Laser Vision Correction for People with High Levels of Astigmatism

Understand the risks and benefits associated with laser vision correction procedures such as LASIK or PRK for people with high levels of astigmatism. Learn about regulations for pilots considering LASIK surgery.

Laser Vision Correction for People with High Levels of Astigmatism

People with a high degree of myopia or farsightedness along with astigmatism have less predictable outcomes when considering laser vision correction procedures such as LASIK or PRK. The results depend on refractive error and other factors, and those with mild myopia tend to have more success. LASIK (laser in situ keratomileusis) is a surgical procedure designed to correct refractive errors. It involves creating a corneal flap using a microkeratome or a femtosecond laser, remodeling the cornea with an excimer laser to remove tissue from the underlying stromal bed, and then replacing the flap.

Pilots considering LASIK surgery should measure the size of their pupils in the dark, preferably with one of several infrared-based measuring devices. A very large pupil size (7.5 mm or more in the dark) may suggest an increased risk of having changes in the halo and night vision after LASIK surgery. Older adults may opt for monovision to maintain their ability to see objects up close. Irregular astigmatism is more difficult to treat with refractive surgery and LASIK is generally not an option.

Correcting high myopia may present a greater risk of ectasia after LASIK and a decrease in vision quality in some patients. Before undergoing LASIK surgery, it is important to understand the risks and benefits associated with the procedure. Eye trackers and iris recording technology are increasingly being used to ensure well-focused laser treatment. FemtoLASIK is a type of LASIK surgery to correct vision problems, which involves remodeling the cornea with a laser.

The possible advantages of LASIK over PRK include earlier postoperative stabilization and faster improvement in visual acuity; less postoperative discomfort for the patient; a shorter duration of use of postoperative medications; and a simpler improvement procedure. Over time, refraction may slowly worsen with age, and your vision may not be as good as it was right after surgery. Commercial carriers and pilot unions have different regulations for their pilots regarding LASIK surgery. It is important to understand these regulations before making any decisions about undergoing the procedure.

Ultimately, it is up to the surgeon and patient to decide if LASIK surgery is indicated based on a comprehensive preoperative evaluation and on consideration of objectives and alternatives, such as glasses, contact lenses, and the implantation of phachic intraocular lenses.