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How old do I have to be to get LASIK?

By Joel Hunter, MD | 6/19/17 7:26 AM
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LASIK should be a permanent solution to a temporary problem. That self-referential declaration really falls apart if the problem isn’t temporary. If the problem persists, then you’ve got a bad deal with LASIK. That’s because you end up with a temporary solution to a permanent problem. This is what happens when LASIK is done without being honest or exacting enough in pre-operative testing. This is true at any age, but it is probably the most relevant when discussing LASIK candidacy during the flower of youth. How do you know if you fall within that age group? A simple test is to note what reaction you had when you read the phrase “flower of youth.” If you said, “This dude is lamer than fidget spinners, which I deeply loved two weeks ago, and now make fun of,” then you have tested positive for being young.

LASIK has been performed on younger patients down to the age of 16 with stable results when pre-operative testing is stellar and thorough. Pretty much everyone in refractive surgery agrees, however, that 16 is too young to get LASIK. The main reason is the rigorous detail necessary in past ocular history, imaging diagnostics, and refractive surgeon expertise in interpreting those is so rare. When you’re setting up guidelines and safety barricades, you do it with the people in mind who are likely to walk off the cliff. For that reason, the youngest age most refractive surgeons will consider LASIK is 18. The main reason is how dramatically different the percentage is of patients whose eyes have reached a stable prescription. At 18, it’s probably about 95% of people whose eyes have stopped changing.

The percentage of patients who are good LASIK candidates at 18, however… that number should be much, much lower if you’re doing things right. Why the difference? It’s because there are a lot of other factors involved in determining if someone is a safe and good-for-the-long-haul LASIK candidate. These involve specifics with a lot more nuance and detail than just the stability of a prescription. There are two possible consequences of getting LASIK in an effort to permanently fix a stable prescription, but overlooking the other pertinent details of LASIK candidacy for young eyes. The first is that you end up in glasses again because a variable shows up (it was always there, but it got overlooked) changing the eye in a way not accounted for. The second (and much worse) outcome is that you find yourself with vision that can’t be corrected very well even with a pair of glasses. It’s a miserable, but absolutely possible outcome to wish you saw as well as you did with glasses and contacts. Luckily, there are ways to avoid it.

With eyes from age 18 to 21, the standards for good LASIK candidacy are much, much more strict. From age 22-25, the standards are just more strict. While it’d be nice to give some round figure like “the standards are three times as strict,” it would be oversimplifying it.

There are specific numbers involved, but they have to do with pachymetric corneal thickness measurements and ratios of corneal curvature at different points x number of millimeters apart and so on. Beyond all that, the topographic and volumetric maps—in all of their variegated beauty—paint a picture that only tell a story if you’re willing to spend years learning them instead of having a normal social life. These details matter a tremendous amount and have to be analyzed with a deeply suspicious mindset when you’re determining whether someone younger than 25 can have LASIK.

The reason isn’t that people who are younger are more likely to have problems with their cornea. For most pathologies, it’s actually the opposite. The real reason is that a problem, genetic or acquired, that would show up in an obvious, punch-you-out-of-your-chair way for a 38-year-old might be barely recognizable in someone who’s young. The manifestation hasn’t had time to mature and make itself seen. So to examine these eyes with the care they require, every molehill must be made into a mountain.

So how old do you have to be to get LASIK? Here’s the most accurate answer I can give: when your eye has made it sufficiently obvious it will be a safe, predictable, permanent result, then LASIK might be a great option. For eyes where the testing is flawless, it can be as young as 18 years old. I had one patient for whom I did LASIK on his 18th birthday. He had the eyes of a nearsighted Superman on testing. For the rest of us mortals, it is worth it to find a refractive surgeon who cares about you enough to tell you “wait” if you should. It’s worth checking though, because the answer could be “yes!” It may be that LASIK can help you even in the flower of youth.



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