Can You Get LASIK With Keratoconus?
No — and this is one of the few genuinely absolute answers in eye care. LASIK is contraindicated in keratoconus. A reputable surgeon will decline to operate, and if one offers, that is a reason to get a second opinion rather than a booking.
This page explains why the answer is so firm, what happens when the rule gets broken, and what actually restores vision in a keratoconic eye.
Why LASIK and keratoconus do not mix
LASIK corrects vision by removing corneal tissue. A flap is lifted, a laser ablates tissue from the bed underneath to reshape the surface, and the flap is replaced. It works because a healthy cornea has structural strength to spare.
Keratoconus is a disease of exactly that structural strength. The cornea thins and the collagen scaffolding that holds its shape weakens, which is why it bulges into a cone in the first place.
So the two are in direct conflict: LASIK removes tissue from a cornea that is already too thin, and weakens a structure that is already failing. It is not a matter of degree or of finding a careful enough surgeon. The procedure’s mechanism is the thing the disease cannot tolerate.
What happens if it is done anyway: post-LASIK ectasia
When LASIK is performed on a cornea with keratoconus — usually because the keratoconus was subclinical and missed at screening rather than knowingly ignored — the result can be post-LASIK ectasia.
The cornea, further weakened by tissue removal, steepens and bulges progressively. Vision that may have been briefly good after surgery deteriorates, often over months to a few years, and glasses stop correcting it.
The cruel part is that ectasia is generally harder to manage than the original keratoconus. The cornea now has a flap interface, a thinner bed, and often a more irregular shape than it started with. Fitting it is more complex, and the patient has usually lost time and money getting there.
This is the single strongest argument for thorough pre-operative screening, and it is why the screening question matters far more than most patients realise.
Subclinical keratoconus is the real risk
Most people who end up with post-LASIK ectasia did not know they had keratoconus. They had forme fruste or subclinical keratoconus — corneal changes present but not yet causing obvious symptoms, and not detectable on a standard eye exam or a refraction.
What detects it is imaging: corneal topography, which maps the curvature of the front surface, and tomography, which adds thickness and the back surface. Those maps show patterns — inferior steepening, asymmetry between the two eyes, a thin point that is off-centre — that a prescription check cannot.
Reasonable things to ask before any refractive surgery:
- Was corneal topography or tomography performed, and what did it show?
- Is there asymmetry between my two eyes?
- Does anyone in my family have keratoconus?
- Do I rub my eyes frequently? (Worth raising yourself if so — it is the most consistently reported association in the keratoconus literature, with pooled odds around six and a half times higher.)
A surgeon declining to operate after seeing your scans is doing their job correctly. That is a good sign about the practice, not a setback.
What about PRK, SMILE, or other procedures?
PRK removes the epithelium instead of creating a flap, but it still ablates corneal tissue. The structural objection is unchanged, so it is not a workaround.
SMILE removes a lenticule of tissue through a small incision. Again — tissue removal from a cornea that cannot spare it.
The pattern is consistent: any procedure whose mechanism is taking tissue away runs against what keratoconus is.
What cross-linking is, and what it is not
Corneal cross-linking is frequently confused with refractive surgery, and the distinction matters.
Cross-linking uses riboflavin drops and ultraviolet light to strengthen the bonds within the cornea. Its purpose is to stop the disease progressing. It is not a vision correction — most patients still need a lens afterwards, and that is the expected result rather than a failure.
Some corneal surgeons combine cross-linking with a limited topography-guided procedure in carefully selected cases, aiming to reduce irregularity as well as stabilise the cornea. That is an individual decision made by a surgeon on a specific cornea. It is not a general rule and should not be assumed to apply to you.
Dr. Kresch is an optometrist and does not perform cross-linking. What we do is the imaging that establishes whether you are progressing, and the lens fitting once the cornea has settled — see vision after cross-linking.
What actually restores vision in keratoconus
Since the surgical route is closed, the question becomes what does work. The answer is a lens that does optically what surgery cannot do structurally.
A scleral lens vaults over the cornea entirely and rests on the white of the eye. Tears fill the space underneath, and the smooth front surface of the lens replaces your irregular cornea as the eye’s main refracting surface. The distorted shape is still there — light simply stops having to pass through it unaided.
That is why patients whose vision cannot be corrected past a blur in glasses often read comfortably in a scleral lens. It is also why “nothing more can be done” is usually a statement about glasses rather than about the eye.
Other options exist depending on the cornea — rigid corneal lenses, hybrids, piggyback systems. Which one suits you depends on your corneal shape and stage, not on which is newest.
If you were told you are not a LASIK candidate
For a lot of people, that phone call is how they find out they have keratoconus at all.
It is disorienting news delivered in the least helpful possible setting — you went in hoping to stop wearing glasses and left with a diagnosis. But being turned down for LASIK because of corneal imaging means two useful things happened: something real was caught, and it was caught before anyone operated on it.
The next steps are not dramatic. Find out whether it is progressing, which takes serial imaging over months. Stabilise it if it is, through a corneal surgeon. Correct the vision with a lens designed for an irregular cornea. Most people do well.
Told you are not a LASIK candidate?
Dr. Shira Kresch, OD, MS, FAAO sees patients across Metro Detroit at our Southfield office. A first specialty consultation is free and includes corneal topography, so you leave knowing what your corneas actually look like and whether anything is changing.
Frequently Asked Questions
- Can you get LASIK if you have keratoconus?
No. LASIK is contraindicated in keratoconus and reputable surgeons will decline it. The procedure works by removing corneal tissue to reshape the surface, and a keratoconic cornea is already too thin and structurally weak. Removing more can accelerate the thinning into post-LASIK ectasia, which is harder to manage than the keratoconus you started with.
- What if I already had LASIK and then developed keratoconus?
What usually happens in that situation is post-LASIK ectasia rather than keratoconus appearing independently — often because subclinical keratoconus was present but not detected before surgery. It is managed much the same way: establish whether it is progressing, consider cross-linking with a corneal surgeon if it is, and correct the vision with a specialty lens. See post-surgical ectasia.
- Can you get LASIK after cross-linking?
Cross-linking stabilises the cornea, but it does not make a keratoconic cornea a candidate for tissue removal. Some surgeons combine cross-linking with a limited surface procedure in carefully selected cases, which is a decision for a corneal surgeon on an individual cornea \u2014 not a general rule, and not something to assume applies to you.
- What about PRK instead of LASIK?
PRK avoids the flap but still removes corneal tissue, so the same structural objection applies. It is not a workaround for keratoconus.
- Is there any laser surgery that helps keratoconus?
Cross-linking uses ultraviolet light rather than a laser to cut, and its purpose is to stop progression rather than to correct vision. Some surgeons perform topography-guided procedures alongside cross-linking in selected cases to reduce irregularity. Neither is a substitute for a lens, and both are decisions for a corneal surgeon.
- How do I know if I have keratoconus before refractive surgery?
Corneal topography, and ideally tomography, which map the shape and thickness of the cornea rather than just measuring your prescription. A standard eye exam and a refraction cannot rule out early keratoconus. Any surgeon offering LASIK should screen for it; if you have a family history, worsening astigmatism, or you rub your eyes a lot, it is reasonable to ask directly what the screening showed.
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Michigan Contact Lens fits scleral and specialty lenses for keratoconus, irregular corneas, corneal transplants, and severe dry eye.