The LASIK consultation is the mandatory first step for anyone considering laser vision correction. It is a detailed evaluation designed to determine with high precision whether a patient is a suitable and safe candidate for the procedure. This appointment typically takes between two to three hours, involving numerous diagnostic tests that go far beyond a routine eye exam. The goal is to gather specific data about the eye’s anatomy and overall health to ensure the safety and success of the potential surgery.
Reviewing Medical History and Vision Acuity
The consultation begins with a thorough review of the patient’s general health and medical history, as many systemic conditions can affect surgical outcomes. Autoimmune disorders, such as rheumatoid arthritis or lupus, and uncontrolled diabetes are carefully noted because they can compromise the healing process after surgery. Current medications, including both prescription and over-the-counter drugs, are also discussed, as some may contribute to conditions like dry eye, a common post-LASIK concern.
A discussion about prior eye surgeries or existing eye conditions, like chronic dry eye or glaucoma, is also part of this detailed intake. Patients who wear contact lenses are typically instructed to stop wearing them for a specified period—often days for soft lenses and weeks for rigid gas permeable lenses—before the consultation. This temporary removal is necessary because contact lenses can temporarily alter the natural shape of the cornea, which would skew the precise measurements required for surgical planning.
Following the historical review, basic vision tests are performed to confirm the refractive error. This includes a refraction test to determine the exact degree of nearsightedness, farsightedness, or astigmatism. Visual acuity is also measured by having the patient read an eye chart, both with and without corrective lenses. This step ensures the patient’s prescription has been stable for at least 12 months, a fundamental requirement for candidacy, and establishes the best possible vision achievable with correction.
Detailed Corneal Mapping and Eye Health Screening
The most specialized part of the consultation involves advanced diagnostic imaging focused on the cornea, the clear front surface of the eye that the laser will reshape. Corneal topography is performed using a non-invasive instrument that projects light rings onto the cornea, generating a detailed, color-coded map of its curvature and shape. This map allows the surgeon to identify subtle irregularities, such as early signs of keratoconus, a progressive thinning disorder that would disqualify a patient from LASIK.
Another specialized measurement is pachymetry, the precise measurement of corneal thickness, typically recorded in micrometers. The average central corneal thickness is around 550 micrometers, and a minimum residual stromal bed thickness, often 250 micrometers or more, must remain after laser ablation to maintain structural integrity. Pachymetry is foundational because removing too much tissue from a thin cornea can lead to a complication called ectasia.
The consultation also includes measuring the patient’s pupil size in low-light conditions, often using infrared technology. A larger pupil size, generally over six millimeters, necessitates a larger treatment zone to minimize the risk of nighttime visual disturbances, such as halos or glare. To evaluate the internal structures of the eye, a comprehensive check is performed, which often requires dilating the pupils with drops.
Dilation allows the doctor to thoroughly examine the retina and the optic nerve at the back of the eye, checking for any underlying conditions that could affect surgical eligibility. Conditions like glaucoma, severe cataracts, or retinal tears must be ruled out because LASIK should only be performed on healthy eyes. Tear film analysis is also conducted to assess the quality and volume of tear production, which helps identify or manage pre-existing dry eye before the procedure.
Candidacy Determination and Next Steps
Once all the diagnostic data has been collected, the doctor reviews the findings and determines the patient’s official candidacy status. The synthesis of all measurements, including the stability of the prescription, the sufficiency of corneal thickness, and the overall health of the internal eye structures, leads to a definitive recommendation. If a patient does not meet the criteria for LASIK, the doctor will discuss alternative refractive procedures, such as Photorefractive Keratectomy (PRK) or Small Incision Lenticule Extraction (SMILE).
A mandatory part of this final discussion is a detailed review of the potential risks associated with the procedure. Common risks, including the possibility of temporary or persistent dry eye, the occurrence of night vision symptoms like halos or starbursts, and the rare need for a future enhancement procedure, are explained clearly. The doctor sets realistic expectations for the patient’s post-operative visual outcome based on their specific measurements and prescription strength.
The consultation concludes with an opportunity for the patient to ask any remaining questions about the procedure or recovery. Logistical details are then addressed, covering the scheduling of the surgery and required pre-operative instructions, such as the use of specific medicated eye drops. Financial aspects, including the total cost and available payment plans, are reviewed.