I have a lasik appt. scheduled for June 10th with Dr. Karp of Eye Surgery Associates in Hollywood. My prescription is -6 and -6.5, I was told my corneal thickness is 593, and my pupils are 7.5 and 8. The doctor is planning to do my procedure on the Visx S3 with the software upgrade. Do you think the autonomous laser would be better for me given my pupil size? Is there any data on outcomes for people with large pupils vs. the lasers used? I'm really nervous because I already experience a bit of glare at night.
Thank you!

First - you are in excellent hands with Dr. Karp. He is an excellent surgeon and is very experienced. He should be able to give you a solid answer on the pupil issue.
I can tell you that in my own experience with the VISX laser with the expanded optical zone (to 6.5mm) and the transition zone to 8.2mm, night time issues have not been a problem. But I have not performed LASIK on patients with exactly your situation. I would think that you may be at slightly higher risk than a person with the same prescription and smaller pupils.
In the past - I had a patient with almost your exact same situation. At that time, the VISX did not have the transition zone. I instead opted to use the Autonomous laser with an 8.0mm optical zone. I had to perform PRK (surface treatment) because the amount of cornea that was removed was 150 microns). This patient is doing well. The patient's main risk was corneal haze - which fortunately she did not get.
Even though you have thick corneas, if you wanted to use the Autonomous laser, the amount of cornea that would need to be lasered away would be too high for LASIK - so you would have to consider PRk/LASEK. With the autonomous, using the large optical zones is an off-label use, and there have not been many studies looking at the results with the larger optical zones.
I hope this is helpful. Please pass on my regards to Dr. Karp.

Bill Tratler, MD
Miami, FL

Thank you Dr. Trattler. I was hoping you would respond to my bulletin. You are providing a wonderfully generous service through this message board.

I'm not a doctor but I do not consider the Visx S3 adequate for your large pupils. While the Visx S3 advertises a 6.5 mm optical zone with a 1.7 mm transition zone, it is my understanding that this zone is reduced for prescriptions stronger than -6.0 O.D.

Even without such a reduction, I believe the zone size would be inadequate. At the outer edge of your 8 mm pupil, you would only be getting about 12% correction! Given your moderate prescription, this could be very problematic. I can guarantee that you will get significant halos with such a treatment.

If there is a zone reduction (which I believe is 1 mm), you will be getting no correction at the outer 0.8 mm of your pupil! If you have any astigmatism, it will be even worse.

George: I appreciate your response but you did indicate that you are not a physician. Then how can you "guarantee" I'll have halos? Have you had lasik surgery?

I have to agree with George. You are virtually 100% guaranteed of having night vision problems with your combination of scrip and pupil size. George and I have both had LASIK. I have smaller pupils than you and slightly lower scrip.

My night vision problems are debilitating. After dark, it's like trying to navigate the world on LSD. It's not any fun and it has adversely affected virtually every aspect of my life.

I know Dr. Trattler thinks Dr. Karp is a good doc, but I don't care if Dr. Karp is Jesus Christ. You will most likely NOT get the results you want. The quality of the doc makes a difference, as does the type of laser used, but there is one irrefutable and incontrovertible fact here:

YOU ARE A MARGINAL CANDIDATE, AND THEREFORE NOT A GOOD CANDIDATE.

Just wanted everyone to know that I went ahead and had the surgery despite some skeptics. I am quite pleased with the results. I struggled a bit with dry eyes in the beginning, but I can tell they are getting much better. The halos I see at night are a little more prominent than then were prior to the surgery, but not bad enough to stop me from driving at night, thank goodness.
cheryl

Cheryl, if you are out there can you please post another message. I have pretty much the same characteristics as you. What laser did you end up going with? Who was your doctor? How is your night vision now?

Cheryl,

Can you also tell us what your stats are; pupil size, prescription etc.