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 the quotes from the article in 2012:

“Prof. When Fraunfelder compared the six-month follow-up results of diabetic and non-diabetic LASIK patients, they saw that there was a 49% complication rate in diabetic patients, while this rate was 6.9% in fellow eyes. Corneal complications occurred in diabetic patients.

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

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 also exist before LASIK. Therefore, a detailed examination is of great importance.

These changes in the cornea, namely punctate corneal disorder, recurrent erosions (superficial abrasions), corneal (transparent layer in the front part of the eye) neovascularization, neurotrophic (loss of sensitivity) Ulcers may not cause any symptoms. This is another danger.

Mc Culley from the University of Texas mentions a few red flags: “First, sugar must be under control. Then, the patient should not have any eye complications due to diabetes. Unhealthy eye surface, cataracts, retinopathy of any kind, damage or neovascularization of retinal vessels. If these are present, the patient is not a LASIK candidate for me.”

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

What has changed in 2019?

Dr David Evans says the following on April 22, 2019:

If your diabetes has lasted for a long time, you will have retina-related vision loss. , laser vision increase is not at the desired level. If the sugar is not under control, it shouldn't be done anyway! If blood sugar is going up and down, HbA1C is an important test. It tells us the sugar level for two to three months better. In addition, since fluctuations in sugar level change the degree of vision, surgery can only be performed when the sugar level is under control. PRK (an operation performed by scraping the corneal surface) is not recommended for diabetic patients.

LASIK causes dry eyes in normal patients. This will be more severe in diabetic patients. When using artificial tear support, it is also important that these drops do not contain preservatives. Otherwise, wound healing may be delayed even further.

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

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

Let's end our article with some other information:

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

• If you are under 18 years of age

• If your contact lens or glasses prescription has changed in the last 6 months (Pregnancy and breastfeeding, may make a temporary change in your number.) 

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

• If you have a chronic immune system disease (lupus, rheumatoid arthritis), 

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

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

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

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

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

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

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

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

• If your pupils are extremely large.

• If you have severe dry eye disease.

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