Background:
Lasik 3.5 years ago. Had enhancement in left eye 3 years ago. Fairly large pupils...don't know exact size.

Issues:
1) Probably covered many times in these forums but...
I experience loss of clarity in right eye during night or low-light conditions. Best way for me to describe is to say it's like my right eye goes to 20/40 in low-light (the 20/40 claim is just a guess i'm using to make a point) With bright sun, vision is perfect which makes me think it's pupil related? I do feel that overall night vision is pretty poor (in both eyes) although right eye is very noticeably worse.

2) I've also noticed that my right eye experiences an abnormal amount of "discomfort". It is hard to describe, it's like some weird "pain" that constantly draws my attention to my right eye. It's not present 24/7, but enough to make me ask about it on this forum!

3) Also, (again with the right eye!) it very often feels as if there is some sort of coating on my eye that i can't remove. I find myself blinking a bunch to try to remove it, but to no avail.

Questions:
Is there hope to deal with these?
Should i try pupil constricting drops at night? (note this is not appealing since if pupil goes small at night even less light is getting to brain)
Do i maybe just need an enhancement in right eye?
Any suggestions with regard to the discomfort and coating mentioned above?

Obviously, your right eye has some problems, but what is causing those problems is difficult to judge from here. It could be simple refractive error that could be corrected with glasses, contacts, or possibly additional enhancement surgery. It may be that there are biological problems that would make surgery impossible.

The pupil size and poor night vision situation is covered at http://www.usaeyes.org/faq/subjects/lasik_pupil_size.htm

You may find that Alphagan P or pilocarpine eye drops to reduce your pupil size is appropriate, but first you need to determine exactly what is happening. For that, you need an evaluation by a knowledgeable surgeon.

You don’t mention where you live, but you will want to seek a doctor who has available wavefront technology. Laser manufacturer trade names are CustomVue, CustomCornea, and Zyoptix. Doctors who provide these services are using wavefront technology that may be able to better diagnose (and possibly treat) your situation.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

Thanks for the response Glen.
I live in Chattanooga, TN....but had the surgery in Atlanta at the (presumably infamous by now) Lasik Vision Center. As the initial surgery was over 3 years ago, my surgeon probably isn't even there anymore :(
I will call them and see if they have any suggestions. I suppose i could try to find out if Chattanooga has someone with Wavefront technology...perhaps you know of someone?

I'm having the same problem. My procedure was done about 3 months ago, and my vision deteriorates noticably in low light, where "low" means normal indoor lighting at night. I've done a lot of research into this, and this is apparently what's called "night myopia" -- a change in prescription under low-light conditions.

As for the cause, there are apparently two ways of looking at it. Those who don't think pupil size is correlated with night vision problems will usually say the cause is spherical aberration, which LASIK often induces by creating a sharp transition between the treated and untreated parts of the cornea. On the other hand, those who think pupil size is important would point out that if the treatment area were larger, any such aberration would be moved further from the main optical zone and would be less of a problem. Six of one, half a dozen of the other it seems to me.

In my case, I currently wear glasses to correct a slight astigmatism either caused or at least not treated by my original procedure, but these don't seem to have any effect on my low-light problems. The conditions under which my refractions have been done (a dark room with the only light coming from the Snellen chart projected on the wall) are those in which I typically have problems, but for some reason the glasses still only work to correct my astigmatism in bright light.

I'm hoping to fix or at least improve all of this with an enhancement procedure. My original treatment was standard VISX LASIK, a 6.5mm optical zone with no blend zone. A VISX wavefront enhancement would at a minimum add a blend zone to 8mm, which should reduce any effects resulting from the sharp transition. Some researchers think that the simple addition of a transition zone in a wavefront procedure may do more to resolve night vision problems than actually treating any HOAs.

I'm also considering the possiblity of treatment with a larger optical zone, but with my corneal thickness I couldn't really go that much larger -- maybe 7mm with a blend to 9mm, which would leave a corneal bed of just under 300 microns (300 is my comfort limit despite the fact that some doctors will go less than this). I might also have to switch to a different laser like the Allegretto, which my laser center has, but that might mean switching to another surgeon.

Hi. I have the same issue, although I would only say that the right eye feels different than the left. Can't put a finger on it really. I have annoying blur at night in both eyes and constant blur, although to a lesser degree, in the daytime with the right eye. I do have dry eye, but the tear test scores are identical in both eyes. I had LASIK in the right eye and PRK in the left. My doc suspected that I had EBMD, although another doc said I didn't because I would have a ton of pain if I did. Bottom line is that I suspect the feel thing is due to something epithelial going on in the right eye. I know that it's possible to have this problem with few symptoms. I read that if LASIK is done on an eye with EBMD, the result is a softer visual endpoint, which is a very good description of what my right eye is like. I have crystal clear vision in the daytime with the left eye.

