During the preliminary examination, we make sure that you are suitable for laser eye surgery.
Only then is safe, effective and lasting vision correction possible.
Here we present the most common contraindications.
If these are present, it is possible that laser eye treatment will not be possible for you. However, it is important to know that the presence of one of these factors is not a compelling reason for exclusion within refractive surgery.
Suitability must always be assessed individually by the surgeon at the laser center.

General restrictions that speak against laser eye treatment

Autoimmune diseases

Autoimmune diseases, such as rheumatoid arthritis or lupus, are diseases in which the immune system attacks the patient’s own body.
These incorrect reactions of the immune system can significantly impair the healing process after laser eye treatment. The inflammatory reactions and impaired wound healing make successful and safe laser surgery almost impossible.
For this reason, people with certain autoimmune diseases are generally advised against laser eye treatment.
Before laser eye treatment is carried out, a thorough preliminary examination is carried out.
The patient’s medical history is recorded in detail.
If an autoimmune disease is suspected or has already been diagnosed, specific blood tests and other examinations are carried out to determine the exact state of health.

Alternatives to laser eye surgery for autoimmune diseases

For patients with autoimmune diseases, there are alternative treatment methods to correct visual defects.
One option is the implantation of phakic intraocular lenses (ICL), which are inserted into the eye without altering the cornea.
These lenses offer a permanent solution for correcting visual defects and are particularly suitable for patients for whom laser treatment is not an option.
Special glasses and contact lenses can also be can still be a good option for improving vision (for short-sightedness, long-sightedness and astigmatism) without the risk of surgery.

Diabetes mellitus

Diabetes mellitus can lead to a variety of eye problems, including diabetic retinopathy and delayed wound healing.
These conditions significantly impair healing after laser eye surgery and increase the risk of complications such as infection and inadequate correction results.
Therefore, patients with uncontrolled diabetes are often advised against laser eye surgery.

What to do with diabetes mellitus to correct visual defects

For diabetics, alternatives such as the implantation of phakic intraocular lenses (ICL) are available.
This method enables safe vision correction without the risks associated with laser surgery.

Eye-specific factors as a contraindication to refractive surgery / laser eye surgery

Keratoconus – protrusion of the cornea

Keratoconus is a progressive eye disease in which the cornea gradually thins and becomes cone-shaped – protrusion of the cornea.
This structural weakness of the cornea makes laser eye treatment risky and unsuitable, as the procedure could further weaken the cornea, leading to a deterioration in vision or even serious complications.

First treat keratoconus – then LASIK & Co.

A commonly used method is corneal crosslinking, in which the cornea is strengthened with the help of riboflavin (vitamin B2) and UV light to slow or stop the progression of the disease. In addition, special rigid contact lenses or scleral lenses can help to improve vision.
In advanced cases, a corneal transplant may be necessary.
If keratoconus has been successfully treated, it may even be possible to correct visual defects through refractive surgery. Regardless of the diopters or the type of visual defect – whether astigmatism, myopia or hyperopia.
Femto-LASIK and LASEK (laser in situ keratomileusis) at the eye clinic can then be a possible treatment method.

Dry eyes and laser eye surgery

Dry eyes, also known as keratoconjunctivitis sicca, are a common contraindication for laser eye treatments.
Laser surgery can further irritate the ocular surface and exacerbate symptoms, leading to significant discomfort and prolonged healing times.
Furthermore, the precision of laser treatment can be impaired if the surface of the eye is not sufficiently wetted, which increases the risk of complications and can have a negative impact on the correction results.

Treatment of dry eyes

Before considering eye surgery, dry eyes should be treated effectively.
This may include the use of artificial tears, anti-inflammatory eye drops or omega-3 fatty acids.
In more severe cases, procedures such as punctum plugs, where the tear ducts are partially blocked to keep the tear fluid on the surface of the eye for longer, may be useful.
After successful treatment of dry eyes, suitability for laser surgery can be reassessed.

Retinal diseases / eye diseases – e.g. age-related macular degeneration (AMD)

Retinal diseases, such as diabetic retinopathy or age-related macular degeneration (AMD), affect the light-sensitive layer at the back of the eye and can lead to significant problems.
However, laser eye treatment focuses on correcting vision defects caused by changes in the cornea and cannot address these deep-seated retinal diseases.
In addition, the procedure can put further strain on the already damaged retina and lead to a deterioration in vision.

