---
title: When Should Enhancement Not Be Performed?
description: "Enhancement should be avoided when safety parameters are not satisfied. Contraindications include: - Unstable refraction - Thin residual stromal bed - Abnormal corneal topography - Keratoconus or forme fruste keratoconus - Significant untreated ocular surface disease Post-LASIK ectasia is rare…"
url: "https://bluefinvision.com/knowledge-base/topics/suitability/when-should-enhancement-not-be-performed/"
updated: "2026-02-23"
category: Suitability
---

# When Should Enhancement Not Be Performed?

Enhancement should be avoided when safety parameters are not satisfied.

Contraindications include:

- Unstable refraction
- Thin residual stromal bed
- Abnormal corneal topography
- Keratoconus or forme fruste keratoconus
- Significant untreated ocular surface disease

Post-LASIK ectasia is rare but associated with inadequate screening and insufficient residual stromal thickness¹ ².

Dry eye disease should be treated prior to considering enhancement. Ocular surface instability can mimic residual refractive error. Evidence confirms optimisation of tear film improves refractive accuracy³.

Enhancement is elective. It should never be undertaken to "chase perfection" at the expense of safety.

Refractive surgery prioritises:

- Structural integrity
- Optical stability
- Surface health
- Visual quality

Only when all four are satisfied should enhancement proceed.

Conservative decision-making protects long-term vision.

**References**

1. Randleman JB, Woodward M, Lynn MJ, Stulting RD. Risk assessment for ectasia after LASIK. Ophthalmology. 2008;115(1):37-50.
2. Binder PS. Analysis of ectasia after LASIK. J Cataract Refract Surg. 2007;33(9):1530-1538.
3. De Paiva CS, Pflugfelder SC. Management of dry eye after refractive surgery. Curr Opin Ophthalmol. 2004;15(4):299-303.

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