Outcomes Of Laser Vision Correction With Hypothyroidism: A Retrospective Study

Hypothyroidism (HT) is a common condition that may impair corneal wound healing, and tear-film stability, potentially impacting visual recovery and refractive accuracy after laser vision correction. Evidence guiding procedure choice in patients with HT remains limited and heterogeneous, and many centers treat it as a relative contraindication or modify perioperative protocols. We aimed to evaluate real-world visual and refractive outcomes of photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) in adults with controlled HT as compared to the general population for correction of hyperopia and myopia, and to compare the two surgical techniques within patients with the condition.

Retrospective comparative study at Care Vision Laser Center, Tel Aviv, Israel.

This retrospective comparative study included consecutive myopic and hyperopic adults with either controlled HT or no known chronic systemic disease, all aimed for emmetropia, without ocular comorbidities or prior ocular surgery, who underwent PRK or LASIK between 2013 and 2024. Baseline characteristics were balanced using propensity score matching. Refractive and visual outcomes were assessed between diabetic and control groups for each modality, and between PRK and LASIK within the cohort.

After matching, 5337 eyes (HT 492; controls 4845) were analyzed for myopic PRK; 2137 eyes (HT 198; controls 1939) for myopic LASIK; and 365 myopic HT eyes (PRK 233; LASIK 142) for within-population modality differences. 247 eyes (HT 24; controls 223) were assessed for hyperopic LASIK. For myopia- there were no significant differences between HT and control groups in PRK outcomes. In LASIK, postoperative cylinder was lower in HT compared to controls (-0.12D vs -0.15D; p=0.03) with no other significant differences. Within the HT population, PRK and LASIK showed no significant differences between the groups. Hyperopic LASIK demonstrated a significantly superior safety index in healthy controls as compared to HT (1.02 vs 1.01; p=0.041).

Both PRK and LASIK are effective for balanced HT patients. For the treatment of myopia, the two modalities seem comparable between healthy controls and HT patients, with no significant preferable choice among them, implying other, more substantial factors be taken into consideration for surgery selection. However, for hyperopic patients, LASIK achieved greater safety in healthy controls, suggesting careful consultation preoperatively, and perhaps meticulous control of any endocrinological imbalances prior to surgery.