By Dr Lee Mun Toong
Diabetes is a relatively common disease, affecting almost 14.0% in a 2006 survey for adult Malaysians aged 18 years and above, 17.5 per cent of its citizens aged 18 years based on National Health and Morbidity Survey 2015 and its prevalence is expected to increase in correlation with rising obesity rates by years 2020. As this segment of the population continues to grow, more diabetic patients are requesting Femto-laser vision correction.
The US FDA considers diabetes a relative contraindication for LASIK surgery; however when this recommendation was issued, there was very limited data on the safety and efficacy of LASIK in these patients. The recommendation was therefore based on theoretical, rather than actual, risk.
The link between diabetes and ocular complications is well established, and there was concern that the corneal abnormalities often seen in diabetic patients may increase operative and postoperative complications, and limit successful outcomes. There was also concern that diabetic patients might be at a higher risk for postoperative infections.
Recent research on the outcomes of laser refractive surgery in this patient population is mixed; however there is a growing body of evidence that indicates laser refractive surgery may be safely performed in diabetic patients with tight glycemic control and no systemic or ocular complications.
Patients with diabetes who desire laser refractive surgery for elective correction of vision represent a challenging treatment dilemma. Currently, the FDA and the American Academy of Ophthalmology have a broad recommendation that includes diabetes among the relative contraindications for LASIK and PRK surgery, predominantly due to concerns that the comorbid ocular conditions associated with the disease might lead to poor refractive outcomes and significant postoperative complications. However, we can assume that in a very select group of patients with diabetes, laser refractive surgery may be safely performed as long as the surgeon undertakes a thorough preoperative assessment of the status of the patient’s systemic disease and the presence of associated ocular manifestations. (Information based on a study of Laser refractive surgery in diabetic patients: a review of the literature written by Leopoldo Spadea and Maria Pia Paroli published in Clin Ophthalmol. 2012; 6: 1775–1783.)