Are You a Good Candidate for LASEK? Checklist and Red Flags

If you’ve been thinking about permanent vision correction, LASEK is probably one of the treatments you’re researching. It’s a popular alternative to LASIK especially for people who’ve been told they aren’t suitable for flap-based surgery. But even though LASEK is more flexible, it still isn’t right for everyone.

So how do you know if you’re a good candidate for LASEK? And what red flags would make a surgeon hesitate or recommend another option instead?

In this guide, I’ll break down the essential signs that make someone suitable for LASEK, the situations where surgeons may advise against it, and what really happens during a professional eye suitability assessment. By the end, you’ll have a clear idea of whether LASEK is worth exploring and whether your eyes are likely to qualify.

What Is LASEK and How Is It Different From LASIK?

Before we look at candidate suitability, it helps to understand what makes LASEK unique.

LASEK

• No corneal flap is created.
• The surface epithelium is loosened, moved aside, and replaced after laser reshaping.
• Healing is slower, but the structure of the cornea remains intact.

LASIK

• A flap is created in the cornea.
• Laser reshaping happens under the flap.
• Healing is faster, but flap-related risks exist.

Why this matters for suitability

Because LASEK preserves the corneal surface, it’s often chosen for people with thin corneas, dry eyes, active lifestyles, or borderline measurements cases where LASIK might not be safe.

If you’ve been told LASIK isn’t ideal for you, LASEK could still be a strong option. But the only way to know for sure is by understanding the main eligibility factors.

Checklist: Signs You May Be a Good Candidate for LASEK

Here are the strongest indicators that LASEK might be suitable for you.

You’re 18 Years or Older With a Stable Prescription

Age matters but prescription stability matters even more.

Good Candidate If:

• You’re aged 18 or older.
• Your prescription hasn’t changed significantly in the last 12 months.
• Your optician confirms no major fluctuations.

Red Flag If:

• You’re under 18 (vision typically still changes).
• Your prescription is still shifting.
• You’re pregnant or breastfeeding (temporary vision changes are common).

Your surgeon needs to confirm stability before recommending LASEK because operating on a changing prescription reduces long-term accuracy.

You Have a Suitable Prescription Range

LASEK can correct:

• Short-sightedness (myopia)
• Long-sightedness (hyperopia)
• Astigmatism

It works well for a broad range of prescriptions, but extremely strong or unstable prescriptions may require alternative treatments.

Good Candidate If:

You fall within the treatable range based on corneal thickness and eye health.

Red Flag If:

You have very extreme prescriptions that require additional laser strength or carry higher risks.

Your surgeon will assess how much cornea needs reshaping and whether LASEK can do it safely without compromising long-term stability.

You Have Thin Corneas (LASEK’s Biggest Advantage)

This is where LASEK often shines. Many people with thin corneas are unsuitable for LASIK because flap creation requires sufficient corneal thickness.

Good Candidate If:

• You’ve been told LASIK isn’t suitable due to thin corneas.
• You want a safer alternative that doesn’t involve flap creation.

Red Flag If:

• Your corneas are extremely thin.
• You show signs of early keratoconus or corneal weakness.

In borderline cases, your surgeon may steer you toward treatments like PRK, SMILE, or crosslinking instead.

You’re Worried About Flap-Related Risks

Because LASEK doesn’t involve a flap, it eliminates risks like:

• Flap displacement
• Flap wrinkles
• Trauma-related complications (especially in contact sports)

Good Candidate If:

• You play sports like boxing, rugby, hockey, martial arts.
• You work in environments where eye injury is possible.
• You simply prefer a flap-free procedure.

Red Flag If:

• You require extremely rapid recovery for work (pilots, emergency responders, surgeons).

LASEK recovery takes longer but long-term stability can be stronger for certain patients.

You Experience Dry Eyes or Are Prone to It

Dry eyes are one of the most common reasons LASIK isn’t recommended.

Because LASIK cuts corneal nerves during the flap process, it can worsen dryness for some people. LASEK avoids this by keeping the deeper corneal structure untouched.

Good Candidate If:

• You suffer from mild to moderate dry eye.
• You’ve been told LASIK may worsen your symptoms.

Red Flag If:

• You have severe dry eye disease that isn’t well-controlled.

Your surgeon will assess your tear film before making a recommendation.

You Prefer a Procedure With Lower Long-Term Risk

LASEK tends to have fewer long-term risks than LASIK for patients with borderline corneal measurements.

Good Candidate If:

• You want a highly stable outcome.
• You’re comfortable with slower healing.
• You want minimal risk of post-operative complications.

Red Flag If:

• You want immediate vision results.
• You can’t take time off for a few days of healing.

LASEK requires more patience but many people find the long-term benefits worth it.

You Don’t Mind a Slightly Longer Recovery

You need to be realistic about healing time.

Good Candidate If:

You can take a few days off work and avoid bright light for a while.

