Saturday, October 25, 2014

Tuesday, February 05, 2013 Julia, Community Member, asks

Q: Is rheumatoid arthritis a contraindication for having lasik surgery?

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Answers (3)
Lene Andersen, Health Guide
2/12/13 1:50pm

I did a bit of poking around and it seems that it generally is contraindicated because people with autoimmune diseases are prone to something called corneal melting (which sounds like a particularly uncomfortable thing to have happen). According to the Mayo Clinic, having autoimmune diseases such as RA can increase the risks. One of these risk is a temporary increase in dryness and since one of the comorbidities with RA is Sjogren's Syndrome, which causes dry eyes, mouth, etc., there is some cause for concern. This article claims that it may not be unilaterally contraindicated anymore, that for people who have well-controlled disease (i.e., are in remission), it may be feasible to get a good result.

 

Personally, given the increased risks due to RA, I'd be very hesitant to have LASIK surgery and definitely have a thorough discussion with my rheumatologist an ophthalmologist before going ahead.

 

 

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Phillip, Community Member
2/ 7/13 3:52pm

I have had ra (smal letters  it is all it gets) for 20 years and I had Lasik 10 years ago with great success 

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Julia, Community Member
2/ 7/13 5:41pm

Hi, thanks for your reply. I am asking to hear from others because I have had an extreme opposite result and am now doing research on the connection between the two. The dr. who did my lasik did not inform me there could be complications from performing the procedure on someone with an autoimmune disorder. He knew I had RA - we discussed my meds and treatment early on. It wasn't until several months later and he was examining my blurred eye, that he got very alarmed about me having RA. I now have a deformed cornea and will eventually need a cornea transplant, along with having cataracts that developed with the use of steroid drops he was prescribing to clear up the lumpy coating over the cornea. The new group of opthamologists/optometrists that are treating my vision problems are all in agreement that having RA is a contraindication to lasik, as does my rheumatologist. I have found many articles supporting that. I wish it was more common knowledge - I never would have taken the risk with my vision had I known.

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Phillip, Community Member
2/ 7/13 7:26pm

Sorry to hear about your comulations. There was a book out about people that had problems but they were mostly Quack Drs.

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Lene Andersen, Health Guide
2/12/13 1:51pm

I'm sorry you went through this, Julia.  It seems as if you have had a doctor who was at best inattentive to your history.

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Julia, Community Member
2/12/13 3:04pm

Hello Lene,

Thank you for your response. Yes, it was - and continues to be - a very upsetting situation.

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Lene Andersen, Health Guide
2/12/13 6:34pm

would you consider doing a SharePost about your experience? LASIK surgery is very popular and I don't think a lot of people know about what can happen, so you could help someone else by raising awareness about this issue. It might also be an opportunity for our community to offer you some support during this stressful time.

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Julia, Community Member
2/12/13 6:56pm

Hello Lene,

 

Yes, I would. It's important to raise the awareness, to let others learn all the facts and potential risks, so they can make an informed decision. I had absolutely no idea there was a negative connection between Lasik and RA (or any other autoimmune disorder) I thought about Lasik for years and did a lot of research prior to find the right opthamologist, but it never occured to me to ask my rheumatologist about it. (nor did the opthamologistd doing my Lasik suggest that) For the average layperson, it doesn't sound like the two would have any relation at all.

 

I'm new to this format - how do I go about writing a SharePost?

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Lene Andersen, Health Guide
2/13/13 3:24pm

thanks so much!

 

to write a SharePost, you hover your cursor over the My Home button in the upper right hand corner of your monitor. Click on My Updates. On the right-hand side, you'll see an area called My Communities and Rheumatoid Arthritis should be listed. Next to that, you'll see two buttons — one with Create a SharePost and one with Ask a Question. click the SharePost button and off you go!

 

looking forward to reading it. If you have any problems, shoot me an e-mail.

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Julia, Community Member
2/19/13 7:44pm

Hello Lene,

 

I just did my SharePost. Thanks, Julia

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Lene Andersen, Health Guide
2/19/13 7:46pm

wonderful! I look forward to reading it.

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emelman, Community Member
10/ 5/13 11:15pm

A recent review found that RA was not an absolute contraindication and for those in remission for at least a year results were good and complications similar to controls who didn't get lasik. Careful monitoring and consultation with rheumatology was strongly advised. Julia, your story is a cautionary flag of possible disasters. Was your RA well controlled and in remission at the time of surgery? Did you have any additional risk factors?

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Julia, Community Member
10/ 7/13 6:53pm

Hello,

At the time of my Lasik, my RA was under control with Methotrexate and Enbrel. But my rheumatologist had never mentioned anything about remission. I didn't even know that was a possibility. A few months after I had Lasik, I started seeing a new rheumatologist (insurance changed) and he suggested I might be in remission and then backed me off the meds. And right around that time is when I started having all the vision problems. The dr. who did the Lasik had not asked me to discuss anything with my rheumatologist prior to surgery - he never gave any hint of potential risks and I had no reason to think there could be a negative connection between Lasik and RA. After all my vision problems developed, he said that even though RA might not be showing the obvious symptoms, it still lurks beneath the surface and causes damage. Well, it would have been nice to be forewarned! (obviously being very sarcastic here)

thanks for taking the time to read and respond.
J

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emelman, Community Member
10/ 7/13 10:05pm

Julia, you are absolutely correct that this should have been discussed with you in advance and your rheumatologist should have been consulted. Most of my patients with RA do not have significant eye findings but a small percentage can have debilitating corneal melts or ocular inflamations and uveitis ( intraocular inflammation ). I had a patient last week who was diagnosed with RA 3 years ago and was put on Methotrexate. She has had no symptoms since then and they are considering taking her off the meds. She is very anxious to get lasik and that prompted me to do some updated research. Your story is the negative and the report I referenced is the pro. Her rheumatologist and the surgeon will review the risks with her. Obviously I appreciate your sharing your story. How do I access your storyshare?

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Julia, Community Member
10/ 8/13 12:25pm

Hello, here is the link to where my full story is posted:

 

http://www.healthcentral.com/rheumatoid-arthritis/c/571649/159298/laser-surgery

 

(I had to type "julia share" in the search window - I couldn't figure out how to get to it!)

 

Please tell her to proceed with caution! The bottom line is - and every opthomologist I've seen since has said this - is that doing Lasik on someone with an autoimmune disorder can produce unpredictable results. Not always, but there is no way to tell who it might affect or how or the severity. Even the studies that claim if someone is symptom-free it's ok, don't address the fact that one may not stay symptom-free forever and when a flare-up occurs, will it affect the eyes? I don't think there has been enough research done to say this is a 100% safe surgery to perform on autoimmune disease patients. And with your eyes, anything less than 100% is not worth it.

 

thanks, I appreciate you taking the time to read my story.

J

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We hope you find this general health information helpful. Please note however, that this Q&A is meant to support not replace the professional medical advice you receive from your doctor. No information in the Answers above is intended to diagnose or treat any condition. The views expressed in the Answers above belong to the individuals who posted them and do not necessarily reflect the views of Remedy Health Media. Remedy Health Media does not review or edit content posted by our community members, but reserves the right to remove any material it deems inappropriate.

By Julia, Community Member— Last Modified: 10/08/13, First Published: 02/05/13