Short-sightedness (myopia)

When can a teenager have laser eye surgery? LASIK, the age rule and why the number must be stable

A teenager tired of glasses will ask about the laser. Here is the age rule, why the glasses number has to stop changing first, what the checks look for, and what to do while you wait.

by Dr Chan Li Yen · MBBS, MOphth (UM), Fellowship in Paediatric Ophthalmology & Strabismus

Dr Chan Li Yen, consultant paediatric ophthalmologist, MMC 43128, NSR 132980 · Eagle Eye Centre Kuala Lumpur, Petaling Jaya

12 min read · 2,077 words

Key takeaways

The FDA states that no lasers are approved for LASIK on persons under the age of 18, and the Royal College of Ophthalmologists says you must be over 18 with a stable prescription.
Eighteen is the earliest age, not the right age. The American Academy of Ophthalmology says candidates should ideally be over 21, when vision is more likely to have stopped changing.
The surgeon needs proof the number has stopped moving, from past records. The sources set this at no real change in the past year, or no change greater than 0.5D over two years.
Before any laser, the surgeon checks corneal thickness and shape, keratoconus, dry eye and pupil size. A teenager with keratoconus should not have LASIK.
Until then, wear current glasses, use contact lenses with strict hygiene if the eye doctor agrees, ask about myopia control while the eye is growing, and wear sports eyewear.

A teenager who is tired of glasses, a lens case in the school bag and a fogged-up mask will ask the question sooner or later: can I just have the laser? The honest answer is "not yet, and here is how you will know when".

What is the age limit for LASIK, and can a teenager have it?

A teenager under 18 cannot have LASIK. The US Food and Drug Administration (FDA) states it plainly: "Currently, no lasers are approved for LASIK on persons under the age of 18." The Royal College of Ophthalmologists, which sets standards for eye surgeons in the United Kingdom, tells patients: "You must be over 18 years of age and have a stable glasses prescription."

Eighteen is the floor, not the target. The American Academy of Ophthalmology says candidates "should be 18 years or older (ideally, over 21 years old, when vision is more likely to have stopped changing)". So a young adult can be old enough on paper and still be told to wait, because the second half of the rule matters as much as the first.

The action for a teenager and a parent: treat 18 as the earliest date a refractive surgeon may even consider it, and treat the prescription as the thing that decides. Contact lenses for children and teens covers what you can use in the meantime.

Why does the glasses number have to stop changing first?

Laser surgery reshapes the clear front window of the eye (the cornea) to match the number measured on the day. If the number then keeps moving, the new shape no longer matches the eye, and glasses come back. The surgery cannot follow a number that is still on the move.

The FDA lists, among the reasons LASIK may not be right for you, that "you required a change in your contact lens or glasses prescription in the past year", and calls this refractive instability. The American Academy of Ophthalmology says "your eye prescription should not have changed much in the last year". The Royal College of Ophthalmologists defines a stable prescription as "no change greater than 0.5 units (0.5D) in the last two years". The wording differs between these sources, one year or two, which is one more reason the final decision belongs to the surgeon who has your records in front of them.

Stable means shown on paper. Keep every glasses receipt and eye check result from the last few years, because a surgeon will ask for them.

Why does a teenager's prescription keep changing?

Because the eye is still growing. In short-sightedness (myopia, rabun jauh) the eyeball grows too long front to back, so light focuses in front of the retina instead of on it. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) says myopia "often starts in childhood and gets worse each year until the late teen or early adult years".

The Royal College of Ophthalmologists says short sight and astigmatism "normally stabilize in the late teens or early 20s, but natural prescription changes can occur at any stage in life". "Normally" is the right word. Some young people settle at 16 and some keep moving into their twenties, and nothing on the day of the eye test tells you which. At what age does short-sightedness stop getting worse goes through what the studies show about the late-teen plateau.

A teen who has the laser and then grows another half a dioptre is back in glasses, with a cornea that has already been reshaped. That is what the rule exists to prevent.

What do the checks before surgery look for?

A surgeon looks at the front of the eye in detail before anyone is booked for the laser. Four things matter most for a teenager's family to know about.

Corneal thickness and shape. The FDA warns that "performing a refractive procedure on a cornea that is too thin may result in blinding complications". The cornea is mapped for thickness and shape.
Keratoconus. This is a condition where the cornea thins and bulges into a cone shape, and the American Academy of Ophthalmology lists it as a reason LASIK is not suitable. It often shows up in the teens, with a prescription that jumps and astigmatism that keeps increasing. Keratoconus in teenagers explains the eye-rubbing link. A cornea map picks it up, and a teen with keratoconus should not have LASIK.
Dry eye. The FDA says LASIK "tends to aggravate" dry eye, so the surface of the eye is checked first.
Pupil size. Large pupils can bring "glare, halos, starbursts, and ghost images" after surgery, in the FDA's words, so the pupil is measured in dim light.

The action: if your teen rubs their eyes a lot, or the glasses number has jumped from one visit to the next, tell the eye doctor now. Do not wait for a surgery consultation to find it.

What should we do while we wait?

Look after the eye you have, because the habits of the teen years carry into the surgery years.

Glasses that are current and fit well come first. Reading your child's myopia prescription explains the numbers on the receipt.

Contact lenses suit some teens, as long as hygiene is taken seriously: hands washed and dried before touching a lens, no sleeping in lenses unless the eye doctor has said so, no swimming or showering in them, and no lenses bought online without a fitting.

If the eye is still growing and the number is still moving, ask about slowing it down. Slowing myopia down sets out the options and the honest limits of each.

