Laser Eye Surgery in St. Louis: Who Is a Candidate?
Revised November 9, 2026
How do I tell if I’m a candidate for LASIK?
You’re likely a candidate if you’re an adult with a prescription that has held steady for a year or more, healthy corneas that are thick and regular enough to reshape, no significant dry eye or active eye disease, and no health condition that slows healing. A surgeon’s screening exam is the only thing that confirms it.
Keep reading ↓It’s 6:40 on a weekday morning in Bethalto, and a nurse heading out for a twelve-hour shift is on her knees on the bathroom tile, patting around for a contact lens that just jumped off her fingertip. She finds it. It’s got lint on it. She rinses it, puts it in, blinks hard, and decides, not for the first time, that she’s going to look into LASIK this year.
Then the questions start.
Is she too old at forty-three? Are her eyes too dry? Does it matter that her prescription crept up a couple of years ago? And why do the ads all sound so sure of themselves when her sister-in-law was told flat out she wasn’t a candidate?
This guide walks through how candidacy actually gets decided, what a screening consult checks, the alternatives when laser surgery isn’t the right fit, and what to ask a surgeon before you book anything. No practice names, no prices, no promises. Your eyes are your own, and the only opinion that settles the question is the one from a surgeon who has measured them.
How do I tell if I’m a candidate for LASIK?
You’re likely a candidate if you’re an adult with a prescription that has held steady for a year or more, healthy corneas that are thick and regular enough to reshape, no significant dry eye or active eye disease, and no health condition that slows healing. A surgeon’s screening exam is the only thing that confirms it.
Is your prescription stable?
Eyes that are still changing are a moving target. If your glasses or contacts prescription has shifted recently, most surgeons will want to wait, because reshaping the cornea corrects the eye you have today, not the one you’ll have after it drifts again. Dig out your old prescriptions before the consult. They tell a story.
That’s one reason age matters. LASIK in the U.S. is generally limited to adults, and many surgeons prefer patients somewhat past their early twenties, when nearsighted prescriptions often settle down. Is there an upper limit? Not a hard one. Older eyes bring different questions, like early cataracts and presbyopia, and we’ll get to both.
What about the shape and thickness of your corneas?
The laser removes tissue. That’s the whole trick, and it means your cornea needs enough thickness left over afterward to stay strong. Surgeons also study its shape. A cornea that’s irregular, or shows early signs of keratoconus, a condition where it thins and bulges outward over time, can be a reason to skip LASIK entirely, since removing tissue could make things worse. You can’t judge any of this in a mirror.
Very strong prescriptions run into the same wall. The bigger the correction, the more tissue has to go, and at some point a surgeon may steer you toward a different procedure altogether.
Do dry eyes rule you out?
Not always, but dry eye is one of the most common reasons a consult slows down. LASIK can make dryness worse for a while because it disrupts corneal nerves that help trigger tears. Someone who already fights gritty, burning eyes by midafternoon might need treatment first, or a different procedure, or a frank talk about whether surgery makes sense at all. Tell the surgeon how your eyes really feel. Downplaying it helps nobody.
Which health conditions matter?
Healing matters as much as the laser work. Surgeons tend to look closely at autoimmune conditions such as lupus or rheumatoid arthritis, diabetes that isn’t well controlled, anything that weakens the immune system, and eye problems like glaucoma, cataracts or a history of eye infections. Some medications raise flags too. None of that is an automatic no for everyone. It’s a conversation, so bring a full list of what you take.
What about pregnancy?
Pregnancy and nursing are usually a pause, not a no. Hormonal shifts can temporarily change your prescription and your tear film, so most surgeons prefer to wait until things settle after you’ve finished nursing. Planning a pregnancy soon? Mention it. Timing matters here.
What does the screening consult actually check?
A good screening consult measures far more than your prescription. Expect corneal thickness readings, a map of the corneal surface, pupil measurements, a tear-film check, eye pressure, a dilated look at the retina and lens, and a long talk about your health history, your job and what you’re hoping surgery will do for you.
Plan on it taking a while. Dilation drops blur your near vision for hours and make daylight feel blinding, so bring sunglasses and, ideally, a driver. Contact lens wearers usually get told to leave the lenses out for a stretch beforehand, because contacts can temporarily change the shape of the cornea and throw off the measurements. How long depends on the lens type. Ask when you book, not the night before.
Sometimes the consult turns up something that needs a medical eye doctor first, like signs of glaucoma or a retina problem. That’s the system working. Our guide on when to see an ophthalmologist in St. Louis covers the difference between routine eye care and a specialist visit.
What does a no at screening really mean?
A practice that turns you away is telling you something useful. So is one that recommends a different procedure than the one you walked in asking about. Picture a guy from Wellston who’s been saving up for LASIK for two years, only to hear that his corneas are on the thin side and PRK or a lens-based option would be safer for his eyes. Disappointing? Sure. It beats the alternative.
