Many patients with obstructive sleep apnea still can have successful LASIK or PRK laser vision correction eye surgery. However, independent of having surgery, patients with sleep apnea can have eye problems that need to be checked before having surgery.

A patient who lives in Santa Barbara and suffers from obstructive sleep apnea asked me if he could still have LASIK.

Over the years, I have performed LASIK and PRK laser eye surgery on many patients with sleep apnea with good results. However, there are certain eye problems that patients with sleep apnea are more likely to suffer from and these need to be carefully addressed before LASIK.

The most common problem in patients with obstructive sleep apnea is floppy eyelid syndrome. In this condition, patients have redundant, loose, floopy, and rubbery upper eyelids. Often, patients have the problem on only the side of the head they sleep on, meaning it can be seen often only in one eye. Between 2 and 5 percent of patients with obstructive sleep apnea have floppy eyelid syndrome, but in the converse, up to 90% of patients with floppy eyelid syndrome have obstructive sleep apnea. The main concern in terms of LASIK is whether there is poor wetting of the surface of the cornea due to the lid problems, leading to dry eyes. If the eyes are too dry, the patient may not be a good candidate for laser vision correction, either with LASIK or PRK.

Glaucoma also is seen more commonly in patients with sleep apnea. One study showed that 27% of patients with glaucoma have sleep apnea. Another study showed that patients with sleep apnea were four times more likely to develop glaucoma than patients without sleep apnea. Patients with glaucoma often should have PRK instead of LASIK when undergoing laser vision correction in order to provide maximum safety to the optic nerve.

Optic nerve disc swelling — or “papilledema” — also is more common in patients with obstructive sleep apnea. Papilledema can create visual loss in various portions of the patient’s field of vision. It is important to document these before LASIK or PRK so the patient can be reassured that the laser eye surgery is not the cause of these changes. Also, if a patient is found to have optic nerve swelling during a LASIK work-up and consultation, I would refer the patient to a neurologist to rule out any intracranial issues such as tumors or other masses before proceeding with laser eye surgery.

Non-arteritic anterior ischemic optic neuropathy also is associated with sleep apnea. Patients with this condition usually have such significant visual loss that they are not candidates for having their vision improved by corneal laser refractive surgery such as LASIK or PRK.

The last common eye association of obstructive sleep apnea is retinal vein occlusion. Again, patients with this eye condition typically have very, very poor vision which will not be improved with LASIK or PRK and therefore are not good candidates for these vision correction surgeries.

On a practical note, the other problem I’ve seen over the years in patients with obstructive sleep apnea is that the CPAP machine used at night can blow air onto the eyes and dry out the cornea after surgery. Typically, however, careful positioning of the CPAP machine can avoid this problem.

Most patients with obstructive sleep apnea do not have any of the eye problems mentioned above. However, these problems are more likely to occur in patients with sleep apnea than in the general population, so it is important for me to carefully screen for these when patients come in for their LASIK consultation and work-up.

See Also

Sleep Apnea and Sleep
National Sleep Foundation’s discussion of sleep apnea.

Obstructive Sleep Apnea
American Academy of Dental Medicine’s discussion of obstructive sleep apnea.

Obstructive Sleep Apnea and the Eye: The Ophthalmologist’s Role
American Academy of Ophthalmology discussion of the ophthalmologist’s role in managing obstructive sleep apnea, which can affect the eyes.

Crystalline Obstructive Sleep Apnea and the Eye
American Academy of Ophthalmology discussion of ocular involvement in obstructive sleep apnea.

The Eye and Sleep Apnea
A scholarly article from the medical literature on the relationship of sleep apnea to eye disorders and diseases.