The nighttime problem for me is probably spherical aberration in the left and coma in the right.

I have had no luck with RGP lenses due to the dryness, tried attacking the dryness (long story), bottom line is that my OD cannot do anything with lenses to make me see better. Pilocarpine gives me headaches and Alphagan does help somewhat with the starbursts/nighttime blur, but it still leaves my near vision somewhat fuzzy in the right eye.

If you can figure out what it is, please post it here.

I had visx customvue 1.5 years ago. My vision was -7.75 and -7.25 with a mild astigmatism in each. My pupils were measured at 7.5-8 mm however i had been to about 5 different doctors before which measured my pupils at 8.5-9mm(huge I know and my biggest concern before surgery), I feel this figure is probaly more acurate. I was part of a study for customvue in the -6.00 to -12.00 range.
My day vision is excellent at 20/12. In low light situations I often get a fuzzy or double bottom edge on light sources or say black text on a white background. In night situations I do have some starburt effect around streetlights and similar low light sources. The starburst effect is much more on the lower bottom part of the lightsource, in very dark areas the starburst effect is around the entire light source. On coming car headlights have no distortion I suspect because the brighter lights shrink my pupils. This is the same in both eyes. I can see street signs fine and drive with no problem at night.
My question is why is the bottom double edge or bottom starburst effect only in the bottom. I was concerned about centering and asked my doctor, she said centering is fine and its just that my pupils are probably dialating unevenly, does this make sense? and after 1.5 years can I expect any improvement in low light or night effects?
This is not a problem but more of an anoyance, I have no other issues, no dry eye, no pain, no sensitivity, no contrast issues and my wavefronts are about as close to zero as they can be. These low light and night issues are just a side effect of my huge pupils and cannot be corrected right? and I propably should leave well enough alone and not risk messing up a 20/12 result right?
On a side note if anyone with high myopia is considering lasik go with the customvue I heard it was just approved in september for high myopia. I will tell you the study location and group I was in had excellent results only one person last I heard had 20/30 in one eye all the rest were 20/20 or better and this is with no enhancement, group range was -6.00 to -12.00. I can recommend a great doctor if your willing to pay her $5700 fee.
Any comments on the low light and night effects are appreciated. Thanks

I had visx customvue 1.5 years ago. My vision was -7.75 and -7.25 with a mild astigmatism in each. My pupils were measured at 7.5-8 mm however i had been to about 5 different doctors before which measured my pupils at 8.5-9mm(huge I know and my biggest concern before surgery), I feel this figure is probaly more acurate. I was part of a study for customvue in the -6.00 to -12.00 range.
My day vision is excellent at 20/12. In low light situations I often get a fuzzy or double bottom edge on light sources or say black text on a white background. In night situations I do have some starburt effect around streetlights and similar low light sources. The starburst effect is much more on the lower bottom part of the lightsource, in very dark areas the starburst effect is around the entire light source. On coming car headlights have no distortion I suspect because the brighter lights shrink my pupils. This is the same in both eyes. I can see street signs fine and drive with no problem at night.
My question is why is the bottom double edge or bottom starburst effect only in the bottom. I was concerned about centering and asked my doctor, she said centering is fine and its just that my pupils are probably dialating unevenly, does this make sense? and after 1.5 years can I expect any improvement in low light or night effects?
This is not a problem but more of an anoyance, I have no other issues, no dry eye, no pain, no sensitivity, no contrast issues and my wavefronts are about as close to zero as they can be. These low light and night issues are just a side effect of my huge pupils and cannot be corrected right? and I propably should leave well enough alone and not risk messing up a 20/12 result right?
On a side note if anyone with high myopia is considering lasik go with the customvue I heard it was just approved in september for high myopia. I will tell you the study location and group I was in had excellent results only one person last I heard had 20/30 in one eye all the rest were 20/20 or better and this is with no enhancement, group range was -6.00 to -12.00. I can recommend a great doctor if your willing to pay her $5700 fee.
Any comments on the low light and night effects are appreciated. Thanks

Your pupil size is of course related to your symptoms. you probably notice that if you leave a light on in your car, the starburst decreases...because the pupil size has gotten smaller.
After 1.5 years, this may not improve on its own. You can consider a touch up to expand the optical zone. Or consider drops to slightly shrink the pupil size...or just continue living with it.

I hope this helps

Bill Trattler, MD
Miami, FL

Kathine, I have had good luck with soft contacts like Focus Night and Day and EBMD. EBMD does not have to be painful, as you discovered in your research. But, it does cause these variable "lakes and islands" of epithelium that cause reduced tear breakup time, and a feeling of dryness. If these occur on the visual axis, the vision will be blurred. The soft contacts can do a good job of smoothing over these surface imperfections.

DrG