What if LASIK isn’t the right fit?
LASIK is one option among several. PRK reshapes the cornea without cutting a flap. SMILE removes a small disc of tissue through a tiny incision. Implantable lenses sit inside the eye and remove no corneal tissue at all, and refractive lens exchange replaces your natural lens. Which one fits depends on your measurements, and your surgeon makes that call.
LASIK
In LASIK, the surgeon creates a thin hinged flap in the front of the cornea, folds it back, reshapes the tissue underneath with an excimer laser, and lays the flap back down. Many people see well quickly, often within a day or so. The flap is also its main tradeoff, since that part of the cornea doesn’t fully regain the strength of untouched tissue.
PRK
PRK came before LASIK and it’s still widely used. Instead of making a flap, the surgeon removes the thin surface layer of the cornea and reshapes what’s underneath, and that surface grows back over the following days. Recovery is slower. It’s more uncomfortable, too, and vision can take weeks to sharpen fully.
So why pick it? PRK leaves more of the cornea intact, which can make it the better choice for thinner corneas, and there’s no flap to dislodge. People in contact sports, the military or law enforcement sometimes care a lot about that last part.
SMILE
SMILE uses a femtosecond laser to shape a small lens-shaped piece of tissue inside the cornea, then removes it through a short incision. No flap. It’s newer than LASIK and PRK, it’s approved for a narrower range of prescriptions, and not every practice offers it. Ask whether it applies to your eyes specifically, not just in general.
Implantable lenses
An implantable collamer lens, or ICL, is a thin lens placed inside the eye in front of your natural lens, a bit like a contact lens that stays put. Nothing gets removed from the cornea. That makes it a common suggestion for very high nearsighted prescriptions or corneas too thin for laser work. It’s surgery inside the eye, though, and it carries its own risks your surgeon should walk you through.
Refractive lens exchange
Refractive lens exchange removes your natural lens and replaces it with an artificial one. It’s the same basic operation as cataract surgery, just done before a cataract forms. It tends to come up for people in their mid-forties and beyond with high prescriptions, early lens changes or a strong wish to cut back on reading glasses. Bigger step. And unlike a contact lens, you can’t just take it out.
What happens to your reading vision after 40?
Somewhere in your early to mid-forties, the natural lens inside your eye stiffens and loses its ability to focus up close. It’s called presbyopia, and it catches up with nearly everyone. LASIK reshapes the cornea, not the lens, so it doesn’t stop presbyopia. Plenty of people over 40 still need readers after surgery.
This is the part that surprises people. Say you’re nearsighted at 45 and you’ve been slipping your glasses off to read a menu. That trick works because your nearsightedness happens to offset your aging lens. Correct the distance vision fully and the menu trick disappears, so you may walk out reading highway signs crisply and reaching for drugstore readers at dinner.
What about monovision?
One workaround is monovision. The surgeon corrects your dominant eye for distance and leaves the other slightly nearsighted for reading, and your brain learns to use each eye for its own job. Some people love it. Others find their depth perception or night driving feels off. Many surgeons suggest trying it with contact lenses first, which makes for a cheap, reversible test drive.
What changes after 60?
A retiree in Kimmswick asking about LASIK at 62 might hear something different altogether. By the sixties, many people have early cataract changes, and reshaping a cornea that sits in front of a slowly clouding lens may not make much sense. Cataract surgery with a lens chosen to reduce glasses dependence often becomes the better conversation. Age alone isn’t the barrier. The lens is.
Will insurance pay for any of it?
Most health and vision plans treat LASIK and similar procedures as elective, so they usually don’t cover them. Some vision plans offer member discounts through certain providers. Flexible spending and health savings accounts may help, since refractive surgery is often an eligible expense. Confirm with your plan administrator before you schedule anything at all.
Call the member number on your card and ask three things. Does the plan cover refractive surgery at all? Does it have a discount arrangement, and with whom? What counts as an eligible expense for your FSA or HSA? FSA money often comes with a use-it-or-lose-it deadline, so timing a procedure around your plan year can matter. We’re not tax advisors, though, and your administrator is the one who knows your plan.
The routine eye exams around surgery are a separate question. Plenty of plans cover an annual exam even when they won’t touch the procedure, and our look at eye exam costs with a St. Louis optometrist explains how that usually works. Ask the surgical practice what care comes after the procedure, too, like follow-up visits and what happens if you need a touch-up later.
What are the real downsides?
Dry eye is the most common downside, and for many people it eases over the following months, though for some it lingers. Glare, halos and starbursts around lights at night are common early on. Serious complications like infection, flap problems or corneal weakening are rare but real, which is exactly why careful screening exists in the first place.
