RA - a contraindication to laser eye surgery

By Julia Thursday, February 21, 2013

Hello, I thought I would share my experience in the hopes that others with RA can learn from it and be aware of the possible risks involved if considering refrative eye surgery. I was diagnosed 6 years ago with severe RA, that came on suddenly one night. After several months, it was brought under control with methotrexate and Enbrel. in 2010, I decided to have my nearsightedness/astigmatism corrected after many years of thinking about it. I did my research with doctors and consultations and chose one. During my initial exams, he noted I had marked RA on my health questionnaire and we discussed my meds and how I was doing (very well, thanks to the meds). He never mentioned the possibility of any risks or that having RA is considered to be a contraindication, and I certainly had never heard that. He only casually mentioned the possibility of dry eyes, "but there are drops for that" (yeah, at $300 a box!!) and didn't seem overly concerned about it. I had Lasek (with an "e"), which differs slightly from Lasik in the cut of the epithelium and the healing time. My vision was great for the first several months, then my right eye started going blurry. I attributed it to long hours on a laptop at my new job, but after a few weeks, went back to see the opthamologist who did the surgery. He examined my eyes, then stood back and looked very alarmed. He said, "Do you have RA? Have you started or stopped any meds?" Several thoughts went through my head at once: "He knows I have RA - we discussed it; what does that have to do with my blurred vision; yes, it so happens that my rheumatologist has recently backed me off the meds because I had been symptom-free for quite a while; and again - what would being off meds have to do with my eye?" And mostly: Why does he look so worried?" He said the coating of my cornea, the epithelium, was all dimpled and lumpy, and it was because I was no longer taking the meds to suppress my immune system. I was suprised the two could even be related. He prescribed steroid drops and initially, they helped, but not for long. That started about a year of going on and off them, with no success. (plus they can give you cataracts, which I do have one now) Eventually, he said I needed to have the epithelium scraped off in the hopes that it would grow back smooth. He did not take my health insurance and advised me to go to UCLA medical center. I started the process with the eye group I was insured with and a cornea specialist had just joined, so I stayed with them. He did the scraping (very gruesome - I bled from my eye for a couple of days!) and after my eye healed and was smooth, he could do a more comprehensive exam. It turned out that I had developed keratoconus in that right eye, which is a deformation of the cornea. Enough progression and a cornea transplant is required. He told me that as an RA patient, I should not have had refractive eye surgery. I was absolutely stunned. I had no idea it was a contraindication. I am now fitted with a special contact lens on the right eye, which works allows me to see ok most of the time. Who knows about as I get older. Glasses are not able to correct the vision I have with keratoconus. There is a depth perception problem and everything "swims" when I turn my head. The vision in my left eye had slipped back, so I do have a regular contact lens in that. All the opthamologists/optomotrists in that group, plus my rheumatologist, agree that I should not have had Lasek and don't understand why he didn't warn me there could be risks. It does not happen to everyone, but I wish I had had the opportunity to make that decision on my own. I certainly would never have risked my vision had I been made aware of even the slightest danger. Please, if you are considering Lasik/Lasek, talk to your rheumatologist and several opthamologists first. Do research. It never occurred to me to put the 2 words in the same sentence: "Lasek and RA" and it's not common knowledge, so search it out. Thanks.

Rheumatoid Arthritis and Sjögren’s Syndrome
Lene Andersen, Health Guide
2/22/13 2:53pm

This is a very important post. Thank you so much for sharing your experience — it will be a tremendous help to our community. It's unbelievable that the doctor didn't give you more information — this is what informed consent is all about! You're the one who has to live with the consequences of his lack of due diligence.

 

Please continue to share your progress with us?

2/22/13 7:24pm

Thanks. My hope is that this contraindication becomes common knowledge among RA patients (and others with auto-immune disorders) and something every rheumatologist and opthamologist would bring up during exams. I was completely oblivious.

2/22/13 6:25pm

Julia,

 

 I am so sorry that this has happened! Even sorrier that it's going to be an ongoing problem. Personally, I think that doctor should have his license revoked!!

 

But thank you for sharing this information! I'm sure I'm not the only one here who has thought that it would be nice to get rid of their glasses. I now have a new appreciation for mine.

