Diabetes and LASIK

An article written in 2012 caught my attention: 1 cornea 2002;21:246–248. Lori Baker Shena, editor

In this article, it was explained based on scientific studies that there should be a yellow flag in LASIK surgery in diabetic patients. The most important of these concerns was the delay in wound healing in diabetic patients. Here are excerpts from the 2012 article:

“Prof. When Fraunfelder compared the six-month follow-up results of diabetic and non-diabetic LASIK patients, they found that while 49% of diabetic patients had complications, this rate was 6.9% in the other eyes. Corneal complications were occurring in diabetic patients.

However, after six months of follow-up, there was no significant difference in visual acuity and degrees of astigmatism between patients with and without diabetes. Diabetic patients improved within a few weeks or months with adjunctive measures such as frequent tear drops. Therefore, it is important to explain the situation thoroughly to patients with diabetes.”

Preliminary examination of diabetic patients:

Retinal problems in diabetic patients are well known. However, many clinicians are unaware that 50-75% of diabetic patients have corneal problems. These problems existed before LASIK. Therefore, a detailed examination is of great importance.

These changes in the cornea, namely point corneal disorder, recurrent erosions (superficial abrasions), corneal (clear layer in the anterior part of the eye) neovascularization, neurotrophic (due to loss of sensitivity) ulcers may not give any symptoms. This is another danger.

Mc Culley, of the University of Texas, cites a few red flags: “First, sugar has to be under control. Then, the patient should not have any eye complications related to diabetes. Such as unhealthy eye surface, cataract, retinopathy of any kind, damage to retinal vessels or new-vessel formation. If these exist, the patient is not a LASIK candidate for me.”

Another doctor, S. Durrie (Kansas), who performs LASIK on patients with controlled diabetes, says these patients require a very detailed eye scan. “ Detailed retinal examination, detailed examination of the eye surface with biomicroscope, tears and eye surface tests… We encounter high complication rates in diabetic patients with LASIK. If these preliminary examinations are done carefully, the complication rates can be reduced.”

What changed in 2019?

Dr David Evans says on April 22, 2019:

If your diabetes has lasted for a long time, laser vision increase will not be at the desired level, as you will have retinal vision loss. If sugar isn’t under control, it shouldn’t be done anyway! If sugar goes up and down, HbA1C is a valuable test. It tells us better about the sugar level of two to three months. In addition, since fluctuations in sugar level change the degree of glasses, surgery can be performed only when the sugar level is under control. PRK (an operation performed by scraping the corneal surface) is not recommended for diabetics.

LASIK causes dry eye in normal patients. This will be more severe in diabetic patients. When using artificial tear support, it is also important that these drops contain no preservatives. Otherwise, wound healing may be delayed further.

There may also be problems in the healing process: Since wound healing is delayed in diabetic patients, patients should be followed up more frequently. In addition, cortisone drops, which are used frequently in LASIK operation, can increase blood sugar when absorbed into the body. For this reason, it can be prevented from going to the tear ducts by different methods.

In our country, diabetes rates are above the world average and the young population is quite dense. Therefore, considering the demands of these patients to become LASIK candidates, the importance of sharing this information is obvious.

Let’s end our article with some other information:

You want to be LASIK : Which situations are not suitable?

  • if you are under 18

  • If your contact lens or eyeglasses number has changed in the last 6 months (Pregnancy and breastfeeding may temporarily change your number.)

  • If it interferes with your profession (some employers and professional organizations do not accept LASIK surgery. In the army, especially in positions such as diving and piloting, it is approached with caution.)

  • If you have a chronic immune system disease (lupus, rheumatic joint disease),

  • If you have uncontrolled diabetes or any disease that makes wound healing difficult.

  • If you are taking a medicine that affects vision and slows wound healing: eg retinoic acid, cortisone and other medicines that suppress the immune system.

  • If you do sports where eye injuries are common (Boxing, wrestling)

  • If you have an eye inflammation such as uveitis or iridocyclitis

  • If you have herpes simplex or herpes zoster (shingles) infection.

  • If you have glaucoma or any disease that changes the intraocular pressure.

  • If your corneal thickness is below the appropriate limit or if you have a disease in which the center of your cornea is domed outward (keratoconus).

  • If your cornea has been deformed due to trauma or previous eye surgery.

  • If your pupils are too large.

  • If you have severe dry eye disease.

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