Alternatives for patients with retinal diseases

For patients with retinal diseases, there are alternative methods to improve vision.
One option is the implantation of phakic intraocular lenses (ICL), which are inserted without altering the cornea and thus minimize the risk to the retina.
In addition, special glasses or contact lenses can support vision without requiring invasive surgery.
In some cases, targeted therapies for the retinal disease itself, such as injections or laser treatments of the retina, may also be necessary to stabilize or improve vision.

Eye infections during preliminary examination speak against the procedure

Acute eye infections are a contraindication for laser eye treatments, as they can significantly increase the risk of complications and impair healing after the procedure.
An infection can lead to inflammation and scarring, which negatively affects the treatment results.
After successful treatment and complete healing of the infection, suitability for laser eye surgery can be reassessed.
It is important to allow sufficient time for recovery and to have the treatment assessed by an ophthalmologist.

Insufficient corneal thickness

A cornea that is too thin poses a considerable risk during laser eye treatment, as the laser removes corneal tissue during the procedure in order to achieve the vision correction.
This is particularly true for LASIK treatment (also with femtosecond lasers) with flaps.
With insufficient corneal thickness, this process can compromise the structural integrity of the eye, which can lead to complications such as keratectasia, a progressive thinning and deformation of the cornea that severely impairs vision.

Methods for measuring corneal thickness

The corneal thickness / corneal surface is measured by pachymetry before laser eye treatment.
This method uses ultrasound or optical coherence tomography (OCT) to determine the exact thickness of the cornea.

Treatment alternatives for thin corneas

For patients with a cornea that is too thin or an unusual curvature of the cornea, there are alternative procedures for correcting vision.
One option is the implantation of phakic intraocular lenses (ICL), which are inserted into the eye without changing the cornea.
Surface ablative procedures such as trans-PRK with excimer lasers, in which less tissue is surgically removed, can also be an option.
Patients can also stand well again afterwards without reading glasses.

Personal factors as contraindications for laser eye surgery

Age and eye development – important for laser vision correction?

In young patients whose eyes are still developing, visual acuity can continue to change, which can affect the long-term results of treatment.
Therefore, laser surgery is usually only recommended after the age of 18, when vision is stable. In older patients who may suffer from age-related changes such as presbyopia (presbyopia or presbyopia) or incipient cataracts, the results may also be less predictable.
These age-related changes may require additional procedures that are not covered by a simple laser treatment.

Suitable time slots and alternatives for different age groups

For younger patients whose visual acuity could still change, it is advisable to wait with the laser treatment until a stable visual acuity has been achieved.
In the meantime, you can wear contact lenses or glasses as a good alternative.
Older patients who suffer from age-related vision problems may benefit from other treatments such as multifocal lens implantation / lens replacement (cataract surgery).
These procedures can simultaneously correct visual defects and treat age-related changes.

Pregnancy and laser eye surgery – whether Femto-LASIK, LASEK or SmartSight

During pregnancy and breastfeeding, the body undergoes significant hormonal changes that can also affect the eyes.
These hormonal fluctuations can lead to temporary changes in visual acuity and corneal thickness.
Laser eye treatment during this time could therefore lead to inaccurate results and impair vision correction.
It is also advisable to avoid possible risks to the unborn child or breastfeeding baby, as the safety of certain medications and procedures has not been adequately studied during this particular stage of life. After pregnancy and breastfeeding, hormonal fluctuations and their effects on the eyes should have completely subsided before laser treatment is considered.
It is recommended to wait at least three to six months after weaning to ensure that visual acuity is stable and no hormone-related changes occur.

Drug influences as a contraindication for laser eye surgery

Medication that may or may not be an obstacle to laser eye surgery:

1. corticosteroids (e.g. prednisone, hydrocortisone)

• Can delay healing and increase the risk of infection.

2. immunomodulators and immunosuppressants (e.g. methotrexate, cyclosporine)

• Can impair the immune response and influence the regeneration of the cornea.

3. blood thinners (e.g. warfarin, heparin)

• Increase the risk of bleeding and can slow down healing.

4. antidepressants (e.g. fluoxetine, sertraline)

• Can aggravate dryness of the eyes and impair healing.

5. acne medication (e.g. isotretinoin)

• Can affect the regeneration of the cornea and increase the risk of eye irritation.

6. antihistamines (e.g. loratadine, cetirizine)

• Can lead to dry eyes, which can impair healing after the procedure.

7. beta-blockers (e.g. propranolol, metoprolol)

• Can influence the blood circulation and thus the healing of the eyes.