Red Flag If:

You have a work schedule that requires instant visual clarity (e.g., drivers, surgeons, emergency responders).

You Have Realistic Expectations

LASEK cannot guarantee perfect vision for every person, and natural ageing still affects your eyesight later in life.

Good Candidate If:

• You’re aiming for significant improvement.
• You understand that enhancements may sometimes be needed.
• You’ve researched how your vision may still change over time.

Red Flag If:

• You expect superhuman or permanent vision.
• You’re hoping to avoid reading glasses forever.

Your surgeon will discuss what you can realistically expect based on your current eye health.

Red Flags That May Disqualify You From LASEK

Even though LASEK has wider suitability than LASIK, certain signs might make surgeons cautious.

Corneal Diseases (Especially Keratoconus)

LASEK is not suitable if you have:

• Keratoconus
• Severe corneal thinning
• Corneal scarring
• Significant irregular astigmatism

These conditions weaken the cornea, and reshaping it with a laser could worsen instability.

Autoimmune or Systemic Medical Conditions

Some medical conditions affect healing.

High-risk conditions include:

• Lupus
• Rheumatoid arthritis
• Sjögren’s syndrome
• Diabetes (if uncontrolled)

If healing is compromised, LASEK may not be safe.

Pregnancy or Breastfeeding

Hormonal changes can alter your prescription temporarily. Surgeons usually recommend waiting at least six months after breastfeeding before booking LASEK.

Severe Dry Eye Disease

While LASEK is better for dryness than LASIK, severe dry eye may still cause:

• Delayed recovery
• Discomfort
• Additional aftercare costs

Your tear film must be evaluated before proceeding.

Unrealistic Expectations or Anxiety About Recovery

If you struggle with recovery instructions or expect perfect, instant results, LASEK may not be suitable.

Poor General Health

Healing requires good overall health. You may be unsuitable if you have:

• Uncontrolled high blood pressure
• Severe eczema or dermatitis affecting the eye area
• Active infections

What Happens During a LASEK Suitability Assessment?

When you come in for a professional consultation, your surgeon doesn’t just check your prescription. A full suitability assessment includes several advanced tests.

Here’s what you can expect during a Lasek surgery suitability consultation:

Corneal Mapping (Topography and Tomography)

This test gives a 3D map of your cornea and reveals:

• Thickness
• Shape
• Curvature
• Any signs of instability

This is the most important test for determining whether LASEK is safe.

Tear Film Evaluation

Your surgeon checks for dryness using:

• Tear breakup time
• Schirmer test
• Meibomian gland assessment

Your tear film must be healthy enough to support healing.

Prescription Stability Check

Your optometrist or surgeon compares past prescriptions to confirm whether your refractive error is stable.

Pupil Size Measurement

Larger pupils may increase the risk of night glare after surgery. This helps determine whether LASEK or alternative procedures are better.

Corneal Thickness Measurement

Using pachymetry, your surgeon checks if you have enough corneal thickness for safe reshaping.

Eye Pressure Test

This rules out glaucoma or related conditions that can affect eye surgery.

General Medical and Lifestyle Review

Your surgeon will ask about:

• Medications
• Past eye surgeries
• Allergies
• Hobbies and job requirements

This helps personalise the recommendation to your lifestyle and health.

FAQs:

