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Not a Candidate for LASIK Surgery? Explore Your Options

LASIK (laser-assisted in situ keratomileusis) is a type of laser eye surgery designed to correct myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. The procedure was invented by Dr. Gholam A. Peyman, a retina surgeon and ophthalmologist. In 1989, he was awarded the first patent in the United States.

Not everyone is a good candidate for the surgery, but the good news is there are a number of other options available if you’re not. Cornea, cataract, and refractive specialist Dr. Stephen Khachikian in Sioux Falls, South Dakota, has performed extensive research in the fields of eye disease, medical eye equipment advances, and state-of-the-art surgical techniques. If you’re looking for laser vision correction, he’s the doctor you want to see.

Who isn’t a candidate for LASIK surgery?

At your consultation, Dr. Khachikian evaluates a number of factors to determine whether LASIK is right for you. These include:

In addition, the doctor needs to consider the degree of your visual impairment. LASIK works for mild-to-severe nearsightedness and mild-to-moderate farsightedness and astigmatism.

If you don’t meet one or more of these criteria, you’re not a good candidate, and you’ll need to explore other options.

What alternatives are there to LASIK?

There are a number of alternatives for correcting eyesight if you’re not a good candidate for LASIK, including:

Photorefractive keratectomy (PRK)

With the PRK procedure, Dr. Khachikian doesn’t make the corneal flap used in LASIK. Instead, he removes the top layer of tissue from the cornea, known as the epithelial tissue layer, to access the cornea itself and reshape it with a laser.

By bringing the cornea back to a more spherical shape, PRK corrects nearsightedness, farsightedness, and astigmatism. If you have presbyopia — focus problems with close-up vision that arise as you age — you may still need to use reading glasses after the procedure.

In some cases, though, the doctor may recommend a corneal implant like KAMRA® to correct your presbyopia at the same time you undergo PRK surgery. 

Another possibility is monovision PRK. This technique works well for multiple vision problems because the doctor optimizes each of your eyes for a different distance, and your brain learns to integrate the different signals coming from each eye

The recovery period is slightly longer for PRK than for LASIK, with a maximum of 4-5 days. One week after the surgery, Dr. Khachikian removes the contact he placed over the cornea as a bandage, because at that point the epithelium has largely regenerated.

PRK is very effective. According to the American Academy of Ophthalmology, 90% of PRK patients obtain 20/40 or better vision after their surgery.

Phakic intraocular lenses (IOLs)

This procedure is designed for people who have high degrees of refractive errors that aren’t able to be corrected safely with corneal-based refractive surgeries like LASIK and PRK. 

Dr. Khachikian surgically implants the phakic IOL, an implantable contact lens, inside the eye in front of the eye's natural lens and either in front of or behind the iris. The natural lens isn’t removed, so you can keep your pre-existing ability to focus. Once the IOL is properly positioned, it corrects incoming light rays and redirects them precisely onto the retina.

Refractive lens exchange (Clear Lens Extraction)

With the RLE, the doctor removes your eye’s natural lens and replaces it with an artificial one to improve vision; in that sense, it’s a lot like cataract surgery. RLEs can include multifocal or accommodative IOLs, which allow you to focus at all distances.

RLEs are also options for those with severe hyperopia (farsightedness), for which LASIK is not recommended. We should note that RLE is not FDA-approved; however, ophthalmologists can legally perform this surgery in what’s known as an “off-label” use.

If you’re not a good candidate for LASIK but still want to improve your vision, you have options. Contact the office of Dr. Khachikian to set up a consultation by calling us at 605-203-4268 or by booking online.

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