I have terrible night vision (ghosting, starbursts, etc.) as a result of (customvue) lasik surgery. I can't drive at night, I can't go to movies... I have large pupils, 7.5 - 8mm. Alphagen doesn't really work for me; it gives me headaches, and makes my eyes burn. My last hope is for an enhancement.

Has anyone with large pupils had an enhancement to improve night vision? How did it work out for you?

I have carefully been studying the effects of Customvue surface ablation and night vision problems. Patients with up to 8.5 mm pupils have been treated. In general, my large pupil patients have done just as well as my small pupil patients in regards to night vision quality.
So with Customvue - if you are having night vision problems - I would suspect that you have some residual refractive error or perhaps some astigmatism or irregular astigmatism. A pair of glasses, or even contact lenses - should be able to improve your night vision problems. If this is the case - and enhancement with a prescription similar to the glasses or contacts would improve your night vision.
The big question was - how near-sighted were you before the procedure? And have you tried glasses or contacts to see if the vision improves.

Thank you

William Trattler, MD
Miami, FL

Thank you for responding. I was -4.00 in one eye, and -4.25 in the other prior to surgery.
I'll go to an optometrist and see if glasses make a difference before I go see my surgeon.

I'd still like to here from anyone who has had an enhancement to eradicate or improve night vision complications, if you're out there.

As someone who has done extensive research into night vision problems after refractive surgery, my opinion is that, like me, you probably suffer from a bit of spherical aberration and irregular astigmatism. After healing, its not uncommon to have a little irregular astigmatism.

I should tell you that all lasik surgery introduces higher order aberrations that affect night vision. My guess is that CustomVue helped, but did not eliminate these problems.

The belief that residual refractive error is the reason for these problems is questionable. Residual refractive error magnifies but does not causes these problems. Treatment is probably RGP lenses or Alphagan P.

Dr. Trattler, thank you so much: I have discovered that a pair of low prescription eyeglasses curb the nighttime haloes enough so that I can drive after dusk.

Fred, thanks for responding. I am having a wavescan done soon to determine the cause of my night vision problems.
However, I am not so certain that "all lasik surgery introduces higher order aberrations that affect night vision." Would not the existence of individuals who have had lasik surgery without any permanent nighttime vision problems serve to contradict this statement?

The human optical system is complex, and many individuals can adapt to a large variation in higher order aberrations. We know for certain that Lasik introduces additional HOAs into the human eye. However, some may disappear during the healing process and some may "come out in the wash" during the visual process involving multiple parts of the human eye. I wouldn't necessarily say that everyone's vision is adversely affected, but it seems clear that almost everyone witnesses these affects during at least the initial healing process and beyond.