I am wondering if I'm really a good Lasik candidate, as my doctors seem sure of, or if my pupils are really too large to avoid all these night driving problems I' reading about here.

I'm scheduled to have LASIK surgery tomorrow with an Autonomous laser with LADARVision. My prescription is -4.75 in one eye and -5.5 in the other eye. Both eyes have slight astigmatism of about -1.25 I believe. I don't have the exact numbers because my optometrists haven't actually handed me copies of my scripts. My pupils have been measured at 7mm with a slit-beam light by an OD, but were also estimated at 8mm by one technician (what I'd call moderately dim light), and 9mm by another technician (very dim light) using the pupil-size cards. I have had corneal topographies and depths measured and been assured that all is very ok there ( I believe corneal depths were about 500-550nm). From what I read the Autonomous can treat an 8mm zone so I should be ok???? I want Lasik quite a bit, since I can't comfortably wear contacts for more than an hour or two. But my vision is great with glasses. Any opinions appreciated!

I was about -4 in each eye with a slight astigmatism. My pupils are 7mm. My surgeon used a Nidek 5000. I have some ghosting and starbursts at night, nothing debilitating, I can still drive and otherwise function but ... it does bother me. The only time I have real trouble is the reflective signs and porch lights on country roads (I turn on the dome light in my car)

Realize you are taking a bigger risk having lasik with larger pupils. Definately get multiple opinions and get a surgeon who has a lot of experience with perscriptions such as yours.

-Jacque

Jacque,
Thanks for the reply. That's where my concern lies, trading being bothered by wearing glasses now for just being bothered by something else - halos at night. I see the Nidek 5000 can ablate up to a 6.5 mm zone with transitioning to 7.5mm. I believe the Autonomous can do up to 8mm but will definitely be asking my surgeon this specifically. Maybe that will improve my chances. My quesion for you is, if you could go back in time knowing how you're bothered by the nighttime glare, would you still have lasik?

I'm in the same boat. I was -4.5 with 7.5 mm pupils. I was treated with the B&L Technolas 217 using a 6 mm optical zone with a blend to 9 mm.

I get some haloes at night. I wish they weren't there but, looking at the big picture, I love the overall results. Daytime activities -- especially swimming -- are sooo nice without contacts or glasses.

Where did you read that the Autonomous LADARVision has an 8 mm zone? The Autonomous LADARVision website says that it has "5.5 mm with a 1 mm blend zone for a total 5.5 x 7.5 mm treatment zone for
myopic astigmatism." Myopic astigmatism is what you have.

See:
http://www.ladarvision.com/pros/ladarvision/compare_lasers.asp

Determine EXACTLY what your pupil size is and EXACTLY what treatment zone your surgeon will use before you submit to LASIK. It is imperative that you make sure the zone will be adequate for your pupil size. You don't want to overlook this and risk a lifetime of regret.

Honestly, I don't know. Sometimes I love the surgery but other times, especially when my eyes are dry and irritated (another side affect of Lasik) I would prefer my glasses. The ghosting and starbursts usually aren't bad enough to make me regret the surgery which I believe is your concern.

It's wonderful to be able to see in the swimming pool but then again, the chlorine dries out the eyes. It's great to go hiking without my glasses (especially in the rain!) but I have to remember to bring my drops.

Every cloud has a silver lining and every silver lining has a cloud.

-Jacque

The surgeon can vary the optical zone on the Autonomous laser out to 8.0mm. Remember that as the optical zone treatment is expanded, more corneal tissue is removed per diopter. So for wide 8.0mm optical zones, there are advantages of performing surface ablation (PRK/LASEK) - since the total depth will be less (depth = combo of flap depth plus ablation depth.

I hope this helps

Bill Trattler, MD
Miami, FL

Thanks to everyone for replying so quickly to my message. I appreciate the chance to educate myself on this board since apparently it is necessary when considering LASIK. I backed out of my LASIK procedure today after being told my pupil size was actually 9mm! I even made a special trip a week ago for just this purpose, and then they told me I had 7mm pupils. It was disturbing to see such a large difference in these measurements when it seems the outcome can be dramatically different between the two.

My surgeon was still willing to treat me with a 7.5mm optical zone and a 1mm blend zone for a total of 8.5mm. He said he couldn't go to 8+1 because my prescription was too high for that (I'm around -5). I was surprised they were still willing to treat me, since, the way I see it, I would definitely be looking through 1.5mm of blended/not-fully-corrected corneal tissue no matter what. Due to this board I decided the risks were too high and that waiting and learning more couldn't hurt. But I am still disappointed since I was really looking forward to getting rid of the glasses.

Dr. Trattler, I would be interested in your opinion. Would you even consider treating a 9mm pupil size? And if I did plan to use Alphagan P drops, how much would they reduce my pupil size? One of the doctors today said it would only reduce them from .5 to 1mm smaller than my maximum, another said "Oh, they'll only enlarge to 5-6mm when you use the drops". Seems to me that I should get a consistent answer to such an important question. Especially when I'm half an hour before the surgery. Also they told me slightly tinted gray lenses sometimes help reduce halo and glare, is this true? I don't want to say I'll never have Lasik, but am feeling a litte skeptical after my "top-rated" surgeon was willing to treat even a 9mm pupil.

Brad,
The first thing is that I have yet to see any good studies looking at night time vision problems in patients with 9.0mm pupils. Any answer I provide is based on current knowledge and experience - but I do not have statistics to back up my thoughts.
The current thinking process is that the best way to reduce the risk of night time vision problems is to provide a treatment zone as wide as the night time pupil size. The main issue is that as the optical zone is made wider, the laser removes more tissue per diopter. For example - for a 6mm optical zone - 12microns are removed per diopter. With an 8.0mm optical zone, 21 microns are removed per diopter (the exact amount varies by laser).
When wide optical zones are required, there may not be enough room to treat under a flap (because you can not laser too deeply into the cornea). So the best option is to treat on the surface of the cornea - either with PRK or LASEK. Surface laser also helps, as it eliminates the risk of flap complications. And the flap itself may not be wide enough - so when a 9.0mm pupil is maximally dilated, the edge of the flap may be in the visual axis - causing visual aberrations.
I have used the Autonomous laser for one of my patients with 8.0mm pupils - and performed PRK a few years ago. She had 7.0 diopters of myopia, and she did great, and continues to report that she does not have any night time vision problems (remember this is just one patient). The one issue with surface ablations and wide optical zones is that a deep treatment is placed - so that there is an increased risk of corneal haze. I personally have found that with my patients - oral Vitamin C 1000mg/day has been helpful to reduce the risk of corneal haze. A study by Alexander Stojanovic has been submitted on his experience with Vitamin C to prevent haze, and other surgeons, such as Tom Claringbold in Michigan have confirmed its effectivenss. Another option to prevent haze is called Mitomycin C (please talk with your doctor if you elect this).

I hope this information is helpful.

Best of luck

Bill Trattler, MD
Miami, FL

Dr. Trattler,

So are you basically saying that Lasik is not a good option for me (since I could only have a 7.5mm treatment zone, any more would be going too deep), that PRK would probably work better for someone with 9mm pupils?

Dr. Trattler:

You say the Autonomous optical zone can be adjusted to go out to 8 mm. The Autonomous web site indicates that, for myopic astigmatism (what the patient here has), it creates an elliptic sized treatment zone. Wouldn't this still be true at the 8mm setting? That is, would he get something like 6mm x 8mm instead of 8mm x 8mm?