Keratoconus is a progressive thinning and protrusion of the cornea that leads to irregular astigmatism and visual distortion.
Because laser surgery removes tissue from the cornea, performing LASIK in keratoconus significantly increases the risk of postoperative ectasia.
Multiple studies document severe corneal destabilisation when LASIK was performed in eyes later recognised to have keratoconus. ¹ ²
Professional guidelines consistently list keratoconus as a contraindication for laser refractive surgery. ³
Even mild cases, or cases corrected well by glasses, represent structural weakness.
The issue is not visual acuity on the day of assessment. It is long-term biomechanical endurance.
In these patients, protecting the cornea may include cross-linking, rigid lenses, or non-corneal refractive options, but never corneal tissue removal.
Saying no in keratoconus is not conservative.
It is evidence-based.
References
- McLeod SD, Kisla TA, Caro NC, McMahon TT. Keratectasia after laser in situ keratomileusis. J Cataract Refract Surg. 2000;26(7):958-963.
- Randleman JB, Woodward M, Lynn MJ, Stulting RD. Risk assessment for ectasia after corneal refractive surgery. Ophthalmology. 2008;115(1):37-50.
- American Academy of Ophthalmology Refractive Surgery PPP Panel. Refractive Surgery Preferred Practice Pattern®. Ophthalmology. 2017;124(1):P1-P104.
Related Topics
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- Why Thin Corneas Can Make Laser Eye Surgery Unsafe
- Percent Tissue Altered (PTA): The Biomechanical Threshold That Can Rule Out LASIK
- Why Normal Topography Isn’t Always Enough to Clear You for Laser Eye Surgery
- Keratoconus: Why Laser Eye Surgery Is Contraindicated
- Subclinical Keratoconus: When a Borderline Scan Still Means No
- Can I Have Laser Eye Surgery If I Have Dry Eyes?
- Severe Dry Eye and LASIK: When Symptoms Make Surgery Too Risky
- Is My Prescription Too High for Safe Laser Eye Surgery?
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- Laser Eye Surgery and Retinal Disease: When We Must Defer
- Why Active Macular Pathology Is a Red Flag for Laser Vision Correction
- Am I Too Young for Laser Eye Surgery? Understanding Age and Prescription Stability
- Unstable Refraction: Why We Often Say “Not Yet”
- Is Laser Eye Surgery Safe If You Play Contact or Combat Sports?
- LASIK and High-Impact Jobs: When Trauma Risk Tips the Balance
- Large Pupils, Night-Time Halos and LASIK: When We Advise Against Surgery
- Autoimmune Disease, Systemic Medications and LASIK: Who Should Not Proceed?
- I Was Told I’m Not Suitable for Laser – What Safe Alternatives Do I Have?
- Why a Perfect Eye Test Doesn’t Guarantee You’re Suitable for Laser
- Is My Prescription Still Changing? Why Stability Matters Before Laser Eye Surgery
- Pregnancy, Breastfeeding and Laser Eye Surgery: Why We Defer
- Monocular Patients: When One Seeing Eye Changes the Threshold
- Previous Corneal Surgery: Why Prior Procedures Change Suitability
