Rheumatoid Arthritis + Lasik

[Toadkiller Dog]

A friend of mine just saved up his $1700 and went down to get lasik surgery from a local ophthalmologist. While taking his medical history, it came out that he carries a diagnosis of JRA (juvenile RA) from when he was a kid. The doc stopped the visit right there and said "I can't do the surgery, then". Since I was sitting right there (and didn't tell him I was a budding ophtho), I asked why not. He mumbled something about how having a "positive ANA" at anytime in your life could lead to serious complications, and absolutely would not discuss it any further.

It didn't sound like he really knew what he was talking about, so I thought I'd check here and see if anyone knows about RA being a contraindication. Some interesting points:
1. The test for RA is rheumatoid factor (RF), not ANA, and in JRA, >90% of pts do not have a positive test ("seronegative")--on talking with my friend's parents, it turns out it is indeed this flavor of RA he had.
2. As such, JRA is a clinical diagnosis; there is no confirmatory test.
3. He has been in "remission" >20 years, with minimal sequelae (some big MCPs on his right hand, no real ulnar deviation).
4. To make matters more complicated, he had what his parents believe was untreated Lyme disease as a kid (grew up in CT) in the early 80's. Hmmm....septic Lyme arthritis?

Soooo....is the doc FOS? Or is he Lasik-able? I myself wonder if he ever had JRA at all. Curious what you all think.

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[ckyuen]

Toad Killer not everyone is a good candidate for lasix, if the doctor said no, I'm sure you could find someone who would be willing to do it but would this be the best thing for your friend? I don't think so. Look up Mooren's ulcer, it's a nasty thing. Also when JRA is concerned those at highest risk for uveitis are rf neg, ana +, which I believe your friend is. Don't go into an eye that's proned to becoming "hot". You're asking for trouble. Pt's with JRA who get uveitis are proned to CME, band keratopathy, and cataracts. Vision loss from CME can be irreversible, and it could take years to quiet an eye down enough in a pt with JRA to do his cataract if that develops. Not to mention the potential for your friend to be a steroid responder. Mucking around with the eye to do a refractive ELECTIVE procedure is the last thing I would do. Does your friend get good vision with CTL and glasses if so, great. Stick with them. Lasik can be great for those who are good candidates.