1. Is LASEK safer than LASIK for people with thin corneas?
   Yes, LASEK is often considered the safer option if you have thinner-than-average corneas. This is because LASEK doesn’t involve cutting a flap in the cornea like LASIK does. Instead, the outer epithelial layer is temporarily loosened and then replaced, leaving the corneal structure more intact. For patients who have been told they are unsuitable for LASIK due to thin corneas, LASEK offers a way to achieve vision correction without increasing the risk of long-term instability or ectasia.
2. How long does it take to recover after LASEK?
   The recovery timeline for LASEK is slower than LASIK, but it’s manageable with proper care. Most people notice a gradual improvement in their vision within a few days, although full visual clarity may take one to two weeks. Some patients experience light sensitivity or mild discomfort during the initial healing phase. You’ll typically need to use prescribed eye drops and attend follow-up visits to ensure your cornea heals properly. The trade-off for this longer recovery is often a lower risk of certain flap-related complications and more stable long-term results.
3. Can I have LASEK if I have dry eyes?
   LASEK can actually be a good option for patients with mild to moderate dry eyes. Because the procedure doesn’t involve creating a flap, it preserves more of the corneal nerves that control tear production, reducing the likelihood of worsening dryness. However, if your dry eye condition is severe or poorly controlled, your surgeon may recommend treating it first before proceeding. A tear film assessment is always done during your suitability test to confirm whether your eyes can tolerate the procedure safely.
4. Will I need to repeat LASEK in the future?
   Most people enjoy long-lasting results from LASEK, often for decades. However, natural ageing changes, such as presbyopia, can affect near vision over time. In some cases, a small number of patients might require an enhancement or “touch-up” years later to refine their vision further. These adjustments are generally minor and depend on how stable your original prescription was. Overall, LASEK is designed to provide durable correction with very low rates of regression.
5. What’s the difference between LASEK and PRK?
   LASEK and PRK are closely related surface laser techniques, but they differ slightly in how the surface epithelium is managed. In PRK, the outer corneal layer is completely removed and allowed to regrow naturally after the laser treatment. In LASEK, the epithelium is carefully loosened and repositioned after reshaping, which can make recovery more comfortable for some patients. Both methods deliver comparable vision outcomes, but LASEK may be preferred for those seeking slightly faster healing and reduced discomfort during the initial days.
6. Are there any risks associated with LASEK?
   Like any surgical procedure, LASEK carries some risks, though serious complications are rare when performed by an experienced surgeon. The most common temporary side effects include mild pain, light sensitivity, and hazy vision during healing. In rare cases, complications such as corneal haze, infection, or under-correction can occur. Following your aftercare instructions, using prescribed eye drops, and attending follow-up visits greatly minimise these risks and support smooth recovery.
7. Can LASEK correct both short-sightedness and astigmatism?
   Yes, LASEK effectively corrects short-sightedness (myopia), long-sightedness (hyperopia), and astigmatism. The excimer laser reshapes the cornea to improve how light focuses on the retina, creating clearer vision. Your eligibility depends on the strength and stability of your prescription as well as the thickness and curvature of your cornea. During your assessment, your surgeon will confirm whether your eyes fall within the safe treatment range for optimal results.
8. How soon can I return to work after LASEK?
   Most people can return to work within four to seven days after LASEK, depending on their comfort and vision clarity. However, if your job involves extensive screen use or bright light exposure, you might need a few extra days to adjust. During the first week, it’s essential to avoid rubbing your eyes, wearing makeup, or being in dusty environments. Your surgeon will provide personalised recovery guidance based on your lifestyle and healing progress.
9. Who should avoid LASEK surgery altogether?
   LASEK isn’t suitable for everyone. People with active eye diseases like keratoconus, severe dry eye, or corneal scarring are typically advised against it. Additionally, those with autoimmune disorders, uncontrolled diabetes, or systemic conditions that delay healing may not be good candidates. Pregnant or breastfeeding women should also wait until their hormones and prescriptions stabilise. The best way to find out if you qualify is through a comprehensive eye examination with corneal mapping and tear film analysis.
10. How do surgeons decide if I’m a good candidate for LASEK?
    Your suitability is determined through a detailed eye examination and discussion about your medical history. Surgeons assess factors such as your prescription stability, corneal thickness, surface health, tear film quality, and general eye anatomy. They’ll also consider your occupation and lifestyle for instance, if you play contact sports or work in dusty environments, LASEK might be safer than LASIK. This personalised assessment ensures that the procedure chosen is not only effective but also safe for your long-term visual health.

Final Thoughts: Finding Out If LASEK Is Right for You

Choosing vision correction is a significant decision, and knowing whether you’re a suitable candidate for LASEK is essential for safe and lasting results. While LASEK is ideal for patients with thin corneas, mild dry eyes, or an active lifestyle, only a comprehensive professional assessment can determine if it’s the right procedure for your eyes.

If you’re thinking about Lasek surgery in London, you can get in touch with us at the Eye Clinic London to explore your options. At the same time, you can also learn more about our Lasek surgery offerings and consultations to find the best solution for your vision needs.

References:

1. Fu, M., Wang, D., Wu, Y., et al. (2022) ‘Long‑term visual quality after small incision lenticule extraction for myopia: implications for surface ablation suitability in thin corneas’, Eye & Vision, 9, 32. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9386982/
2. Li, S.M., Zhu, Y., Zhang, X., et al. (2016) ‘Laser‑assisted subepithelial keratectomy versus laser in situ keratomileusis for myopia: meta‑analysis’, Clinical & Experimental Ophthalmology, 44(3), pp. 177‑185. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032141/
3. Yahalomi, T., Achiron, A., Arnon, R., Stanescu, N. & Pikkel, J. (2023) ‘Dry Eye Disease following LASIK, PRK, and LASEK: An Observational Cross‑Sectional Study’, Journal of Clinical Medicine, 12(11): 3761. Available at: https://www.mdpi.com/2077-0383/12/11/3761
4. Dastjerdi, M.H. & Soong, H.K. (2002) ‘LASEK (laser subepithelial keratomileusis)’, Current Opinion in Ophthalmology, 13(4), pp. 261‑263. Available at: https://pubmed.ncbi.nlm.nih.gov/12165712/
5. Kuryan, J., Corbett, M., Kirwan, C., et al. (2017) ‘Laser‑assisted subepithelial keratectomy (LASEK) versus laser in situ keratomileusis (LASIK) for correcting myopia: systematic review and meta‑analysis’, Eye, 31(4), pp. 515‑522. https://pmc.ncbi.nlm.nih.gov/articles/PMC5408355/