocular lenses

If you have moderate to severe nearsightedness, these lenses are a possible alternative to LASIK and other laser eye procedures. In some cases, the results are more predictable and better compared to laser surgery.

The doctor will implant these lenses into the eye. This can be done behind the iris or between the iris and cornea. Your natural lens can stay in place.

Phakic lenses allow light to better focus on the retina. This results in clearer vision without having to use corrective eyewear.

Some research shows that this procedure can be just as effective as LASIK. One study concluded that both LASIK and these lenses have about the same success rate for helping people to achieve 20/20 vision one year following surgery. These results were without corrective lenses.

Pros

  • Dry eyes don’t usually occur.
  • The lenses are biocompatible.
  • They offer excellent visual quality since they maintain the natural shape of the cornea.
  • This procedure is reversible and requires no maintenance.
  • Putting the lenses into place is minimally invasive.

Cons

  • These lenses are not ideal for people over 50 or under 18.
  • You will need an annual checkup to make sure the implants are functioning properly and in the right position.

Intracorneal Rings

 

During this procedure, the doctor will place two plastic arcs into your cornea. They go opposite of each other on the outer edge. They help to flatten the cornea by stretching it.

Pros

  • This procedure is reversible.
  • This procedure may give people with progressive keratoconus more time before they need a corneal transplant.
  • Contact lenses can become more comfortable.

Cons

Radial Keratotomy

 

While now considered outdated, this was once a popular option to correct nearsightedness. However, it remains a viable alternative for people who cannot get laser surgery. To correct the issues, the doctor will cut into your cornea to reshape it to clarify your vision.

Pros

  • The procedure is fast, painless, and simple.
  • Low to moderate myopia can be eliminated or reduced.
  • The recovery period is short.
  • There are no major complications.

Cons

While laser eye surgery is popular, there are multiple other viable options. Consider the vision health issues you have to determine which laser surgery alternative may be the best choice for you.

References

 

The Basics of LASIK Eye Surgery. Federal Trade Commission.

LASIK Surgery: Is It Right for You? Mayo Clinic.

8 Reasons Lasik Eye Surgery Might Not Be Right for You. (October 15, 2018). Verywell Health.

Refractive Lens Exchange (Lens Replacement Surgery). All About Vision.

Astigmatic Keratotomy. American Academy of Ophthalmology.

Conductive Keratoplasty. University of Utah Moran Eye Center.

Phakic IOLs (Implantable Lenses). All About Vision.

Intrastromal Corneal Ring Segments (INTACS). University of Utah Moran Eye Center.

Radial Keratotomy: Pro and Con. (June 1, 1981). Ophthalmic Surgery, Lasers and Imaging Retina.