Am I eligible for refractive surgery? The complete guide
Published June 25, 2026
It is the very first question you ask yourself before considering life without glasses: “Can I have surgery?” The good news is that most people bothered by stable myopia, hyperopia or astigmatism are eligible for some form of refractive surgery. But the decision is never based on your prescription alone: it rests on a set of criteria that only a full assessment can confirm.
In this article, I explain openly the five key criteria I look at, the contraindications, how the assessment works and, above all, what to do if laser surgery is not the right option for you.
The short answer — in 30 seconds
As a general rule, you have a good chance of being eligible if you are over 18, your prescription has been stable for at least one year, your cornea is healthy and thick enough, and you have no progressive eye disease. Here are the five criteria I systematically check.
Age & stability
Adult age reached and refraction stable for at least one year (change < 0.5 D/year).
Type & strength of prescription
Myopia, hyperopia, astigmatism: the amount points toward laser surgery or a lens implant.
Healthy, thick cornea
Sufficient thickness and a regular topography, with no sign of keratoconus.
Ocular surface
Significant dry eye is treated beforehand, for comfort and a better-quality result.
General & eye health
No progressive eye disease or condition that makes the procedure inadvisable.
The five criteria — what I really look at
1. Age and prescription stability
Laser surgery is legally possible from age 18. But age matters less than stability: we operate on an eye whose refractive error is no longer changing. In practice, I check that your prescription has not changed by more than 0.5 diopter over the past year. This is why a record of your previous glasses prescriptions is very helpful to me.
Since myopia often keeps progressing until age 22–25, I rarely operate before this progression has ended. At the other end of the spectrum, after 50, I also discuss presbyopia and whether lens surgery might be more appropriate than corneal surgery.
2. The type and strength of your prescription
Corneal laser surgery (LASIK, SMILE, PRK) corrects low to moderate myopia, hyperopia and astigmatism very well. Beyond a certain level of correction — high myopia in particular — or when the cornea does not allow enough tissue to be removed, the ICL phakic lens becomes the option of choice. The strength of your prescription is therefore a signpost, not a cut-off: each profile has a matching technique.
3. A healthy, sufficiently thick cornea
This is the most technical criterion. The laser reshapes the cornea, so it must be thick enough to keep a safety margin after treatment. Reference data use a residual stromal bed of at least 250 µm, and many surgeons — myself included — prefer to aim for 300 µm [2].
Above all, I screen for early keratoconus: a weakness of the cornea that rules out laser surgery. It is the major risk factor for ectasia (corneal bulging) after surgery [1]. For this reason, corneal topography/tomography is the central test of the assessment.
4. The ocular surface
Untreated dry eye disease can reduce comfort after the procedure and interfere with healing. I evaluate it systematically. If it is present, I treat it before operating, and it may influence the choice of technique.
5. General and eye health
Some situations make the procedure inadvisable, sometimes only temporarily: pregnancy and breastfeeding, uncontrolled autoimmune diseases, certain progressive eye conditions. We discuss these during the assessment — see the details below.
Contraindications — absolute and temporary
Being honest about what prevents surgery is part of my job. Most contraindications are temporary: it is often a matter of waiting, treating, then reassessing.
Contraindications to corneal laser surgery
- Progressive keratoconus or a cornea too thin for the intended correction
- Irregular corneal topography (suspected corneal weakness)
- Uncontrolled autoimmune or immune disorders, listed as contraindications by health authorities [3]
- Certain progressive eye conditions (uncontrolled glaucoma, active ocular herpes, etc.)
Temporary situations (we wait, then reassess)
- Unstable refraction — we wait for it to settle
- Pregnancy and breastfeeding — temporary hormonal changes
- Dry eye requiring treatment first
- Early cataract — in that case we turn to lens surgery, which also corrects vision
What if laser surgery isn't for me? The alternatives
“Not eligible for LASIK” does not mean “stuck with glasses.” In most cases, there is another way.
The ICL phakic lens
If your cornea is too thin, your prescription too high or your ocular surface too dry, the ICL phakic lens is often the best answer: it is placed inside the eye without touching the cornea, corrects very high myopia, and remains reversible.
PRK / Trans-PRK
For some thin corneas or particular profiles, PRK (surface laser treatment) may still be possible where LASIK is not.
Treat first, operate later
Dry eye that needs to be brought under control, a prescription that still needs to stabilize, an ongoing pregnancy: sometimes it is simply a matter of postponing the procedure for a few months, then reassessing.
Lens surgery
After 50, or in the case of early cataract, replacing the eye's natural lens with an intraocular lens (IOL) corrects both the refractive error and presbyopia. For this age group, it is a relevant alternative to corneal surgery.
Your questions about eligibility
Laser surgery (LASIK, SMILE, PRK) is legally possible from age 18, but in practice I wait for adulthood and, above all, a stable refraction. Stability is the decisive criterion: a change of less than 0.5 diopter per year over at least one year. ICL phakic lenses are generally considered from around age 21.
Yes. Contact lenses temporarily change the shape of the cornea and would distort the topography measurements. I recommend stopping soft lenses from a few days to one to two weeks before the assessment, and longer for rigid lenses. You will be given precise instructions at the practice.
Laser correction (LASIK, SMILE, PRK) reshapes the cornea permanently. The ICL phakic lens, on the other hand, is reversible: it can be removed or replaced. No technique prevents the eye from changing naturally with age, particularly presbyopia after 45 and cataract later on.
It is better to wait. Hormonal changes during pregnancy and breastfeeding can temporarily alter refraction and the ocular surface. This is a temporary contraindication, until your refraction is stable again after this period.
No. If the cornea is too thin or shows keratoconus, corneal laser surgery is not recommended, but other solutions exist: the ICL phakic lens does not touch the cornea and can correct even high prescriptions. Keratoconus first requires its own specific treatment (cross-linking, intracorneal ring segments). The assessment settles the question.
Not necessarily. Moderate dry eye is treated before the procedure to prepare the ocular surface and improve post-operative comfort. Severe dry eye may make a surface technique (PRK) preferable or lead to postponing the procedure. It all depends on the tear film evaluation during the assessment.
Find out if you are eligible
The only way to get a reliable answer is a personalized assessment. I see patients at Cabinet OPHTALIFE, in Boulogne-Billancourt and Paris, to examine your eyes and tell you honestly which solution suits you — or whether it is better to wait.
Related pages
Scientific references
This article is based on international guidelines and key publications. Sources can be verified via their DOI or PubMed.
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1
Randleman JB, Russell B, Ward MA, Thompson KP, Stulting RD. Risk factors and prognosis for corneal ectasia after LASIK. Ophthalmology. 2003;110(2):267-275.
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2
Santhiago MR. Percent tissue altered and corneal ectasia. Curr Opin Ophthalmol. 2016;27(4):311-315.
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3
American Academy of Ophthalmology. Preferred Practice Pattern (PPP) — Refractive Errors & Refractive Surgery. aao.org
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4
U.S. Food & Drug Administration (FDA). LASIK — When is LASIK not for me? Criteria and contraindications. fda.gov
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5
Mechai N, Hage A, Baudouin C. Correction des erreurs réfractives par chirurgie cornéenne soustractive : histoire et perspectives. J Fr Ophtalmol. 2026;49(4):104829.
The content of this website is for information only and is not a substitute for a medical consultation. Any treatment decision should be made together with your ophthalmologist.