Cosmetic Eye Surgery

When can refractive eye surgery be considered non-cosmetic?

When stronger prescriptions no longer help vision and headaches become a near daily occurrence, what medical options are there to improve vision that would be considered necessary rather than cosmetic?
Is there such a thing as preventive eye surgery, such as to prevent a detached retina? (eyes around -6.0, prehypertension, and father had a detached retina at age 50)

Generally it is ‘medically indicated’ and not purely cosmetic in nature when the individual cannot receive adequate corrected (20/40 or better in ONE eye) vision with glasses OR contacts. If contacts, maybe some specially designed, or hard RGP, etc give you improved vision that your glasses can’t,.. it is still “cosmetic”.

Now,.. even if the ‘laser’ eye surgery (generally anyway) is deemed 100% a necessity for medical needs.. ie: you are legally blind without it — Insurance companies still usually won’t pay it. They have such things as Lasik and the like coded as cosmetic, and generally won’t budge unless you really make your own case for it (and it isn’t stated VERY specifically in their policy).

I am unfamiliar with ‘vision insurance’ — I do know medical insurance covers alot of ‘eye procedures’ as the eye is an organ of your body — so I would think ‘vision insurance’, specifically, might be a bit more lenient in the rarer case of a surgery , usually cosmetic in nature, needed as medical necessity and might pay it.. or partial.

Things are changing though — all over. I’m not saying it will be covered any time soon.. in fact if you are referring to Lasik — the FDA, among other organizations are really starting to turn their heads with the vast surfacing of the small percentage of strongly negative outcomes. I doubt it will ever be FDA ‘dissaproved’ — but it is possible some tighter regulations could be placed. Though 1-2% of cases (and that is being under-conservative) do end up horribly.. and I would guess up to 10% of cases end up much less than what the person expected. IE: Maybe end up with 20/40 in one eye, 20/60 in the other.. etc. But I digress.

Medical options to improve vision that are necessary —

Grafts — (Corneal replacements) *Cornea is the outer surface of your eye just in front of your Iris*

Cataract surgery (IIRC).

Vitrecomy due to complication.

Laser in the eye(s) to relieve pressure.

Corneal Dystrophy, like Keratoconus is most certainly a ‘medical condition’ — and there are quite a few treatments coming out for this progressive disease — The latest is something call corneal cross linking (CXL) which takes Riboflavin drops in the eye, with a special wave length of UV-A light.. to strengthen the cornea and essentially (so far in the follow up studies) — Halt the progression of a generally progressive disease. With often some slight regression in the disease (minor). Yet this is FAR from covered by insurance.. even though if the studies continue to show people’s eyes holding out it would be most advantageous for insurance to pay for it because it would essentially eliminate them paying (potentially) for multiple Corneal Transplants in the future (ALOT more expensive). Just another example I’m familiar with. — I absolutely despise insurance companies.. really do. I wish there were a ‘good’ way to pay for health care that didn’t involve a company interested in only the bottom line approving or denying what you can or cannot have done medically. But, such is the way it is!

I can only say that in some cases where you can find a STRONG medical causation for your vision (especially with a doctor or two confer) — You can advocate for yourself to your insurance and it isn’t unheard of for them to pay for a procedure that otherwise never would have been approved.

Best of luck,

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