How often it happens, and why
A good remote pre-screen — a recent prescription, your age, your history of stable vision, your dry-eye and medication picture — catches most non-candidates before they buy a flight. That's why we ask for what we ask for in What to send with your LASIK inquiry. But some things only show up on the exam-day scans: corneal thickness under the surgeon's threshold, an irregular topography that hints at early keratoconus, a tear-film result that's worse than your symptoms suggested, a prescription that shifted since your last test. When any of those appear, a careful surgeon says no, or says "not this, but maybe that."
The frequency is low but not zero, and it's higher for people who skipped the pre-screen or who wore contacts inside the cut-off window (the cornea hasn't returned to its natural shape, and the scans are unreliable). If you followed the When to stop contact lenses before LASIK timeline and sent a full pre-screen, your odds of a surprise are as low as they can be made.
The first conversation
When a surgeon tells you no, you're dilated, disappointed, and in a foreign clinic. Ask three things before you leave the room, and write the answers down or have your companion do it.
- What specifically disqualified me? You want the measurement, not the category. "Your thinnest pachymetry reading is X microns and my minimum for LASIK is Y" is an answer you can take to another surgeon or your home optometrist. "Your corneas are a bit thin" isn't.
- Is it permanent, or could it change? Contact-lens warpage resolves with more time out of lenses. A tear-film problem may improve with treatment. A thin cornea is what it is. Early ectasia is a reason never to have corneal refractive surgery. Each of these leads somewhere different.
- What would you do instead, for my eyes? This is the question that turns a no into a plan. See the alternatives below.
What the alternatives usually are
If it's not LASIK, what might it be?
Common reasons for a 'no' and where each tends to lead — a planning guide, not a clinical one
| The finding | What it means for LASIK | Where it usually leads |
|---|---|---|
| Cornea too thin for the planned ablation | Not enough tissue for a flap plus correction with a safe residual bed. | PRK/LASEK (no flap, so less tissue used) — often same trip, longer recovery. Or SMILE at some clinics. |
| Contact-lens warpage on topography | Scans unreliable; cornea hasn't settled. | Wait — sometimes days, sometimes weeks — and re-scan. May mean a second trip or extending this one. |
| Suspicious topography / early keratoconus | Corneal laser surgery is contraindicated. | No refractive laser. Possible referral for cross-linking or an implantable lens (ICL) assessment. The trip becomes a diagnostic one. |
| Severe dry eye / poor tear film | LASIK likely to worsen it. | Treat first (drops, plugs, lifestyle), reassess. PRK sometimes preferred. Usually a later trip. |
| Prescription out of range or unstable | Beyond the laser's safe correction, or still changing. | ICL for high prescriptions; wait 12 months of stability for a changing one. |
| Undisclosed medication or condition | Some drugs and autoimmune conditions affect healing. | Depends on the item. Sometimes a short delay; sometimes a different procedure; sometimes no. |
Categories and typical next steps as discussed with refractive surgeons in the network. Individual decisions are the operating surgeon's. PRK, SMILE, ICL and cross-linking availability varies by clinic.
What happens to your deposit
This is the question people are embarrassed to ask in the room, so we'll answer it plainly: at the clinics we book with, a deposit paid for a procedure you're medically ruled out of is refunded or transferred. The exam fee itself — the scans and the surgeon's time — is usually retained, because that work was done and it's what produced the "no." Read your quote: it should separate the exam fee from the surgical deposit, and if it doesn't, that's a question for the coordinator before you pay. The payment mechanics are in Deposit and payment for LASIK abroad.
Transfer is the common outcome when the surgeon offers an alternative. If you were quoted LASIK and the surgeon recommends PRK, the deposit rolls over and the price difference (often none, sometimes a little less) is settled at the clinic. If the alternative is an ICL, it's a substantially more expensive procedure that needs its own quote and usually its own trip, so the LASIK deposit is refunded instead.
