I am scheduled for Lasik surgery on May 31, 2000.

After leaving the office, I've become concerned about my pupil size and possible night vision complications.

The doctor completing my evaluation first measured my pupils (with a ruler-type instrument) at 7mm under dim light. Then she used an another instrument (that she said was more accurate - it almost looked like the radar gun that police use) that measured my pupils at 5.5mm under dim light. So, she said I was probably somewhere inbetween... In any event, the doctor explained that, with my pupil size, I might have problems with halos and starbursts.

From reading other measages posted on this site - I understand that the risk of complication is related to the amount of myopia - my contacts are: Left -3.25 BC 8.4 / Right -2.75 BC 8.4.

I'm very concerned because my night vision is very important - I drive race cars (NASCAR Modifieds) and I have several events that are run at night. The reason I'm so interested in Lasik surgery is because I cannot wear my contact when I'm racing (they constantly dry-out). Also, my glasses aren't really an attractive option because they significantly reduce my peripheral vision.

Therefore, I am wondering what to do?! In your experience, do you think I'll have long term problems? Are there lasers that can accomodate more than 6.5mm - now or in the near future? Is there a certain type of laser that would produce better results on my eyes?

Please offer me some words of wisdom...?!

First - we find that night time problems after LASIK related to pupil size are only significant in people with atleast 6-8 diopters of myopia (over twice what you have). All of the lasers that I am familiar with treat to atleast 6.5mm (I use the VISX and treat with 6.5 mm zones).
No one can guarantee that night time problems will not be an issue, but I have performed LASIK on numerous patients with larger pupils than you and myopia levels higher than what your quoted - and they have done exceptionally well at night without problems.

Remember that there are other causes of night time problems after LASIK that are not associated with pupil size, such as having residual myopia or astigmatism after LASIK

I hope this helps

Bill Trattler, MD
Miami, FL

I seriously disagree with the Dr. on this. Dr. Horn at the Chicago Laser Center won't do anyone over 8mm. Check out his BB.

I'm 8mm, had 3 diopters, and have horrible low light vision despite having no remaining prescription.

However, Renee's pupils are 5.5 mm. I concur with Dr. Trattler's comments. Sorry.

mark,
In general - night time difficulties are not related to pupil size in patients with low levels of myopia. My experience, and the experience of numerous other LASIK surgeons has found this to be the case. There are of course exceptions - but lets get some more details
You state that you began with 3 diopters of myopia, had LASIK, and now have night time problems.
1. Did you have any night time problems prior to LASIK?
2. Did you wear contact lenses or glasses primarily prior to LASIK
3. Following LASIK, what level of difficutlies are you having at night? Is there a difference between eyes
4. During your last exam, what was your refractive error
5. Have you had corneal topographies recently. Are your ablations well-centered or are they off-center? Is there topographic astigmatism? Is there irregular astigmatism?
6. Does your LASIK flap edge intersect with your pupil? If the LASIK flap is not centered, the edge of the flap can be in the visual axis. Since slight haze/scarring can occur at the flap edge, this may be a cause of your night time problems
7. Do you have striae or wrinkles in your flap? What about debris under your flap in the visual axis
8. What is your age (I should have asked this first)
9. Have you tried pupil-constricting drops as a test to see if the night-time symptoms are eliminated with a smaller pupil?

I await your reply. I oof course will be happy to answer any further questions

Bill Trattler, MD
Miami, FL

Just my two cents.
I have 8mm pupils and a 6mm zone, and I have some night symptoms, but they do not interfere with my life in any way.
I was -4.50 previously.
So who knows what the "right answer" is.
It really depends on what you're looking for and what you're will to accept in exchange for going without glasses and contacts.

Dean Hu, M.D.

Dean,

Thanks for your input. I have been trying to get inputs from people who have have larger pupils than optical zones in order to help with my own decision. In my case I am -5.5 diopters, a near-darkness pupil size of 8mm (measured carefully in a dark room using a pupil card and mini-flashlight, a previous measurement with a pupilometer device yielded a measurment that was too small), and I am only considering surgery using the Visx S2 with the 8mm transition zone upgrade (6.5mm optical zone).