 

Ish

2/22/13 7:29pm

Thanks. Like I said, a situation like mine would not happen to everybody, but it is scary enough to take note of. And now that i'm in the middle of it, I'm finding more articles supporting the contraindication and doctors saying, "why take the risk?" I am grateful the contacts are working for now and we'll see (haha, no pun intended) what the future will bring. My doctor does not want to discuss cornea transplant yet. Fingers crossed.

Anonymous
Lynne
2/23/13 2:44am
Wow, great information! I see my eye doc every three months, to get plugs for my tear ducs. She oversaw my LASIK surgery about fifteen years ago. It was fabulous. I asked if I could get the surgery again because after my RA diagnosis my vision took a turn for the worse. All she said was "No", you have RA and cannot get it done again. So, now I wear glasses again. Thanks for letting me know why she was so adament. Lynne
V, Health Guide
3/ 5/13 8:05am

Hello, Julia,

 

I am stunned.  What a terrible and unnecessary thing for you to have to endure.  I had no idea that this type of surgery was contraindicated for RA patients.   Thank you so much for sharing.  This is such an important post.  I am going to share it on my FB page so that my other AI friends will be aware.  Hope everything goes well for you and your vision and RA.  Please keep us informed.

 

Blessings,

V

3/ 6/13 2:17pm

Hi and thanks for taking the time to read. Yes, share it! People with auto-immune diseases that are considering Lasik need to be aware of the potential danger when mixing the two. I'm sure there are many who have done it without complications, but in general the medical world advices against it, so why take a chance with your vision? You only get one pair of eyes.

thanks,

J

3/ 7/13 6:17pm

I have a very rare eye disease that when it flares up  sand type of grit forms in my eye and tears through my corneas. This is extremely painful and it seems that every time my flare up subsides , my vision gets worse.  I too have RA.  I had scraping and laser done to both eyes to remove a lot of the scarring.  I then had to have a hole lasered into each cornea to allow fluid to get in between the cornea and the irises. Then I had cataract removal and lenses implanted into both eyes.  My vision went tfrom 20/500 to 20/40 in one and 20/60 in the other and thats without glasses.  I had a flare up and now I need to have a scar thinned out but I'm holding off for awhile. I had all of those surgeries in about a yr.  All of the things I had done had to be one eye at a time and one of the eye drops I had to be on with these surgeries made me deathly ill. I can't remember ever seeing this good in my life.  I started wearing glasses in grade school and I will be 57 next month. I had to sleep in my glasses for yrs and yrs because al  I could see was big blobs of color without them.  My surgeon moved to San Diego so I kind of worry about trusting anyone else.  The other thing is that all of my family members that have the disease all had corneal transplants done but the disease comes back in approx. 3 yrs.  I kept holding out because I didn't want corneal transplants because I have such terrible side effects from so many drugs.  I was worried that I would have a reaction and lose my vision for good.  If you're on the west coast look him up.  He has gifted hands, truly.  His name is Dr. Francis Mah.  I gave up on taking anything for my RA because I was so sick from all of the different drugs.  Sometimes the pain is so incredible it makes me sick.  I will keep you in my prayers.

3/12/13 1:48pm

ohmygoodness, Tina, you have been through the wringer! Thanks for sharing and thanks for the name of your surgeon. I am just a few hours north of SD (went to college there, love that city) and will keep his name on file. That is encouraging to hear how succesfully your cataract surgery turned out. Just yesterday I saw my opthamologist and was somewhat depresed, asking him what does he think will happen with my vision in the future? He said probably cataract surgery with the implants in a few years and that it might help to the point that I could use glasses again. But on the other hand, the keratoconus will worsen over time and eventually I will need a cornea transplant, complete with a lifetime of anti-rejection drugs. He did mention a study being done on collagen-strengthening for the cornea, but it's a few years away from being available. So for now, I'm praying I can keep going with the special contact lens. (Although of course I tore it yesterday in his office because I can't see a darn thing when they're not in!) Thanks again for writing - J

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By Julia— Last Modified: 05/27/13, First Published: 02/21/13