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.


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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?
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.