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LASIK and Problems of the Retina

Problems of the retina almost always pose an elevated risk for refractive surgery patients. Vision loss associated with retina conditions are not refractive errors and therefore cannot be corrected by refractive surgery. However, refractive error can exist along with retina conditions, further limiting eyesight, and in many cases vision can be significantly improved, even if for a limited time, by refractive surgery. Procedures such as LASIK use a suction ring and temporarily increase intraocular pressure, which is not advisable for most people with retina conditions. There are alternative refractive surgeries which are appropriate in some cases.

High myopia and retinal detachment
The shape of the eye in people who are nearsighted (myopic) naturally creates pressure inside of the eye which pulls on the retina and increases the risk of detachment. The greater the myopia, the more likely that retinal detachment will occur. Severe myopia can mean that, even with corrective lenses, eyesight is poor. Refractive surgery is often the only way to achieve acceptable best corrected vision. Procedures, such as LASIK, which involve the use of a suction ring can cause the retina to detach in people who already have an elevated risk of detachment. Alternative refractive procedures, such as PRK or LASEK, should be considered.

Macular degeneration
Macular degeneration causes the loss of central, but not peripheral vision. It is the deterioration of the macula, the center of the retina. Vision loss caused by macular degeneration is not refractive error, and therefore cannot be corrected by refractive surgery. The condition typically occurs in people 65 or older. Refractive surgeries, such as LASIK, which involve the use of a suction ring and temporarily increase pressure inside the eye (IOP), can worsen macular degeneration.

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Diabetic retinopathy
Diabetic retinopathy damages and weakens the blood vessels which supply the retina. Refractive surgeries, such as LASIK, which involve the use of a suction ring can cause further damage to these weak blood vessels, and should be avoided. Refractive surgery which does not raise IOP may be safe a safe alternative, but for some, no refractive surgery is safe.

Artery Occlusion
When an artery leading to the retinal is blocked, usually by a blood clot, the retina is damaged due to lack of oxygen. Vision loss is sudden and painless. If the central retinal artery is affected vision loss is total. If the affected artery is one that branches off of the central artery partial vision loss occurs. Refractive surgery cannot correct vision loss caused by retinal artery occlusion.

Central Serous Chorioretinopathy (CSCR)
CSCR is much like a blister and forms on the macula. The cause is uncertain, but it seems to be stress-related. It typically occurs in people between the ages of 25 and 50 and is more common in men than women. In most cases SCR will heal on its own. In some it will result in permanent, but not severe, vision loss.

Ocular Histoplasmosis
Histoplasmosis is caused by a fungus. It can create inflammation and scarring of the retina, but in most people it does not have a noticeable effect on vision. In people with ocular histoplasmosis, LASIK can trigger choroidal neovascularization.

Retinitis Pigmentosa (RP)
RP is the degeneration of the rods of the eye, damaging peripheral and night vision, often causing glare and loss of contrast sensitivity. Because refractive surgery can sometimes cause some of the same problems, it can worsen the problems associated with RP. RP does not automatically mean that you cannot have refractive surgery, but depending on your individual circumstances, your ophthalmologist may advise against it.

If you have a condition of the retina and are considering LASIK to improve vision, talk to your ophthalmologist about the benefits, risks, and alternatives today.

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