Psoriasis: LASIK or PRK?

If you are thinking about having Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL eye surgery, this is the forum to research your concerns or ask your questions.

Psoriasis: LASIK or PRK?

Postby MarkD » Sun Sep 09, 2007 7:58 pm

Excellent Forum! I'm contemplating LASIK or PRK but have a concern or two (just like everyone else posting here!):

OD -1.00 -1.25 093
OS -1.00 -1.00 087

Minor myopia, some astigmatism, all in all means I need to wear glasses from morning alarm clock to lights out at night. I'm 35 and have been wearing glasses since I was 24. I'm an avid skier and my goal is to ski without glasses.

Anyway, I have psoriasis as well as psoriatic arthritis. My arthritis is very much under control with a once a week injection of Enbrel. My skin condition is actually doing very well right now due to the Enbrel, but in general psoriasis has good days and bad days.

I've done 2 consults with surgeons and while both believe I'm a candidate for laser correction, they differed on the exact treatment:

One doctor recommended the PRK route just to be 100% cautious. He said I'd do fine with LASIK, but was worried if years down the road my disease could go through a rough period and lead to flap complications. I don't know nearly enough about the interaction of psoriasis and the eyes, so I'm not sure if there is actually a concern here. Honestly, I'm concerned that the doctor didn't know either, and automatically moves people to PRK if they aren't ideal for LASIK.

Second doctor recommended LASIK as the healing time was faster and therefore there was a much smaller window in time where we needed to worry about my skin disease doing something unexpected. During that window the combination of Enbrel plus an oral steroid should keep my immune system in check. He was not worried at all about future flap issues related to psoriasis. Personally I connected with this doctor a bit more, and was swayed by the fact that he personally had LASIK done, and he's got psoriasis.

Anyone else with psoriasis that can share the advice they received?

Thanks,
Mark
MarkD
 
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Postby LasikExpert » Tue Sep 11, 2007 2:25 am

I can find nothing in the medical literature that directly relates to psoriasis and Lasik, but systemic autoimmune diseases such as arthritis are a contraindication for elective surgery and my research found several reported cases of uveitis related to psoriatic arthritis (PsA), dry eyes, and corneal epithelium problems. Although I'm sure surgeons will provide Lasik or PRK to a patient who has controlled PsA and psoriasis (with massive quantities of legal releases), you want to keep things in perspective.

The most you can expect from Lasik or similar vision correction surgery is the convenience of a reduced need for corrective lenses. To achieve that convenience, you must accept some risk. Your risk is elevated. Perhaps not so much directly related to the surgery, but certainly elevated to the potential long-term consequences of your existing conditions. Also, your benefit is limited. You have relatively low refractive error (although your astigmatism is moderately high). Your benefit does not seem so great, but your risk is elevated.
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Postby MarkD » Tue Sep 11, 2007 4:56 am

Glenn - Thanks for the help. Some of the psoriasis sites out there have lots of discussions about whether to get laser correction or not, but I haven't been able to find any info specific to procedures and psoriasis.

Any thoughts about getting 1 eye done, and then allowing some time to pass before doing the second eye (maybe >4 weeks)? With my low prescription this might be something I could tolerate, and it could help to mitigate my personal risks. Probably a question I'll pose back to the surgeons.

Thanks,
Mark
MarkD
 
Posts: 10
Joined: Sun Sep 09, 2007 4:39 am
Location: Hudson, NH

Postby LasikExpert » Tue Sep 11, 2007 4:54 pm

From what I have researched, I doubt that a psoriasis related problem would be emergent and occur during surgery or during the immediate postoperative period. It seems more likely that you would have some other problem that is related to the psoriasis or the PsA that is exacerbated by previous surgery. A systemic autoimmune disorder can respond to surgery - which the body considers a traumatic event - in unpredictable ways. It is that lack of predictability that concerns me most. You really don't know what is going to happen until after it occurs, and even then you may not know if it was due to the surgery or due to the psoriasis or due to the PsA. We know that it is possible to have uneventful Lasik if you have psoriasis or PsA, but we don’t know the predictability of surgery being uneventful.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
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Posts: 3309
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Location: California


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