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You were told
it wasn't possible

Second-opinion consultation in refractive surgery

“Your cornea is too thin.” “You are too short-sighted.” “There is something on your topography.” These sentences put an end to a plan, often without the patient understanding why. Sometimes they are final. Often they only mean that the technique being considered was not suitable, not that none is.

Thin corneaThe lens does not touch it
Prescription too highBeyond the limits of laser
Questionable topographyTo be reassessed, not decided in haste
Dry eyeOften treatable beforehand
EligibilityTechniques What you should knowFrequently asked questions

Eligibility

Does this apply to you?

These criteria point the way; they do not decide. Only the pre-operative assessment, which measures the actual geometry of your eyes, can settle the question.

Depending on the reason for the refusal

“It isn't possible for you”The reason for the refusal determines what remains possibleCornea too thinICL phakic lensThe lens uses up none ofthe corneal thickness.Prescription too highICL phakic lensBeyond the limits oflaser, the lens takesover.Questionable topographyTo be reassessedNew topography andanalysis of how it evolves.Dry eyeTreat it firstOften reversible; theplan resumes afterwards.Or the refusal is confirmedA clear, reasoned answeris better than doubt.

The full assessment determines which of these branches applies to you

Favourable profile

  • Refusal because the cornea is too thin for the intended correction
  • Myopia or hyperopia beyond what corneal laser can treat
  • Dry eye, which can often be treated before surgery
  • Topography judged borderline, with no confirmed keratoconus
  • An old refusal: techniques and lenses have moved on since
  • An explanation that fell short, or simply a need to understand the decision

What rules it out or means waiting

  • Confirmed progressive keratoconus: the refusal is justified and will remain so
  • Macular disease or advanced glaucoma
  • A prescription that is still changing
  • Hoping for an accommodating opinion rather than a reasoned one

Techniques

The options to consider.

None is better than the others in absolute terms: each one suits a specific anatomical situation.

ICL phakic lens

The most common answer to a refusal for a thin cornea or high myopia: the lens uses up none of the corneal thickness.

Trans-PRK

Removes less tissue than LASIK for the same correction. Some corneas ruled out for LASIK remain eligible for it.

PreLex

After 55, working on the natural lens sidesteps the corneal question entirely.

Already had cataract surgery

A monofocal lens already in place does not rule out correcting your vision afterwards: laser enhancement, a reversible second lens, or a lens exchange.

Sometimes, none

Sometimes the refusal is confirmed. You then have a clear, reasoned answer, which is better than doubt.

What you should know

The point that is too rarely explained.

A second-opinion consultation only makes sense if it relies on a new, complete examination: topography, pachymetry, aberrometry, measurement of the anterior chamber and, where relevant, an endothelial cell count. Bring your previous reports and your old prescriptions: whether your prescription has stayed stable over time is something only your records can establish. And know this from the start: I will confirm the refusal if the measurements justify it.

SFO information leaflets (in French)

Published by the French Society of Ophthalmology (Société Française d'Ophtalmologie), they describe the procedure, its results and its risks. They form the basis of informed consent and do not replace a consultation.

Frequently asked questions

What I am asked most often.

I was turned down for LASIK because of a thin cornea: can I still have surgery?

Often yes, but differently. The ICL phakic lens does not touch the cornea, and Trans-PRK removes less tissue than LASIK for the same correction.

I am very short-sighted. Is there a solution?

Beyond six to eight dioptres, laser reaches its limits. The phakic lens is designed precisely for these corrections.

Keratoconus was mentioned, but without certainty. What should I do?

A new topography and an analysis of how it changes over time are essential. Confirmed keratoconus rules out corneal laser; an isolated suspicion needs to be settled one way or the other.

I was turned down several years ago. Does that still stand?

Not necessarily. Lenses and ablation profiles have moved on, and your prescription may have stabilised in the meantime.

What should I bring to the consultation?

Your previous examination reports, your old and recent glasses prescriptions, and the letter from the other ophthalmologist if you have it.

Find out whether it is possible for you

The questionnaire gives a first indication in three minutes. The pre-operative assessment measures what cannot be guessed: your corneal topography, your corneal thickness and the condition of your retina.

Take the eligibility test Book an appointment

Dr Emmanuel Halimi

Ophthalmic surgeon  ·  RPPS 10100555084  ·  Medical Council of Hauts-de-Seine no. 92/23003

Page written and approved by the surgeon.
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