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Glaucoma and Lasik

Causes and treatment of a central island after Lasik, Bladeless Lasik, PRK, LASEK, or Epi-Lasik.

Image of smiling woman.  
Glaucoma must be managed before Lasik laser eye surgery.  

Glaucoma is a condition in which the internal ocular pressure (IOP) of the eye is elevated, causing damage to the optic nerve. The most common type of glaucoma will show no symptoms until loss of vision has started, but can be diagnosed with a complete eye examination. Glaucoma can be treated with medicated eye drops, laser surgery, and/or conventional surgery.


Glaucoma is detected by the measurement of the eye pressure, visual examination of the optic nerve during a complete eye exam, and a visual field test to determine if loss of vision has started.

Causes of Glaucoma

Aqueous humor flows into and out of the anterior chamber of the eye to bathe and nourish the intraocular structures. When a patient has glaucoma, the fluid drains too slowly out of the anterior chamber. As the fluid builds up, the pressure inside the eye rises. If the eye pressure is not controlled, damage to the optic nerve may occur, which will lead to vision loss and eventually blindness if not treated.

Lasik Concerns

Glaucoma may be a problem if you are considering refractive surgery, but different types of refractive surgery are less problematic than others. Individuals with very highly IOP or predisposed to glaucoma may not be appropriate for conventional or custom wavefront Lasik, Bladeless Lasik, or Epi-Lasik, but may be appropriate for other types of refractive surgery like PRK, LASEK, P-IOL, or RLE. While glaucoma does not automatically exclude a person from many refractive surgery techniques, glaucoma should be treated and stabilized before considering refractive surgery.

Raised IOP

During Lasik, Bladeless Lasik, and Epi-Lasik surgery, a microkeratome is affixed to the eye with suction. This suction greatly increases the IOP of the eye for a brief time. The temporarily elevated IOP may negatively affect a patient with glaucoma or someone predisposed to glaucoma. PRK, LASEK, CK, P-IOL, and RLE do not require a microkeratome and do not dramatically raise the patient's IOP. These techniques may (emphasis on "may") be appropriate for consideration.

Risk Factors

About 3 million people in the United States have glaucoma. Some risk factors for glaucoma include a family history of glaucoma, ancestry of the Negro race, high blood pressure, diabetes, smoking, advanced age, the use of corticosteroids, and previous ocular trauma. If you have been previously diagnosed with glaucoma or are a member of a glaucoma risk group, be sure to discuss with your refractive surgeon any concerns you may have regarding refractive surgery and glaucoma.

Online Glaucoma Test

An FDA approved online glaucoma test is available that you can use from your own computer to determine if you have glaucoma. Visit Online Glaucoma Test

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

Recent Glaucoma Medical Journal Articles...

Related Articles

Interface Fluid Syndrome Induced by Uncontrolled Intraocular Pressure Without Triggering Factors After LASIK in a Glaucoma Patient: A Case Report.

Medicine (Baltimore). 2015 Sep;94(39):e1609

Authors: Shoji N, Ishida A, Haruki T, Matsumura K, Kasahara M, Shimizu K

This study sought to describe a glaucoma patient with interface fluid syndrome (IFS) induced by uncontrolled intraocular pressure (IOP) without triggering factors after laser in situ keratomileusis (LASIK).Case report and review of the literature.A 23-year-old man with open-angle glaucoma underwent bilateral LASIK for myopia in 2009. Two years later, the patient reported sudden vision loss. The IOP in the right eye was not measurable using Goldmann applanation tonometry (GAT), but was determined to be 33.7 mm Hg using a noncontact tonometer. IFS was diagnosed based on the presence of space-occupying interface fluid on anterior segment optical coherence tomography images. After a trabeculectomy was performed, the IOP decreased to 10 mm Hg, and GAT measurement became possible. However, the corneal fold remained visible in the flap interface. Six months later, the IOP in the left eye increased, and a trabeculectomy was performed during the early stages of this increase in IOP. Following this procedure, the IOP decreased, and visual acuity remained stable.In glaucoma cases that involve a prior increase in IOP, IOP can continue to increase during the disease course even if temporary control of IOP has been achieved. If LASIK is performed in such cases, the treatment of glaucoma becomes insufficient because of underestimation of the typical IOP. In fact, the measurement of IOP can become difficult because of high-IOP levels. Therefore, LASIK should not be performed on patients with glaucoma who are at high risk of elevated IOP.

PMID: 26426645 [PubMed - as supplied by publisher]


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