If you booked through us, refund or transfer is handled between us and the clinic. If you booked direct, ask for the refund confirmation in writing before you leave the building. Card refunds to a foreign card can take a couple of weeks to show; a bank transfer can be faster but ask about fees.
We don't push you to a second clinic in the same week for a second opinion that might say yes. If a surgeon has ruled you out on a corneal finding, the right next step is a calm conversation with your own optometrist at home, not a hunt for someone who'll operate anyway.
If the alternative is same-trip PRK
This is the most common rescue, and it's usually good news dressed as bad. PRK removes the surface layer instead of cutting a flap, uses less tissue, and produces the same eventual result. The costs are a slower and more uncomfortable recovery — three to five days of real discomfort and blurry vision, and clearer sight over weeks rather than a day — and a later safe-to-fly date. If your flights are fixed to an 8-day plan built for LASIK, PRK may need them moved by two to four days. What that does to your ticket is in booking flights around LASIK cut-offs. Most patients who can extend, do; the ones who can't sometimes go home and return for PRK on a later trip, deposit intact.
If the answer is "wait"
Contact-lens warpage is the frustrating one because it's self-inflicted and it's temporary. If the surgeon wants another week out of lenses, you have three choices: extend the stay (Medellín and Bogotá are cheap to spend a week in), fly home and come back (the deposit holds), or accept a re-scan on your last day and, if it's clear, surgery with a shortened post-op window and a home follow-up plan. The third option depends on the surgeon and on your home optometrist being lined up, which is what Setting up LASIK follow-up care at home covers. Do not fly home and quietly put your lenses back in; you'll be back at square one.
If the answer is "never"
A keratoconus or ectasia-risk finding is the hardest news to get in a foreign clinic, and also the most important. Corneal laser surgery on an eye with early keratoconus can cause progressive damage; the surgeon who caught it has done you a genuine service. Take the scans — ask for the topography images and the report, in a format your home doctor can open — and get a corneal specialist's opinion at home. Cross-linking to stabilise the cornea and, later, an implantable lens for the refractive error are both real paths, and both are available in Colombia if you decide to come back. Just not this week.
Making the week count anyway
You're in Medellín or Bogotá with several days and no surgery. A few things are worth doing before you leave:
- Get the full exam report — topography, pachymetry, wavefront, the surgeon's note — as PDFs. This is a complete refractive work-up you'd pay several hundred dollars for at home, and it's yours. Translating records covers what to ask for so it's usable back home.
- Get the refund or transfer in writing, with a date.
- If dry eye was the finding, start the treatment plan there. Colombian pharmacies stock the same preservative-free drops at a fraction of the price.
- Have the holiday. The restrictions that would have applied post-LASIK don't. Go to the coffee farm.
How to lower the odds before you fly
Everything above is easier to read than to live through, so here's the prevention list, short. Send a real pre-screen. Honour the contact-lens cut-off with margin. Disclose every medication and condition. If you have any history of dry eye, keratoconus in the family, or a prescription that's moved in the last year, say so up front — a surgeon can often assess those remotely from a recent topography, and would rather tell you no by email than at the clinic. The remote assessment is free through the desk; the flight isn't.
Questions we get at the desk
Will I get my deposit back if the exam rules me out of LASIK?
At the clinics we work with, the surgical deposit is refunded or transferred to an alternative procedure. The exam fee is usually retained since that work was done. Check your quote separates the two.
Can I have PRK on the same trip if LASIK is ruled out?
Often, yes — it's the most common alternative for thin corneas. Recovery is slower and your safe-to-fly date moves later, so flights may need adjusting.
Should I get a second opinion from another Colombian clinic the same week?
Not to find a yes. If the finding is corneal, take the scans home to your own eye doctor or a corneal specialist first.
How do I avoid being ruled out on exam day?
Send a complete pre-screen with a recent prescription, stop contact lenses on time with margin, and disclose all medications and any dry-eye or family keratoconus history in advance.
Ready for a date?
Send your prescription and your travel window. We come back with a surgeon, a slot, and a trip plan.