Visual and refractive outcomes of laser vision correction in carefully selected patients with diabetes mellitus

To evaluate real-world visual and refractive outcomes in the diabetes mellitus (DM) population. DM may impair corneal healing and neurosensory function, often serving as a relative contraindication for laser vision correction (LVC). This study evaluated visual and refractive outcomes of photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) in adults with controlled DM compared with healthy controls and compared the 2 techniques within the diabetic cohort.

Care Vision Laser Center, Tel Aviv, Israel.

Retrospective comparative study.

This retrospective study (2013 to 2024) included consecutive primary PRK or LASIK procedures in adults with controlled DM (hemoglobin A1c <8.0%, no worse than mild nonproliferative diabetic retinopathy, and no diabetic macular edema) and healthy controls. Eyes were propensity-matched on baseline characteristics. Outcomes included refractive and visual measures and complications (retreatment, dry eye, glare, infectious keratitis, haze, epithelial ingrowth, and diffuse lamellar keratitis).

After matching, 784 myopic PRK eyes (158 DM), 471 myopic LASIK eyes (96 DM), 123 myopic DM eyes (86 PRK; 37 LASIK), and 611 hyperopic LASIK eyes (31 DM) were analyzed. Mean follow-up was approximately 3 to 5 months. Generalized estimating equations-adjusted analyses showed no significant differences in visual, refractive, or complication outcomes between DM and controls for myopic PRK or LASIK. Within the diabetic population, PRK and LASIK outcomes were comparable. Hyperopic LASIK outcomes were similar, although patients with DM showed a higher retreatment rate.

In carefully selected adults with controlled DM, both PRK and LASIK yielded comparable safety and visual outcomes with controls. These findings suggest LVC is viable for this population and that current guidelines may be overly conservative.