For badminton, football, basketball and other sports, wear sports glasses with impact-resistant lenses or sports goggles, not everyday frames. Sport is often why a teen wants the laser, and proper sports eyewear solves that now, with no surgery.

What options will an adult refractive surgeon discuss later?

I am a paediatric ophthalmologist and I do not perform refractive surgery. When your teenager is 18 or older and the number has been stable, the right person is an adult refractive surgeon, who will measure the eye and explain the choices.

The Royal College of Ophthalmologists names the main laser types used in the UK as LASIK, surface laser treatments and a lenticule extraction technique, and describes lens implants as another route, including implantable lenses placed in front of the natural lens for younger patients. In plain words:

LASIK cuts a thin flap in the cornea, reshapes underneath with the laser and lays the flap back.
Surface laser reshapes the cornea without cutting a flap.
Lenticule extraction uses a laser to shape a thin disc of tissue inside the cornea, which is then removed through a very small opening.
Implantable lenses are placed inside the eye in addition to the natural lens, and may suit some people with a higher number.

The Royal College's leaflet notes that the surgeon "will advise on your best treatment options after reviewing your test measurements and your eye health". Laser surgery is elective: the same leaflet says the alternative is staying in glasses or contact lenses.

Two honest limits. Surgery at 18 or 21 does not guarantee the number stays put for life: the Royal College's leaflet says "natural prescription changes can occur at any stage in life", so laser correction "sometimes needs to be repeated". And laser surgery reshapes the front of the eye. It does not make a long eye shorter, so a person who had high myopia still has the retinal risks that come with a long eye, and checks of the retina remain part of life. High myopia: what changes once the number gets high explains those checks.

Is laser ever done in a child?

Only in narrow circumstances, and never because a family asks for it. A paediatric specialist may consider it when a child has a large difference in prescription between the two eyes (anisometropia) that is causing a lazy eye (amblyopia), and the child cannot wear glasses or contact lenses, for example because of a developmental condition. A review of this area in Review of Ophthalmology describes the main indications as "anisometropic amblyopia and bilateral high ametropia", for the situation where "glasses and contact lenses fail", and adds that these techniques in children remain "infrequently studied".

This is a specialist's decision after all the usual treatment has been tried properly, not a shortcut for a child who dislikes glasses. If you are worried that your child cannot manage with glasses, the next step is a conversation with a paediatric eye doctor about what is getting in the way. Contact lenses for children and teens and the glasses pages on this journal are the places to start.

For everyone else the plan is simple: keep the glasses current, keep your records, and book an adult refractive assessment once the age and the stable number have both arrived.

Don't wait for the next routine check if…

Vision changes suddenly, in one eye or both.
The glasses number jumps from one visit to the next, or the picture looks warped or doubled even with glasses on.
A contact lens wearer has a red, painful eye, or light hurts. Take the lens out and see an eye doctor the same day.
Flashes of light, a shower of new floaters or a curtain over part of the view appear.
An eye is painful, or has been hit or scratched.

Common questions

What is the age limit for LASIK?

The FDA states that no lasers are approved for LASIK on persons under the age of 18. The Royal College of Ophthalmologists says you must be over 18 and have a stable glasses prescription, and the American Academy of Ophthalmology says candidates should be 18 or older, ideally over 21.

Can a 17-year-old have laser eye surgery?

No, not LASIK, because no lasers are approved for it under 18. A 17-year-old's glasses number is also still likely to be moving. The exception is a narrow one decided by a paediatric specialist, for a child who cannot wear glasses or contact lenses.

How long must my glasses number be stable before surgery?

The FDA lists a change in your glasses or contact lens prescription in the past year as a reason LASIK may not be right for you. The Royal College of Ophthalmologists defines a stable prescription as no change greater than 0.5D in the last two years. The surgeon makes the call from your records.

Why does a teenager's eye power keep going up?

The eyeball is still growing. The American Association for Pediatric Ophthalmology and Strabismus says myopia often starts in childhood and gets worse each year until the late teen or early adult years. For some young people it settles earlier and for others later, so only the records can show it.

Does keratoconus stop someone having LASIK?

Yes. The American Academy of Ophthalmology lists keratoconus among the conditions that make LASIK unsuitable. It often appears in the teens, so a cornea scan is part of the checks before any laser. If your teen rubs their eyes a lot or the number keeps jumping, tell the eye doctor now.

Does laser surgery cure short-sightedness?

It reshapes the front of the eye so light focuses on the retina, but it does not shorten a long eyeball. A person who had high myopia keeps the retinal risks that come with a long eye, so retinal checks stay part of life. The Royal College also notes prescriptions can change later and laser treatment sometimes needs to be repeated.

Do paediatric eye doctors perform laser eye surgery?

I am a paediatric ophthalmologist and I do not perform refractive surgery. When your teenager is old enough and the number is stable, an adult refractive surgeon is the right person to assess them.

Is laser ever done in children?

Only in narrow circumstances, such as a large difference in prescription between the two eyes causing a lazy eye, when the child cannot wear glasses or contact lenses. A paediatric specialist decides, after the usual treatments have been tried properly, and never on request.

References

US Food and Drug Administration · When is LASIK not for me? · www.fda.gov
American Academy of Ophthalmology · LASIK: laser eye surgery · www.aao.org
American Association for Pediatric Ophthalmology and Strabismus · Refractive errors in children · aapos.org
Royal College of Ophthalmologists · Laser Vision Correction, patient information (copy of the leaflet) · bluefinvision.com
Royal College of Ophthalmologists · Professional standards for refractive surgery · www.rcophth.ac.uk
Review of Ophthalmology · Refractive surgery in pediatric patients (2018) · www.reviewofophthalmology.com

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.