Why would someone not be a candidate for LASIK?

Common reasons include corneas that are too thin, prescriptions that are too high, chronic dry eyes, keratoconus, large pupils, or age-related lens changes like presbyopia. A thorough pre-surgical assessment identifies which factors apply to you.

What is the difference between LASIK and PRK?

Both reshape the cornea with a laser, but LASIK creates a flap in the cornea first, while PRK removes the outer layer and reshapes the surface directly. PRK requires less corneal thickness and is often suitable for people whose corneas are too thin for LASIK.

What is an implantable collamer lens (ICL)?

An ICL is a thin lens surgically placed inside the eye, between the iris and the natural lens. It corrects vision without removing any corneal tissue, making it a strong option for high prescriptions or thin corneas.

Can ortho-K replace LASIK?

Ortho-K uses specially designed rigid contact lenses worn overnight to temporarily reshape the cornea. The effect lasts through the day but is fully reversible — you need to keep wearing the lenses each night. It works best for mild to moderate myopia.

What role does my optometrist play in laser eye surgery?

Your optometrist provides the initial assessment, determines whether you are a candidate, and refers you to an ophthalmologist (eye surgeon) for the procedure. After surgery, your optometrist often handles follow-up care through a process called co-management.

Not a LASIK Candidate? Your Alternatives

Being told you are not a candidate for LASIK can be frustrating, especially if you have been looking forward to life without glasses or contacts. The good news is that LASIK is only one of several proven ways to correct vision. Depending on the reason you were ruled out, there may be a better-suited option.

Why are some people not candidates for LASIK?

LASIK works by reshaping the cornea — the clear front surface of the eye — with a laser. To do this safely, the cornea needs enough thickness, a stable shape, and a prescription within a certain range.

Common reasons for being declined include:

Thin corneas — not enough tissue to reshape safely
High prescriptions — beyond what corneal reshaping can correct
Chronic dry eyes — LASIK can worsen existing dryness
Keratoconus — an already irregular cornea that could destabilize further
Large pupils — higher risk of glare and halos after surgery
Presbyopia — age-related near-vision loss that LASIK alone does not fully address

What alternatives exist?

PRK (photorefractive keratectomy)

PRK reshapes the cornea with the same type of laser as LASIK but without creating a corneal flap. Because no flap is needed, PRK works for people with thinner corneas. Recovery takes longer — vision typically stabilizes over a few weeks rather than a day or two — but the long-term visual outcomes are comparable.

ICL (implantable collamer lens)

An ICL is a thin, biocompatible lens placed inside the eye behind the iris. It does not remove any corneal tissue, making it well suited for people with thin corneas or very high prescriptions. The procedure is reversible — the lens can be removed or replaced if needed. Ask your surgeon about endothelial cell monitoring and long-term follow-up.

Refractive lens exchange (RLE)

RLE replaces the eye's natural lens with an artificial one, similar to cataract surgery. It is most commonly recommended for people over 50 who have presbyopia or very high prescriptions. Because the natural lens is removed, cataracts cannot develop later. Multifocal or extended-depth-of-focus lens implants can reduce dependence on reading glasses as well.

Ortho-K (orthokeratology)

Ortho-K uses custom rigid contact lenses worn overnight to gently reshape the cornea while you sleep. You remove them in the morning and see clearly through the day without glasses or daytime contacts. The effect is temporary and fully reversible. Ortho-K works best for mild to moderate myopia and is a good option for people who want corrected vision without surgery.

Specialty contact lenses

For conditions like keratoconus or irregular corneas, scleral lenses or hybrid lenses can provide sharp, comfortable vision where standard soft lenses cannot. These are custom-fitted by your optometrist and are often the best non-surgical path to clear vision.

What should you ask your surgeon?

If you are referred to an ophthalmologist for a surgical alternative, consider asking:

Why was I specifically ruled out for LASIK?
Which procedure do you recommend for my situation, and why?
What are the risks and expected recovery time?
How many of these procedures have you performed?
What follow-up care will I need?

Your optometrist's role

Your optometrist is involved before and after any vision correction procedure. They perform the initial assessment, help determine which options suit your eyes, and refer you to a surgeon when appropriate. After surgery, your optometrist often manages the follow-up visits — a process called co-management. If you are exploring non-surgical options like ortho-K or specialty lenses, your optometrist fits and monitors those directly.

Not being a candidate for LASIK does not mean you are out of options. A conversation with your optometrist is the best starting point to understand what will work for your eyes.

I Was Told I'm Not a Candidate for LASIK — Now What?