Regards,

John

Today was suppose to be my surgery but they have to reschedule because my vision change on my right eye from -5.25 to -6.0 diopters. My left eye remain the same at -4.50.
I also have large pupils at 8mm to 8.5mm on dim light. I'm very concerned with permanent halos and glares. I don't know what to expect after the surgery.
Would it effect my vision at night to the point that it's not safe to drive?
You mentioned that the laser's is 6.5mm and my pupil size is at 8.5mm. Is this means that the flap (cornea) would be undercut?

Please response, I'd appreciate any comments you can give me as a second opinion.

jacob

Sounds like God intervened on your behalf.

I was -3.5 and -3.75, 8 mm pupils, plano now, perfect flap, and I see humongous starbursts and haven't driven at night in over a year. I don't need to try the drops to know it's all pupil size. The flashlight test makes the starbursts disappear.

This notion that low myopia with large pupils is not a concern is one reason why some doctors are being labelled "reckless".

Jay, run for the hills--or your glasses/contacts!!

You have stated previously that the reason that you have significant vision problems after LASIK was that you ended up needing a hyperopic correction following you original LASIK procedure, and you ended up with a "5 diopter paracentral island". It would be this island, which causes severe irregular astigmatism, that would cause your vision problems after LASIK.
In my experience as a doctor who performs LASIK, I have not had any patients who has low myopia and large pupils who has ended up with night time problems after LASIK. For patients with moderate degrees of myopia, pupil size issues are of much more importance.

Bill Trattler, MD
Miami, FL

This is an older post, but I think we now know from experience that it is mostly ALL pupil-related. My pre-op prescription was -4D in both eyes and I have 8-9mm pupils. I have terrible GASH symptoms since I got up off that LASIK table almost 3 years ago. The use of Alphagan (when it works or brite light makes them go away.

Preop: -4.50, -4.75. Pupils were repeatedly measured at 7mm although may actually be closer to 7.5mm Surgery in April 2002
Laser used: Visx Star S3 6.5mm with blend to 8.2mm

Post op incl. enhancement: plano in both eyes, -.25 astigmatism in right eye. Also have contacts to correct to plano, plano.

Wavefront indicates no significant high order aberations that might contribute to the night disturbances.

I STILL have severe starbursts and halos at night related to pupil size. Alphagan-P eliminates the starbursts.

Jay, could you please give me some more informtion about your situation? What laser was used on you? What area did the laser cover? Was there a blend zone? I have been to four different doctors and have gotten four different readings on what my pupil size is. I am trying to sort this all through.

Sounds like God intervened on your behalf.
>

>I was -3.5 and -3.75, 8 mm
>pupils, plano now, perfect flap, and
>I see humongous starbursts and haven't
>driven at night in over a
>year. I don't need to
>try the drops to know it's
>all pupil size. The flashlight
>test makes the starbursts disappear.

>This notion that low myopia with large
>pupils is not a concern is
>one reason why some doctors are
>being labelled "reckless".

>Jay, run for the hills--or your glasses/contacts!!
>

I think it is important to realize that ALL surgery involves some acceptance of risk by the patient because, to the very best of your surgeon's abilities, he or she may not be able to assure you one way or the other if night time vision will be acceptable to you or not.

In addition, ongoing studies are shedding more light on the cause of night vision problems after refractive surgery. One such study found that pupil size was not the most important factor in determining risk for night problems. It was number four behind residual refractive error, pre-operative myopia over -8.00 Diopters, and a poorly centered treatment.

Most surgeons have small pupil patients with night problems as well as large pupil patients with no problems, there is no one simple answer.

I recently treated a 9 mm pupil patient who was -5.00 diopters (only one eye) and he is wearing a contact lens in the other eye. He has more halo effect in the treated eye compared with the contact lens eye, but it is tolerable. He tells me he will likely get the other one done at some point down the road.