Night vision complaints deserve a straight answer before surgery, not after. People with larger pupils or stronger prescriptions sometimes notice more halos. Drive at night for work? Say so at the consult, and expect the surgeon’s answer to be about your measurements, not a general pat on the shoulder.
Some people also end up slightly under- or over-corrected and need an enhancement, meaning a second, smaller treatment. Vision can drift again over the years as the eye ages. Surgery changes the cornea you have. It doesn’t freeze your eyes in time.
And the stuff nobody prints on the brochure? Recovery-week logistics. You’ll use drops on a schedule, avoid rubbing your eyes, skip swimming and eye makeup for a while, and need a ride home on surgery day. Small things. They pile up fast if you’re a parent or work a physical job.
New eyes, same squint at the grocery label: spotting kosher food
How should you interview a laser eye surgeon?
Shortlist two or three surgeons and interview them the way you’d interview any doctor you plan to trust with something important. Tell each one plainly what you want and expect from surgery. Then listen for what they’re prepared to deliver for your eyes specifically. The gap between those two things is the signal, not the price.
Questions worth asking
Am I a good candidate, and for which procedures? A surgeon who explains why you’re better suited to PRK or an ICL, using your own measurements, is showing their work. That’s what you want.
Who performs the surgery, and who handles follow-up? Ask whether the surgeon you meet is the one operating, and who you call if something feels wrong at midnight.
What do you expect my reading vision to look like in five or ten years? That’s the presbyopia question in disguise. A thoughtful, specific answer is a good sign.
What happens if I need an enhancement? Ask how they decide one is needed and how it’s handled.
When would you tell someone like me not to do this? Our favorite. A surgeon who answers without hesitation has probably turned people away before, and that’s reassuring.
What should make you walk away?
Pressure to book on the spot. A consult that skips the dilated exam or the corneal mapping. Promises of perfect vision or never needing glasses again, because nobody can guarantee that and good surgeons don’t try. The nurse in Bethalto doesn’t need a sales pitch. She needs someone who’ll look at her dry eyes, her forty-three-year-old lenses and her shift schedule, then tell her the truth about all three.
Ready for a screening consult? Browse laser eye surgery across the St. Louis metro on St Louis Near Me Directory, shortlist two or three surgeons, and bring your old prescriptions to each consult.
If you’re the shop, being the one people and AI name first is the game when someone tired of fishing contacts off the bathroom floor finally asks whether they qualify, so list your refractive surgery or eye practice.
Frequently asked questions
Is it worth getting LASIK after 40?
It can be, if you go in knowing LASIK won’t fix presbyopia. Many people over 40 get sharp distance vision and still need reading glasses up close. Monovision is one option, and lens-based procedures may make more sense for some eyes. A screening exam and an honest talk about your daily life decide it.
Does insurance cover LASIK eye surgery?
Usually not. Most health and vision plans treat it as elective. Some vision plans offer discounts through participating providers, and FSA or HSA funds may be usable, since refractive surgery is often an eligible expense. Call your plan administrator to confirm what applies to you before you pick a procedure date.
What is the downside of laser eye surgery?
Dry eye is the most common, and it often improves over months but can linger. Glare, halos and starbursts at night are common early on. Some people need an enhancement. Serious complications like infection or corneal weakening are rare but possible, which is why screening matters and why some people get turned away.
Is there an alternative to laser eye surgery?
Yes. Glasses and contacts are the obvious ones. Surgically, an implantable collamer lens corrects vision without removing corneal tissue, and refractive lens exchange replaces your natural lens, much like cataract surgery. For some people, PRK or SMILE is the better laser choice. Your surgeon’s measurements decide which options you actually have.
Do you still wear glasses after laser eye surgery?
Many people don’t need glasses for distance afterward, but plenty still reach for a pair sometimes. Reading glasses are common after 40 because LASIK doesn’t stop presbyopia. Some people keep a light prescription for night driving, and vision can shift over time. Ask your surgeon what they expect for your eyes specifically.
Is 60 too old for laser eye surgery?
Not automatically. There’s generally no firm upper age limit. By 60, though, many people have early cataract changes, and LASIK doesn’t address the lens. A surgeon may suggest cataract surgery or refractive lens exchange instead. Healthy eyes and a stable prescription matter more than the number on your birth certificate.
Can your vision still deteriorate after LASIK?
Yes, it can. LASIK reshapes the cornea but doesn’t stop the eye from aging. Presbyopia still arrives in your forties, cataracts can develop later, and some people notice a small drift that may call for an enhancement. Keep up with routine eye exams after surgery so changes get caught early.
What disqualifies you from getting LASIK?
Common reasons include an unstable prescription, corneas that are too thin or irregularly shaped, keratoconus, significant dry eye, certain autoimmune or poorly controlled health conditions, some eye diseases, and pregnancy or nursing, which usually means waiting. Very strong prescriptions can also rule it out. A screening exam is the only way to know.
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